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Background and Aims Short-lasting unilateral neuralgiform with conjunctival injection and tearing (SUNCT) is a rare cause of facial pain. It has been associated with vascular abnormalities, intracranial masses and trauma but can occur de novo. We share a case of SUNCT which presented after surgery for retinal detachment.
Methods The patient was followed up weekly over telephone consultation. A pain and symptom diary was kept until resolution.
Results A 64 year old man underwent retinal surgery for retinal detachment under sub-tenons block. His past medical history included migraine with aura and ocular migraine. On the evening of day 0 the attacks began to occur. They were described as lasting 45-60 seconds total with a maximum severity on the numerical rating scale (NRS) of 9. The pain built up in a crescendo during the attack and the pain was described as stabbing and spasmodic in the orbital region. There was associated autonomic features which included conjunctival injection, tearing, rhinorrhoea, forehead sweating and ptosis. Neuropathic features included hypersensitivity over the ipsilateral forehead. During the cluster of attacks, another could be initiated through palpation over the orbital and temporal region. There were 50-100 attacks daily which clustered over 3-4 hour periods typically in the evening. He was reviewed by the eye clinic on day 1 who advised cyclopentolate and ibuprofen to no effect. The attacks resolved by day 16.
Conclusions SUNCT can be initiated by peripheral causes as suggested here and in the literature. Therefore it may be an underreported problem after ophthalmic and craniofacial surgery.
Attachment DH SUNCT ptosis.pdf
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