Photophobia

Photophobia
Classification and external resources
Specialty	Neurology
ICD-10	H53.1
ICD-9-CM	368.13
DiseasesDB	24599
MedlinePlus	003041
MeSH	D020795

Photophobia is a symptom of abnormal intolerance to visual perception of light.^[1] As a medical symptom, photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical sensitivity of the eyes,^[2] though the term is sometimes additionally applied to abnormal or irrational fear of light such as heliophobia.^[3] The term photophobia comes from the Greek φῶς (phōs), meaning "light", and φόβος (phobos), meaning "fear".^[4][5]

Causes

Patients may develop photophobia as a result of several different medical conditions, related to the eye or the nervous system. Photophobia can be caused by an increased response to light starting at any step in the visual system, such as:

• Too much light entering the eye. Too much light can enter the eye if it is damaged, such as with corneal abrasion and retinal damage, or if its pupil(s) is unable to normally constrict (seen with damage to the oculomotor nerve).
• Due to albinism, the lack of pigment in the colored part of the eyes (irises) makes them somewhat translucent. This means that the irises can't completely block light from entering the eye.
• Overstimulation of the photoreceptors in the retina
• Excessive electric impulses to the optic nerve
• Excessive response in the central nervous system
• Elevated trigeminal nerve tone (as it is sensory nerve to eye, elevated tone makes it over reactive). Elevated trigeminal tone causes elevated substance P which causes hypersensitivity. Often due to jaw misalignment.^[6]

Common causes of photophobia include migraine headaches, TMJ,cataracts, Mild Traumatic Brain Injury (MTBI), or severe ophthalmologic diseases such as uveitis or corneal abrasion.^[7] A more extensive list follows:

Eye-related

Causes of photophobia relating directly to the eye itself include:

• Achromatopsia^[8]
• Aniridia^[9]
• Anticholinergic drugs may cause photophobia by paralyzing the iris sphincter muscle.
• Aphakia^[10] (absence of the lens of the eye)
• Blepharitis
• Buphthalmos^[9] (abnormally narrow angle between the cornea and iris)
• Cataracts^[9]
• Coloboma
• Cone dystrophy^[9]
• Congenital abnormalities of the eye^[9]
• Viral conjunctivitis ("pink eye")^[11]
• Corneal abrasion^[9]
• Corneal dystrophy^[9]
• Corneal ulcer^[12]
• Disruption of the corneal epithelium, such as that caused by a corneal foreign body or keratitis ^[9]
• Ectopia lentis^[9]
• Endophthalmitis^[9]
• Eye trauma caused by disease, injury, or infection such as chalazion, episcleritis, glaucoma,^[9] keratoconus, or optic nerve hypoplasia
• Hydrophthalmos, or congenital glaucoma^[9]
• Iritis^[9]
• Optic neuritis^[9]
• Pigment dispersion syndrome
• Pupillary dilation (naturally or chemically induced)^[10]
• Retinal detachment
• Scarring of the cornea or sclera ^[9]
• Uveitis^[9]

Nervous-system-related

Neurological causes for photophobia include:

• Autism spectrum disorders^[13]
• Chiari malformation
• Dyslexia^[14]
• Encephalitis^[9] including Myalgic encephalomyelitis aka Chronic fatigue syndrome^[15]
• Meningitis^[9]
• Trigeminal disturbance causes central sensitization (hence, multiple other associated hypersensitivities. Causes can be bad bite, infected tooth, etc.^[16]
• Subarachnoid haemorrhage^[17]
• Tumor of the posterior cranial fossa^[9]

Other causes

• Ankylosing spondylitis^[18] — Causes Uveitis as an extra-articular feature.
• Albinism^[19]
• Ariboflavinosis^[20]
• Benzodiazepines (long term use of or withdrawal from benzodiazepines)^[21][22]
• Chemotherapy^[9]
• Chikungunya^[23]
• Cystinosis^[9]
• Drug withdrawal
• Ehlers-Danlos syndrome^[24]
• Infectious mononucleosis (Glandular Fever)^[25][26]
• Influenza^[27]
• Magnesium deficiency^[28]
• Mercury poisoning^[29]
• Migraine^[30]
• Rabies^[31]
• Tyrosinemia type II, also known as "Richner-Hanhart syndrome"^[9]
• snake bite
• Lyme disease

Treatment

The best treatment for light sensitivity is to address the underlying cause. Once the triggering factor is treated, photophobia disappears in many but not all cases.^[32]

People with photophobia will avert their eyes from direct light, such as sunlight and room lights. They may seek the shelter of a dark room. They may wear sunglasses designed to filter peripheral light and wide-brimmed sun hats.

A paper by Stringham and Hammond, published in the Journal of Food Science, reviews studies of effects of consuming Lutein and Zeaxanthin on visual performance, and notes a decrease in sensitivity to glare.^[33]

Effects

Photophobia may also affect patients' socioeconomic status by limiting their career choices, since many workplaces require bright lights for safety or to accommodate the work being done. Sufferers may be shut out of a wide range of both skilled and unskilled jobs, such as in warehouses, offices, workshops, classrooms, supermarkets and storage spaces.^[34] Some photophobes are only able to work night shifts, which reduces their prospects for finding work.^[35]

See also

• Photic sneeze reflex, a medical condition by which people exposed to bright light sneeze
• Photosensitivity in humans

References

1. thefreedictionary.com/photophobia citing:
   • Dorland's Medical Dictionary for Health Consumers. 2007
   • The American Heritage Medical Dictionary Copyright 2007
   • Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. 2003
   • Millodot: Dictionary of Optometry and Visual Science, 7th edition. 2009
2. thefreedictionary.com/photophobia citing:
   • Gale Encyclopedia of Medicine. Copyright 2008
   • Mosby's Medical Dictionary, 8th edition. 2009
   • McGraw-Hill Concise Dictionary of Modern Medicine. 2002
3. thefreedictionary.com/photophobia citing:
   • The American Heritage Medical Dictionary Copyright 2007
   • Millodot: Dictionary of Optometry and Visual Science, 7th edition. 2009
4. φῶς, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
5. φόβος, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
6. J Pain Res. 2014; 7: 99–115. Published online 2014 Feb 21.Orofacial pain management: current perspectives; Marcela Romero-Reyes and James M Uyanik
7. Hazin R, Abuzetun JY, Daoud YJ, Abu-Khalaf MM (July 2009). "Ocular complications of cancer therapy: a primer for the ophthalmologist treating cancer patients". Curr Opin Ophthalmol 20 (4): 308–17. doi:10.1097/ICU.0b013e32832c9007. PMID 19491683.
8. "Achromotopsoa". Scottish Sensory Centre. Retrieved December 11, 2009.
9. Day, Susan (January 15, 1997). "P9: Photophobia". In Taylor, David. Paediatric Ophthalmology (2nd ed.). Wiley-Blackwell. pp. 1034–6. ISBN 978-0-86542-831-7.
10. "Photophobia". Texas School for the Blind and Visually Impaired. Archived from the original on September 29, 2009. Retrieved December 11, 2009.
11. "Conjunctivitis". Merck Manual of Diagnosis and Therapy. Retrieved December 11, 2009.
12. "Corneal ulcer". Merck Manual of Diagnosis and Therapy. Retrieved December 11, 2009.
13. Fan X, Miles JH, Takahashi N, Yao G (November 2009). "Abnormal transient pupillary light reflex in individuals with autism spectrum disorders". J Autism Dev Disord 39 (11): 1499–508. doi:10.1007/s10803-009-0767-7. PMID 19499319.
14. "Light sensitivity — photophobia". Royal National Institute of Blind People. Retrieved December 11, 2009.
15. "Chronic Fatigue Syndrome". University of Virginia Health System. Retrieved December 11, 2009.
16. J Pain Res. 2014; 7: 99–115. Published online 2014 Feb 21.Orofacial pain management: current perspectives;Marcela Romero-Reyes and James M Uyanik
17. "Photophobia — Glossary Entry". Genetics Home Reference. United States National Library of Medicine. Retrieved December 11, 2009.
18. "Ankylosing spondylitis". United States National Library of Medicine. Retrieved December 11, 2009.
19. "Albinism". MedicinePlus Medical Encyclopedia. United States National Library of Medicine. Retrieved December 11, 2009.
20. Harris, Robert S.; Kenneth V. Thimann (February 11, 1943). Vitamins & Hormones, Volume 1. Academic Press. p. 88. ISBN 978-0-12-709801-2.
21. Wakakura M, Tsubouchi T, Inouye J (March 2004). "Etizolam and benzodiazepine induced blepharospasm". J. Neurol. Neurosurg. Psychiatr. 75 (3): 506–7. doi:10.1136/jnnp.2003.019869. PMC 1738986. PMID 14966178.
22. Pelissolo A; Bisserbe JC (Mar–Apr 1994). "[Dependence on benzodiazepines. Clinical and biological aspects]". Encephale 20 (2): 147–57. PMID 7914165.
23. Mahesh, G; Giridhar, A; Shedbele, A; Kumar, R; Saikumar, SJ (2009). "A case of bilateral presumed chikungunya neuroretinitis". Indian journal of ophthalmology (Indian Journal of Ophthalmology) 57 (2): 148–50. doi:10.4103/0301-4738.45508. PMC 2684432. PMID 19237792.
24. Dr. Diana Driscoll, Ehlers-Danlos Eye Dr PDF
25. A.D.A.M,
26. Gauthier-Smith, P.C. (December 22, 2004). "Neurological complications of glandular fever (infectious mononucleosis)". Brain (Oxford University Press) 88 (2): 323–334. doi:10.1093/brain/88.2.323. PMID 5828906.
27. Hunt, Dr. Margaret. "Influenza Virus (Orthomyxovirus)". University of South Carolina School of Medicine. Retrieved December 11, 2009.
28. Durlach, Jean; Hirotoshi Morii; Yoshiki Nishizawa (March 6, 2007). "10: Clinical forms of Magnesium Depletion by Photosensitization and Treatment with Scototherapy". New Perspectives in Magnesium Research. Springer London. pp. 117–126. doi:10.1007/978-1-84628-483-0_10. ISBN 978-1-84628-388-8.
29. "Elemental mercury poisoning in a household—Ohio, 1989". MMWR Morb. Mortal. Wkly. Rep. 39 (25): 424–5. June 1990. PMID 2113168.
30. Drummond PD (October 1986). "A quantitative assessment of photophobia in migraine and tension headache". Headache 26 (9): 465–9. doi:10.1111/j.1526-4610.1986.hed2609465.x. PMID 3781834.
31. Centers for Disease Control and Prevention (CDC) (28 October 1994). "Human Rabies — Miami, 1994". Morbidity and Mortality Weekly Report (Centers for Disease Control and Prevention) 43 (42): 773–5. PMID 7935313.
32. Bailey, Gretchyn. "Photophobia (Light Sensitivity)". AllAboutVision.com. Retrieved 2012-11-13.
33. Stringham JM, Bovier ER, Wong JC, Hammond BR (2010). "The influence of dietary lutein and zeaxanthin on visual performance". J. Food Sci. 75 (1): R24–9. doi:10.1111/j.1750-3841.2009.01447.x. PMID 20492192.
34. Practitioner - Volume 232. 1988. p. 219.
35. "The West Indian Medical Journal, Volume 11". University of the West Indies: 6. 1962.

External links

• AllAboutVision.com page on photophobia
• WrongDiagnosis.com page on photophobia