NANOSNET

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

Corneal neuralgia? We had a nice talk about this at the NANOS meeting.

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

Corneal neuralgia? We had a nice talk about this at the NANOS meeting.

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

High cervical pathology (C1/2) has been reported in association with pain, either in the medial angle of the eye or the tip of the tongue.

I believe Jim Lance first noted this but have no reference. I have observed it before.

It is presumed related to the descending loff of the trigeminal into the upper spinal canal.

No certainty but have observed the phenomenon.

Regards

Owen

Prof Owen B White MD PhD FNANOS FRACP

Dept of Neurosciences

Central Clinical School

Monash University

Melbourne, VIC, 3004

Tel: +61 3 9576 0022

Fax: +61 3 9576 0019

Mob: +61 418 822 996

Email: owen.white@monash.edu

Orcid ID: 0000-0002-2836-7344

Corneal neuralgia? We had a nice talk about this at the NANOS meeting.

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

High cervical pathology (C1/2) has been reported in association with pain, either in the medial angle of the eye or the tip of the tongue.

I believe Jim Lance first noted this but have no reference. I have observed it before.

It is presumed related to the descending loff of the trigeminal into the upper spinal canal.

No certainty but have observed the phenomenon.

Regards

Owen

Prof Owen B White MD PhD FNANOS FRACP

Dept of Neurosciences

Central Clinical School

Monash University

Melbourne, VIC, 3004

Tel: +61 3 9576 0022

Fax: +61 3 9576 0019

Mob: +61 418 822 996

Email: owen.white@monash.edu

Orcid ID: 0000-0002-2836-7344

Corneal neuralgia? We had a nice talk about this at the NANOS meeting.

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I agree that confocal microscopy can be done to examine neurites in detail. However, the exacerbation with neck movement may also be an important clue. Certainly in older age groups, where cervical pathology is very common, I see this phenomenon from time to time. I assume it is in part referred pain, since the cranio-cervical lies more or less in a straight line behind the orbits. But the upper cervical structures also feed into the spinal trigeminal nucleus. In addition, there are fascial sleeves that connect the cervical musculature with the meninges. In the thalamus, input from intrinsically photosensitive retinal ganglion cells converges directly onto neurons that receive input from the spinal trigeminal nucleus. Thus occipital irritation should be considered in a photo-oculodynia syndrome, and occipital nerve blocks are an important therapeutic and diagnostic tool for patients with otherwise unexplained eye or periorbital pain. I also have conversations with patients about the importance of posture.

High cervical pathology (C1/2) has been reported in association with pain, either in the medial angle of the eye or the tip of the tongue.

I believe Jim Lance first noted this but have no reference. I have observed it before.

It is presumed related to the descending loff of the trigeminal into the upper spinal canal.

No certainty but have observed the phenomenon.

Regards

Owen

Prof Owen B White MD PhD FNANOS FRACP

Dept of Neurosciences

Central Clinical School

Monash University

Melbourne, VIC, 3004

Tel: +61 3 9576 0022

Fax: +61 3 9576 0019

Mob: +61 418 822 996

Email: owen.white@monash.edu

Orcid ID: 0000-0002-2836-7344

Corneal neuralgia? We had a nice talk about this at the NANOS meeting.

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I agree that confocal microscopy can be done to examine neurites in detail. However, the exacerbation with neck movement may also be an important clue. Certainly in older age groups, where cervical pathology is very common, I see this phenomenon from time to time. I assume it is in part referred pain, since the cranio-cervical lies more or less in a straight line behind the orbits. But the upper cervical structures also feed into the spinal trigeminal nucleus. In addition, there are fascial sleeves that connect the cervical musculature with the meninges. In the thalamus, input from intrinsically photosensitive retinal ganglion cells converges directly onto neurons that receive input from the spinal trigeminal nucleus. Thus occipital irritation should be considered in a photo-oculodynia syndrome, and occipital nerve blocks are an important therapeutic and diagnostic tool for patients with otherwise unexplained eye or periorbital pain. I also have conversations with patients about the importance of posture.

High cervical pathology (C1/2) has been reported in association with pain, either in the medial angle of the eye or the tip of the tongue.

I believe Jim Lance first noted this but have no reference. I have observed it before.

It is presumed related to the descending loff of the trigeminal into the upper spinal canal.

No certainty but have observed the phenomenon.

Regards

Owen

Prof Owen B White MD PhD FNANOS FRACP

Dept of Neurosciences

Central Clinical School

Monash University

Melbourne, VIC, 3004

Tel: +61 3 9576 0022

Fax: +61 3 9576 0019

Mob: +61 418 822 996

Email: owen.white@monash.edu

Orcid ID: 0000-0002-2836-7344

Corneal neuralgia? We had a nice talk about this at the NANOS meeting.

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

He may need confocal microscopy to see the aberrant corneal nerves. Deb

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

He may need confocal microscopy to see the aberrant corneal nerves. Deb

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane

He may need confocal microscopy to see the aberrant corneal nerves. Deb

I saw a particularly vexing patient today because of light sensitivity that seems disproportionate to the history and physical findings.  Athletic in appearance and previously active in soccer and golf.

He now wears category 4, wraparound sunglasses pretty much all the time that he would not remove in my pretty dim exam room.  He could read 20/20 OD through them but needed to switch to his category 3 lenses to read 20/20 OS.  Part of my concluding remarks from the first visit 2 years ago:

                "... structurally healthy eyes... generally healthy young man who has experienced intermittent head and eye pains that have been attributed to occipital neuralgia.  The onset of this condition is mysterious.  He has not sustained neck or head trauma and is not felt to have a generalized inflammatory condition.  His vision is excellent and his eyes are structurally healthy.  The uncorrected acuities are good with evidence of binocularity.  Spectacles are not needed."

He would not remove his lenses for examination today.  So we talked for a while.

He had disappeared into the world of neuro-optometry and vision therapy after our one and only meeting 2 years ago.  The ensuing optometry treatments that include various colored lenses and convergence exercises did not lessen his light sensitivity.  5 MRI studies to date all report normal head and neck structures.  The last study found some herniated discs in the thoracic region that he attributes to playing golf.  Mild neck flexion to read books seems to make his light sensitivity worse.  Reading from screens is too unbearable.  He anticipates, probably correctly, that reading from screens will be unavoidable at college.  His grades have always been great in high school and he is interested in language arts as a major in college, a curious interest for someone who says he does not like to read.  I don't think any consideration was ever given to a reading-based learning disorder.  Beyond recommending some dynamic plain films to study the cervical spine in various positions, I'm stumped.  A functional component remains a consideration.

Any suggestions how to help me to help this young man would be appreciated.

Cheers,

Steven Kane