16 year old with daily headaches

Meet Tyler.  Tyler is a 16 year old, Year 10 student who was referred by his psychologist, as he was having difficulty focussing and was getting frequent headaches.

His mother was concerned as Tyler used to be an above average student but stopped studying about 12 months ago.  Tyler reports that his headaches become very intense when he studies, and this causes him to lose interest in studying.

Tyler also has difficulty maintaining his focus at any distance and the edges of his vision blur, the longer he visually concentrates.  His symptoms appear to be worse when focussing further away than at near.  Sometimes when he is concentrating hard, he will see objects in his peripheral vision, which aren’t there, such as a cat running across the ground.

When Tyler wakes in the morning he has trouble focusing on objects and often has double vision, side by side (horizontal diplopia).  He also says that his eyes get very tired after visual concentration, and this is worse in the afternoon or if he hasn’t had a good night sleep.  He rubs his eyes a lot when he gets tired and reports that his eyes feel dry at these times.

Tyler is on mood stabilisers and antidepressant medications.

[Behavioural] Optemetrist findings

Dr Nick carried out a clinical examination of Tyler and found him able to carry out all age-appropriate tasks, focus on tasks and respond well to instructions.  His eye health was normal.

Dr Nick found that when Tyler is extremely relaxed or fatigued, his right eye will drift out causing him to see double.

Tyler’s focussing was poor.  He over-focusses and struggles to relax his focus.  This strain on his focussing system can result in eyestrain.  In Tyler’s case, sore eyes, and headaches.

He can track well but this requires effort and will break down under visual strain.

Recommendations

Tyler has Intermittent Exotropia.  He has poor spatial awareness skills, which make him slow to locate visual targets both close and far away. Once he locates the target, he struggles to maintain his attention on it.  When the effort becomes too difficult, his eyes will diverge.  When this happens, people notice his right eye drifting out and Tyler will experience double vision or suppress the image and experience very wobbly vision.  This will cause his eyestrain and headache symptoms.

In cases of extreme fatigue, it is not unusual to experience visual disturbances such as Tyler reports of peripheral blur or the image of a cat running across the ground.  This is a possible side effect of related migraine headaches or a reduced oxygen flow to the brain.

Dr Nick suggests lenses to improve his ocular co-ordination skills, particularly his ability to converge his eyes.  This will allow Tyler to have a more relaxed visual posture to reduce visual stress, improve his ability to sustain visual attention and reduce his visual fatigue.

Tyler has excellent distance vision without correction; however, the lenses Dr Nick prescribes will balance his two eyes and reduce the drive to diverge with visual concentration at any distance.  Therefore, it is recommended Tyler wear his new glasses for general purpose use and not only for concentrated near work.

First follow up session

Three months after Tyler’s initial eye tests, Tyler reports he is wearing the glasses and has not experienced any eyestrain, headaches and double vision symptoms while wearing them.

Tyler comments ‘I am not as tired when I get home from school, and I am sleeping better.  School is a lot more fun, and I have the motivation to do well again.  I don’t see the cat anymore, either!’

Tyler is to continue to wear his prescribed glasses and Dr Nick will follow-up Tyler’s progress in twelve months’ time.

Tyler’s mother is ecstatic ‘I cannot believe the change in Tyler, he’s like a different child with his schoolwork.’

Eye strain can show as many different symptoms.  Not just headaches, dry eyes and poor sleep as in Tyler’s case but also burning, itchy or watery eyes, sore neck, shoulders or back, increased sensitivity to light, and even the feeling you cannot keep your eyes open!  If you or a loved one experiences any of these symptoms, please get in touch with Dr Nick.  A thorough eye examination may make all the difference.

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