You are currently viewing Headache Around Head & Tired Eyes? *UpdatedAB

Headache Around Head & Tired Eyes? *UpdatedAB

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15/2/2022

Mr Teoh (M/49) our customer friend, Racheal’s husband came for eye examination, with complaint of headache around head for 1+ year. He wears a pair of reading glasses only. He has sinus since 30 years ago.. he recently got warded for treatment on his sinus.

Vision without glasses
R: 6/7.5
L: 6/7.5

Power of own reading glasses
R: +1.75
L: +1.75

Examination shows:
R: +0.50 (6/6) (+1.25 blur lens test 6/7.5-)
L: +0.50 (6/6) (+1.00 blur lens test 6/12) [L: left dominant eye] L>R
Add: +1.50 L>R
Adding longsightedness/hyperopia +0.25 in right eye is not preferred
No further longsightedness/hyperopia accepted binocularly

Other assessments show:

Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small XP, fast recovery @Near
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards

Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 (top arrow paces around 0, slightly on blue & yellow)
Near: 8 – 10 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance; and 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards

NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.25
(normal value: +1.50 to +2.50)

PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)

NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
18/28cm, 18/28cm, 18/28cm, 20/30cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)

Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 8/18/10
Near, Base-In/Divergent, NFV: 2/15/6
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: x/18/16
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman – Adult Data]

We prescribe pencil push up test.

*UpdatedA

6/4/2022

Mr Teoh came back for follow up.

Power
R: +0.75 (6/6)
L: +0.50 (6/6) [L: left dominant eye] L>R
Add: +2.00/+1.75 R>L

Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 1 EP (yellow part) 
Near: 0 – 2 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance; and 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards

NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.50
(normal value: +1.50 to +2.50)

PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)

NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
22/28cm, 22/28cm, 22/28cm, 22/28cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)

Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 16/30/25
Near, Base-In/Divergent, NFV: 8/14/12
Distance, Base-In/Divergent, NFV: x/4/2 (with +0.50 both eyes)
Distance, Base-Out/Convergent, PFV: x/20/16 (with +0.50 both eyes)
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman – Adult Data]

Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Distance, Base-In/Divergent, NFV: x/6/4 (with +0.75 in RE & +0.50 in LE)

Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 9 cpm
Distance: 1 cpm (double with Base-Out)
(normal value: 1 cycle = 2 times clearing target to a clear, single target
Distance: 12-18 cpm
Near: 12-18 cpm)

Interpupillary Distance = 6.8cm

We prescribe a separate pair of glasses for far vision for full-time wear to let his eyes slowly accepting the hyperopic power/long-sightedness. His finding of divergent fusional reserve, NFV @distance tells us that: when his eye can accept higher hyperopic power, it boosts his NFV.

………………………….

*UpdatedAB

Mr Teoh, father of HYin came back & reported that he cannot see dashboard wearing single vision glasses for far vision.

We are not sure whether or not his headache is due to sinus or otherwise.. but we can try to optimise his vision & we see how it goes. We prescribe multifocal and we will see him after 2months of full-time wear of multifocal glasses.

Glad to hear that he finds warm compression & lid massage work for him in alleviating dry, burning sensation due to oil gland blockage. When he feels the same dry, burning sensation coming back, he will then repeat to do warm compression again.

KIV

– NPC
– NFV @Distance