Eye Pain Caused By Persistent A Fever

Ophthalmologist Carolina Valdivia, MD answers a question about eye pain caused by a persistent fever.

Hi Dr. Valdivia. I am a diabetic, which means I have to get my eyes examined once a year. I went three days ago in the morning and had pupil dilation. When the exam was completed, I drove home with sunglasses on, and the drive couldn't have been more than five minutes long. The blurriness from the pupil dilation went away within about an hour and a half and I went to work later that day.

These last two days, I've had really bad eye pain. This has never happened before after pupil dilation. My eyes feel strained and it's painful to move them without turning my head. I've gotten a bad headache from it. Regular light doesn't hurt my eyes, but very bright lights do a little bit. I've been trying to rest and stay inside and keep my eyes closed.

I also had a fever of 104º F this morning and so I went to the doctor. My blood sugar was about 80, but I had slight ketones (which I assume came from the persistent fever). I've been getting hardly any sleep, because the eye pain is so bad and it hurts to keep my eyes shut long enough to fall asleep. I'm exhausted!

The doctor took a urine sample and drew my blood. The blood results should come tomorrow, and I don't have anything like a bladder infection. The doctor gave me some antibiotics to take for 10 days in case there is any kind of infection in my body. My fever comes down with Tylenol and after this morning, the highest my fever has gone up to was about 102º F. I sweat it out and the Tylenol helps, but it keeps coming back.

I'm not really sure if the persistent fever is related to my eye pain or if my pain is somehow associated with the pupil dilation. Either way, is there anything I can do to help my eyes? Please help me out. Thank you so much!

Carolina Valdivia, MD

Thank you for your question and for your confidence in glaucoma-eye-info.com.

I am sorry that you are not feeling well. Let me begin by reviewing the time line as you related it to me.

When viewed from this perspective, we can deduce that your eye exam and your eye pain (and other symptoms) are two independent events that, while close in proximity, actually are unrelated.

The most common complications associated with pupil dilation are photosensitivity (sensitivity to light) and blurred vision. These symptoms usually resolve within a few hours after your eye doctor administers the eye drops. In rare instances, cycloplegia can occur. This is paralysis of the ciliary muscle inside the eye. This muscle controls the focusing power of lens in the eye. The primary symptom is a loss of visual acuity (fine focus), which means that the effects of the eye drops would not resolve with time. To avoid cycloplegia as a potential complication, I avoid pupil dilation in patients with myopia or primary angle-closure glaucoma.

A persistent fever of 104º F is worrisome and steps should be taken to reduce it. The Tylenol that you have been talking is a class of medications called antipyretics (literally meaning against the fire) that are effective in lowering persistent fever. However, the fact that your fever is cycling up and down depending on the Tylenol dosage schedule is a sign that the bacterial infection is not resolved.

Diabetics are highly prone to bacterial infections because sugar in the blood is a good media for rapid and abundant growth of microorganisms. At the same time, bacterial infection itself disturbs the blood sugar levels and may precipitate ketoacidosis. The occurrence of bacterial infection then perpetuates a destructive cycle in which infection results in uncontrolled blood sugar, which in turn causes further aggravation of infections. For this reason, bacterial infections that typically would be deemed simple in non-diabetics can progress quickly and become very complicated in diabetics. A good rule to follow is that all bacterial infections are potentially serious infections for diabetics and need to be addressed by a physician.

Systemic infections, ones in which the infectious agent is distributed throughout the body rather than localized to a particular area, often can have ocular manifestations, including eye pain and headache. Thus, your symptoms are not as unusual as they might seem at first glance.

Your situation needs to be approached very carefully. Because of your diabetes, a bacterial infection like the one that you are presenting rapidly can get worse and without much warning.

Treatment with antibiotics should resolve your bacterial infection over the next few days. As the bacterial infection subsides, so should your eye pain. Moreover, the Tylenol both will help to lower your persistent fever and to diminish your discomfort.

It is important that you take the antibiotic exactly as you have been directed by your doctor and that you finish the entire prescription, even if you start to feel better sooner. Failure to do this could result in the bacterial infection and your symptoms returning, including the persistent fever and your eye pain.

A persistent fever as high as yours has a strong dehydrating effect, as evidenced by the presence of ketones in your urine. For this reason, a high fluid intake that replaces electrolytes is recommended.

If your pain or fever persists, despite taking the antibiotics as directed, then you should contact your physician immediately.To limit the probability of infections in the future, I recommend strict control your blood sugar levels under the supervision of a physician. Watch for the following signs of danger.

REFERENCE:

Khurana AJ. Comprehensive Ophthalmology, 4th Ed. New Delhi: New Age International (P), 2007:436-438.

My goal in answering your questions is to provide you with information, clear up misconceptions, and to explain options so that you can have an informed conversation with your doctor. However, under no circumstances should my response to your question be considered a substitute for ongoing consultation and examination with your doctor. Since I have not examined you, I only can speak in terms of generalities, whereas your doctor has sufficient clinical details to evaluate your case specifically.

EYE PAIN CAUSED BY A PERSISTENT FEVER

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