Warning sign you must not ignore — Sudden onset of painful light sensitivity

I woke up this morning with a light headache. I felt it was most unusual. I had thought I had a goodnight sleep – no frightening dreams and  no discomfort until a few minutes before the sleep started to wane. I opened my eyes to have a feel of my surroundings and get to the bathroom to empty my bladder. A sharp, shooting pain struck me. I shut my eyes instantaneously. “What’s wrong with my eyes?” I asked myself.

At first, I thought it was in both eyes, but before the thought completed its cycle, it dawned on me it was my right eye. I opened my left eye and was happy I still had that. I tried opening my right eye again and regretted it. The pain was intense. Shutting it was not enough. Light still passed through my lids! I cupped my hand over it to get some relief. It was apparent, the light in the distance made it worse.

What is this sudden onset of painful light sensitivity called? It is called “photophobia”? In normal parlance, “photo” means light and “phobia” means hatred. Thus, photophobia means hatred for light. My eyes couldn’t stand the light – not just the intensity but any light at all. It is a symptom of abnormal sensitivity to or intolerance for light. I knew I had a problem and a big one for that matter!

Several possible causes raced through my mind. I remembered, a young man who had called in my office a few days back with a history of a blow to his eye about one week before. He had no visual disturbances and was seeing well at the time so he naturally ignored it and went about his work until about a week after. He experienced exactly what I had described. Sudden onset of photophobia is not an uncommon aftermath of a blunt injury to the eye.

Often overlooked, it bares it fangs with such an intensity about three days or more after the injury. It is so intense that it can’t be ignored. It is aptly called TRAUMATIC UVEITIS or an inflammation of the middle coat of the eye. I did a mental review of my activities in the past two weeks and could not recall any incident of a blunt injury to my right eye. I knocked it off my list.

A middle-aged woman had also complained of photophobia about three months before. I had had difficulty explaining the cause to her. My examination showed that she had a mild corneal ulcer caused by an exposure of her eye owing to the inability to close her eye during sleep.

While examining her eyes, I tried to force a smile by jokingly asking her if  she was afraid of her enemies coming after her and that was why she had slept with one eye open. My joke fell flat! She didn’t take kindly to it. I tried looking at my eye in the mirror, but I just couldn’t open it. I took some analgesics and prepared to go to the hospital.

Dr Charles, my ophthalmologist colleague was on hand to attend to me. He didn’t waste time as he proceeded to examine my eye after listening to my story. To provide some relief, so I could open my eye, he popped a drop of a local anaesthetic agent in my left eye. He related his findings as he went about his examination.

“Your vision is not affected much in that eye – just one alphabet short of what your left eye could read.” I breathed a sigh of relief. As he switched on his torch to look at the anterior part of my eye, I flinched because of the pain. He reduced the intensity of the light to make me more comfortable and make his examination easier. Then concluded his examination with the slit-lamp. “Your right pupil is much smaller than the left. I can see evidence of inflammatory cells in your aqueous humour.”  I felt like telling him that I found no humour in this! My eye was hurting badly. I couldn’t stand the intensity of the light.

“Finally, he pronounced the verdict, he said, “You have an inflammation of the middle coat of your eye – uveitis. I will have to subject you to some investigations, but in many cases we don’t always find any cause.” Why did he have to tell me this? I wonder. Then I remembered, my encounter with doctors. They forget everything they have learnt when it concerns them!”  Charles read my mind, he said assertively, “Dr Ben, you will follow my instructions to the letter. You are my patient and I will treat you as one.” I understood.

Uveitis can cause blindness. It is a serious condition. If missed or badly treated you’ve had it. The warning sign of sudden painful sensitivity to light should never be ignored. It is one of the main keys to its diagnosis. And it should be remembered that there are other causes of photophobia.  Accurate diagnosis before treatment is essential. A word is sufficient for the wise.