Eye Care Providers Struggle to Identify Neurological Causes of Photophobia

Eye care providers are frequently unable to identify causes of photophobia, particularly in children, according to research published in the Journal of Neuro-Ophthalmology.

Researchers retrospectively assessed 111 adults (mean age 37 years, 58 women) and 36 children (mean age 7.4 years, 22 girls) presenting to a single center between 2001-2009. According to the report, photophobia was the chief complaint for 133 patients (90.5%) followed by headache (63.9%), blurry vision (23.4%), dry eyes (12.2%), and diplopia (5.4%). 

Among patients with photophobia, eye care providers reported migraine headaches (53.7%), dry eye syndrome (36.1%), ocular trauma (8.2%), progressive supranuclear palsy (6.8%), and traumatic brain injury (4.1%) as causes. They also noted depression as a contributing factor in 8.8% of patients. However, a total of 25.9% of patients left without a documented cause for their photophobia. Among the subgroup of children, 69.4% left without a diagnosis.   

Investigators note the the significant number of patients, particularly children, who did not obtain a diagnosis or treatment and state, “This observation indicates that eye care providers, especially those caring for children, may not know the most common causes of photophobia and therefore may not know what history questions to ask and what examination techniques to use to identify these most common causes.”

The report encourages clinicians to consider mental health conditions in patients with photophobia including depression, anxiety, and posttraumatic stress disorder and to be aware that migraines are often underdiagnosed or misdiagnosed in children.

Study limitations include its retroscopic nature and single center design.  

Reference

Buchanan TM, Digre KB, Warner JEA, Katz BJ. The unmet challenge of diagnosing and treating photophobia. J Neuroophthalmol. Published online March 25, 2022. doi:10.1097/WNO.0000000000001556