Headache as the main presenting symptom of iritis

Headache is one of the most common outpatient pain conditions encountered in both the private practice and emergency departments. Recognition of serious causes of headache requires a standardized diagnostic approach to history and examination. We will report a patient with iritis associated with elevated intraocular pressure (IOP) that presented with severe sudden onset headache mimicking intracranial hemorrhage. A 60-year old man, a known case of non-insulin dependent diabetes mellitus, referred to the emergency room due to severe, sudden onset of headache associated with nausea without any complaint of ocular problem except mild redness of the left eye. Considering subarachnoid hemorrhage subsequent work ups including brain CT scan and lumbar puncture were performed which proved to be inconclusive. The intraocular pressure (IOP) of the left eye was 50 mmHg and there was significant cell and flare in the anterior chamber. IOP was controlled by administration of intravenous manitol, topical antiglaucoma medications and steroid eye drops. The symptoms were relieved within a few days. This manuscript propounds the importance of the awareness of the possibility of serious headache as the presentation of ocular problems.