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ULY CLINIC

ULY CLINIC

15 Septemba 2025, 13:07:06

Photophobia

Photophobia
Photophobia
Photophobia

Photophobia is an abnormal sensitivity to light. It may occur in patients with normal eye anatomy, such as those wearing contact lenses excessively, or may signal ocular, systemic, traumatic, or drug-induced disorders.


Pathophysiology:

Photophobia arises when nociceptive pathways in the eye and central nervous system are overstimulated. Corneal or iris irritation (e.g., from trauma, inflammation, or infection) activates trigeminal nerve fibers, which communicate with the pretectal and Edinger–Westphal nuclei, causing discomfort and abnormal pupillary responses. CNS disorders such as meningitis or migraine can amplify light sensitivity through heightened cortical processing of visual stimuli. Chemical or UV burns disrupt corneal epithelial integrity, increasing light-induced nociceptive signaling. Drugs causing pupillary dilation or retinal irritation (e.g., mydriatics, amphetamines) similarly increase photophobic responses.


History and Physical Examination

History

  • Onset and severity: When did photophobia start, and how intense is it?

  • Recent trauma, chemical exposure, or UV radiation?

  • Associated eye pain (location, duration, intensity) or foreign body sensation.

  • Other symptoms: tearing, discharge, vision changes, headache, nausea, vomiting.


Physical Examination

  • Vital signs and neurologic status.

  • Visual acuity (unless chemical burn).

  • Inspect eyes for abnormalities in external structures, conjunctiva, sclera, and pupillary reaction to light.

  • Evaluate extraocular muscle function (six cardinal fields).


Note: Photophobia can accompany meningitis, but it is not a cardinal sign.

Medical Causes

Cause

Key Findings

Additional Features

Burns

Photophobia, eye pain

Chemical burn: erythema, eyelid blistering, miosis, diffuse conjunctival injection, corneal changes; UV burn: pain 12h post-exposure

Conjunctivitis

Photophobia, conjunctival injection, tearing

Allergic: stringy white discharge; Bacterial: mucopurulent, sticky lids; Fungal: thick purulent discharge, crusting; Viral: tearing, preauricular lymphadenopathy

Corneal abrasion

Photophobia, foreign body sensation

Excessive tearing, conjunctival injection, visible corneal damage, blurred vision, eye pain

Corneal ulcer

Severe photophobia, eye pain

Blurred vision, sticky eyelids, discharge; bacterial ulcers irregular; fungal ulcers with clear surrounding rings

Iritis (acute)

Severe photophobia, moderate-severe eye pain

Marked conjunctival injection, blurred vision, constricted poorly reactive pupil

Keratitis (interstitial)

Photophobia, eye pain

Blurred vision, dramatic conjunctival injection, cloudy cornea

Meningitis (acute bacterial)

Photophobia

Nuchal rigidity, hyperreflexia, Brudzinski/Kernig signs, fever, headache, vomiting, ocular palsies, seizures in severe cases

Migraine headache

Photophobia, noise sensitivity

Severe throbbing/aching headache, fatigue, blurred vision, nausea, vomiting

Uveitis

Photophobia

Anterior: eye pain, conjunctival injection, small nonreactive pupil; Posterior: gradual visual floaters, pupil distortion, blurred vision


Other Causes

Drugs: Mydriatics (phenylephrine, atropine, scopolamine, cyclopentolate, tropicamide), amphetamines, cocaine, ophthalmic antifungals (trifluridine, idoxuridine).


Special considerations

  • Promote comfort: darken room, instruct patient to close eyes.

  • Persistent photophobia: suggest dark glasses.

  • Prepare for diagnostic tests: slit-lamp exam, corneal scraping.


Patient counseling

  • Explain the disorder and treatment plan.

  • Teach proper administration of eye drops and ointments.

  • Discuss methods to relieve discomfort at home.


Pediatric pointers

  • Suspect photophobia in children who squint, rub eyes frequently, or wear sunglasses indoors/outdoors.

  • Common causes: congenital disorders (albinism), childhood diseases (measles, rubella).


References

  • Gerstenblith, A. T., & Rabinowitz, M. P. (2012). The Wills Eye Manual. Philadelphia, PA: Lippincott Williams & Wilkins.

  • Holland, E. J., Mannis, M. J., & Lee, W. B. (2013). Ocular Surface Disease: Cornea, Conjunctiva, and Tear Film. London, UK: Elsevier Saunders.

  • Huang, J. J., & Gaudio, P. A. (2010). Ocular Inflammatory Disease and Uveitis Manual: Diagnosis and Treatment. Philadelphia, PA: Lippincott Williams & Wilkins.

  • Levin, L. A., & Albert, D. M. (2010). Ocular Disease: Mechanisms and Management. London, UK: Saunders, Elsevier.

  • Roy, F. H. (2012). Ocular Differential Diagnosis. Clayton, Panama: Jaypee—Highlights Medical Publishers, Inc.

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