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Eye pain in preschool children: diagnostic and prognostic significance
Ayo-Lynn Richards1, Vaidehi S Patel, John W Simon
1Albany Medical Center, Albany, New York, USA.
Insights
In preschool children, eye pain without a clear cause is usually functional. An ophthalmologic exam is crucial to rule out serious conditions and reassure parents about the prognosis.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Clinical Diagnosis
Background:
- Preschool children frequently present with eye pain, prompting ophthalmologic evaluations.
- The significance of isolated eye pain in this age group, without obvious causes, is not well-established.
Purpose of the Study:
- To investigate the diagnostic and prognostic implications of eye pain in preschool children without apparent ocular pathology.
- To determine the prevalence of functional eye pain versus organic causes in this population.
Main Methods:
- Retrospective review of 80 consecutive preschool patients (ages 2-6) presenting with eye pain but no red eye or obvious cause.
- Telephone follow-up was conducted for patients seen only once to gather long-term outcome data.
Main Results:
- Functional eye pain was diagnosed in 91% (73/80) of patients.
- Of those with follow-up (mean 21 months), 88% (56/64) had no subsequent diagnosis explaining the initial eye pain.
- Minor diagnoses like dry eyes, blepharitis, or refractive errors were found in 7 patients, but were unlikely causes of the reported pain.
Conclusions:
- Isolated eye pain in preschool children, without an apparent cause, is typically functional, often due to communication difficulties with caregivers.
- Comprehensive ophthalmologic examination is essential to exclude serious conditions and identify unrelated treatable issues.
- Reassurance is warranted for parents, as children with initially normal exams are unlikely to develop significant subsequent diagnoses related to eye pain.
Background:
Preschool children often present for ophthalmologic examination because of eye pain. Although the differential diagnosis includes serious conditions, the diagnostic and prognostic importance of apparently isolated eye pain are unknown.
Methods:
We reviewed records of 80 consecutive patients presenting between 2 and 6 years of age with eye pain but without a red eye or a history of an obvious cause of pain. Families of children seen in the office only once were contacted by phone to obtain follow-up information.
Results:
Functional eye pain was diagnosed in 73 of 80 patients (91%). Of the 64 patients with follow-up between 1 week to 4 years (mean, 21 months), 56 (88%) had no other cause of eye pain. Dry eyes, allergic conjunctivitis, blepharitis, corneal foreign body, sinusitis, and trichiasis were diagnosed in 7 patients. Other children were found to have refractive error, amblyopia, blepharospasm, and nystagmus--all considered unlikely to cause eye pain.
Conclusions:
Absent a preexisting or obvious cause of eye pain, the symptom is usually functional in preschool children who may have difficulty communicating vague visual symptoms to caregivers. However, such children deserve examination, not only so that unapparent causes can be excluded but also because unrelated conditions may require further evaluation and treatment. Parents can be reassured that if no abnormality is found on initial ophthalmologic examination, children with eye pain are unlikely to have subsequent diagnoses.
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