At the other end of the clinical spectrum is the patient whose pain is excruciating and directly localized to the orbit. Such pain is unremitting, and may or may not have a pulsatile quality. The associated symptoms of nausea, vomiting, and abdominal pain can be attributed to spread of pain impulses from trigeminal nuclei to other brainstem nuclei. Severity of the nausea and vomiting, the degree of prostration, and the patient's inability to cooperate during history taking and physical examination may result in unnecessary laparotomy. Fortunately, most patients are able to indicate the eyeball itself as the source of the pain.
Many patients describe aching as the essential quality of their pain.
We have seen three patients with intermittent angle closure glaucoma who were referred with the diagnosis of migraine. Patients with acute angle closure glaucoma also complain of visual loss during the episode. The pain that occurs in acute angle closure glaucoma may be caused by the associated intraocular inflammation. Whether elevation of intraocular pressure alone can cause pain is less clear. Certainly, chronic elevation of intraocular pressure may persist for years without symptoms.