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Many major brain problems can cause both headaches and eye problems. For example, brain tumors may not only cause headaches but also cause double vision by pressing on some of the nerves that control eye movement. They may damage the optic nerve, either by pressing directly on the optic nerve fibers as they pass through the brain or by raising the fluid pressure inside the head, which in turn applies pressure to the optic nerves. An aneurysm, by bleeding suddenly, may cause similar problems. Nerve palsies caused by the shutdown of small blood vessels, as often seen in diabetics, are sometimes accompanied by pain around the involved eye. Some eye medications, such as pilocarpine, a drug used to treat glaucoma,may cause a headache, although in the case of pilocarpine, it is often termed a brow ache. Fortunately, most headaches are not caused by serious problems such as brain tumors or aneurysms.But any new headache, especially one that persists or is different in quality from a person’s “usual”headaches, deserves medical evaluation.
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When the central retinal vein, the main vein that drains blood away from the retina, becomes occluded, the vision usually becomes blurred but does not black out completely. The vein occlusion affects the circulation to the retina, although many people who have central retinal vein occlusions may already have somewhat compromised circulation because of hardening of the arteries in the neck or closer to the eye. The typical appearance of the retina in this situation has been called one of “blood and thunder.” Severe hemorrhaging and leakage from the blood vessels are seen throughout the retina, and the veins appear dark and swollen. In contrast to this picture is a less severe type of central retinal vein occlusion called venous stasis retinopathy. In this form, there is much less hemorrhaging, the vision may remain fairly good, the circulation to the retina is fairly good, and the prognosis over all is much better. Occlusions of branches of the central retinal vein also occur. Sometimes the indentation of the veins by the arteries that cross over them may play a role.
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Formation of epiretinal membranes over the center of the macula, as described above, usually does not result in macular hole formation.However, this condition, also known as macular pucker or cellophane maculopathy (because the membrane has a crinkly, shiny look similar to cellophane), is a common cause of vision problems in the elderly population. The membrane causes the center of the macula to become wrinkled. This can have anywhere from a mild to a severe distorting effect on vision. In some cases, objects may appear smaller than normal. Macular pucker does not always get worse with time, however. Frequently, it just stays the same, and in perhaps 10 percent of cases, it actually improves as the membrane separates itself from the retina. As with macular holes, surgery (vitrectomy) can be done to try to remove the membrane. The surgery is fairly successful in bringing about an improvement in vision, but because of the potential for cataract development and retinal complications, it should be reserved for people who have fairly severe loss of vision.
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