Göz Ağrısına Multidisipliner Yaklaşım
Özet
Göz ağrısı, etiyolojisi son derece heterojen olan ve acil servisten üçüncü basamağa kadar geniş bir yelpazede karşılaşılan bir semptomdur; bazen izole oküler bir patolojiyi, bazen ise görmeyi veya hayatı tehdit eden sistemik ya da nörolojik bir hastalığı işaret eder. Oküler duyu esas olarak trigeminal sinirin oftalmik dalı (V1) aracılığıyla taşınır ve bu ortak nöral ağ, yansıyan ağrı mekanizmalarının temelini oluşturur. Bu bölümde göz ağrısı; oküler yüzey/ön segment kaynaklı, orbital/derin doku kaynaklı ve oküler olmayan (yansıyan) ağrılar olmak üzere üç ana kategoride ele alınmış, doğru tanıya ulaşmak için ayrıntılı anamnez ve sistematik oftalmolojik muayenenin (görme keskinliği, pupilla reaksiyonu, göz hareketleri, biyomikroskopi, tonometri, fundoskopi) önemi vurgulanmıştır. Ayrıca nörolojik (primer baş ağrısı sendromları, nevraljiler, nöro-oftalmik enflamatuar ve vasküler bozukluklar), kulak burun boğaz (sinonazal patolojiler, rinosinüzit komplikasyonları, nazal kontak noktası ağrıları) ve psikiyatrik (santral sensitizasyon, somatizasyon, komorbid depresyon/anksiyete) perspektiflerden ayırıcı tanı seçenekleri gözden geçirilmiştir. Görmeyi veya hayatı tehdit eden kırmızı bayraklar tablo halinde özetlenmiştir. Sonuç olarak, özellikle kronik ve nedeni belirsiz göz ağrılarında oftalmolojik, nörolojik, KBB ve psikiyatrik disiplinlerin bir arada değerlendirilmesi, doğru tanı ve etkili tedavi için kritik önem taşımaktadır.
Ocular pain is a highly heterogeneous symptom encountered across the full spectrum of care, from emergency departments to specialty clinics. It may signal an isolated ocular disorder or serve as the first warning sign of a vision- or life-threatening systemic or neurological disease. Ocular sensation is mediated primarily by the ophthalmic division (V1) of the trigeminal nerve, and this shared neural network underlies referred-pain mechanisms in the periorbital region. This chapter classifies eye pain into three broad categories—ocular surface/anterior segment pain, orbital/deep tissue pain, and non-ocular (referred) pain—and emphasizes the value of a focused history and a systematic ophthalmologic examination (visual acuity, pupillary reactions, extraocular movements, slit-lamp biomicroscopy, tonometry, and fundoscopy) in reaching an accurate diagnosis. Differential diagnoses are further reviewed from neurological (primary headache syndromes, neuralgias, neuro-inflammatory and vascular disorders), otolaryngological (sinonasal disease, complications of rhinosinusitis, contact-point headache), and psychiatric (central sensitization, somatization, comorbid depression/anxiety) perspectives. Vision- and life-threatening red flags are summarized in tabular form. In conclusion, particularly in chronic or unexplained cases, an integrated evaluation spanning ophthalmology, neurology, otolaryngology, and psychiatry is essential for accurate diagnosis and effective management of eye pain.
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