Recurrent bilateral TMJ pain accompanied by eye pain during one relapse

This de-identified case involved a 20-year-old man treated during 2021–2022. Bilateral TMJ pain recurred several times, and one relapse included headache and pain in both eyes.

The first course ended when discomfort was minimal, but right TMJ pain returned about two months later. Roughly nine months after that, bilateral aching returned with headache and eye pain; about seven months later, a vague aching sensation prompted another visit.

The patient reported that headache and eye pain disappeared the day after one injection treatment. This timing is clinically relevant but does not prove that the eye pain originated in the TMJ.

Each episode was reviewed separately. At a later follow-up, the patient directly reported no current discomfort, but that does not guarantee permanent freedom from recurrence.

Overall case summary

The main symptom was recurrent bilateral TMJ pain. The first course included one injection and ended when discomfort was minimal. A right-sided relapse about two months later was managed without injection.

The later bilateral relapse with headache and eye pain involved one injection and two additional conservative visits. The final relapse about seven months later involved one injection and one additional conservative visit.

Recurrence did not automatically mean the earlier treatment had failed. Pain side, accompanying symptoms, opening, chewing, and muscle findings differed at each episode and were reassessed before care was chosen.

Eye pain was assessed separately from jaw symptoms

During the relapse about nine months later, headache and bilateral eye pain occurred with jaw discomfort. The patient said an ophthalmic examination had found no abnormality.

A patient's report of a normal eye examination does not by itself establish TMJ-referred pain. Visual warning signs, ocular causes, and whether jaw and eye symptoms change together in timing, side, and triggers must be considered.

First presentation

He reported bilateral TMJ pain for about one week with occasional throbbing, while eating remained comfortable, opening was adequate, and there was no jaw sound.

Preserved eating and opening and absence of sound are important findings, but they do not mean pain is absent. Pain location and onset, jaw movement, and joint and muscle tenderness were assessed together.

How the first course ended

One injection treatment was performed. At the next visit, the patient felt little discomfort, and the course was ended after his condition was checked.

This individual response does not mean that everyone with bilateral TMJ pain needs an injection or will obtain the same result after one treatment.

Right TMJ pain recurred about two months later

The initial episode was bilateral, but this relapse centered on the right TMJ. It was managed conservatively without injection, and the patient did not return for additional treatment at that time.

No further visit does not prove complete resolution or long-term absence of recurrence. Headache and eye pain were not recorded in this episode, so it was kept separate from the later relapse.

About nine months later, headache and bilateral eye pain accompanied the relapse

The patient described periodic aching in both TMJs that had become worse the day before. Opening and chewing were not greatly limited, but headache and mild pain in both eyes were present.

The symptoms were bilateral rather than right-sided. A report of no ophthalmic abnormality remained one item of information, not proof that the eyes were healthy in every respect or that the jaw caused the pain.

Duplicate celecoxib prescribing was avoided

The patient was already taking Celebrex (celecoxib) prescribed by ophthalmology. When the duplicate ingredient was identified, celecoxib was excluded from the clinic's prescription.

Patients should share medication name, ingredient, dose, frequency, start date, remaining medicines, and prior adverse reactions. This adjustment reflected the prescription information available then and is not advice to stop or change medication without a clinician.

Change after one injection

At the next visit, the patient said he was much better, although mild left-jaw discomfort remained. He reported that headache and eye pain had disappeared from the day after treatment.

This temporal response cannot generalize the cause of all eye pain or headache or predict an identical response. Natural variation, sleep, environment, medicines, and stress may also affect symptoms.

At the third visit, jaw symptoms returned

Despite reduced head and eye pain, chewing became less smooth, opening felt difficult, aching developed below the ear, and the jaw seemed to catch before opening. The patient felt opening was more limited than before.

This relapse course included one injection and two additional conservative visits. There was no later treatment visit, so the record does not claim confirmed complete recovery or long-term freedom from recurrence.

About seven months later, vague aching prompted another visit

The discomfort was not severe and did not hurt with opening or chewing. It improved and returned, with a vague persistent sensation during the preceding week. Headache and eye pain were not recorded in this relapse.

The first visit included one injection, and the second involved conservative care without injection. The patient then made no further treatment visit.

How the final status was confirmed

At a later follow-up visit, the patient directly reported no current uncomfortable symptom. This differs from merely inferring recovery because no treatment visit occurred.

Even direct confirmation of comfort at that time does not establish that recurrence will never happen again.

Does recurrence mean that earlier treatment failed?

Not necessarily.

TMJ and masticatory-muscle symptoms may decrease and later return with changes in daytime clenching, possible sleep bruxism, sleep loss, stress, hard or chewy foods, prolonged talking, posture, neck-shoulder tension, trauma, wide opening, or other unidentified factors.

Recurrence should prompt reassessment of current pain location and intensity, opening, sound, chewing, muscles, and new accompanying symptoms. A treatment that helped before is not automatically repeated.

What to check when eye pain accompanies recurrence

Eye pain may arise from dry eye or ocular-surface disease, pressure-related eye problems, migraine, sinus disease, or neurologic causes. Co-occurrence with TMJ pain does not make the two symptoms one condition.

Warning signs requiring ophthalmic or emergency assessment

Sudden vision loss or field change, severe redness with abrupt intense eye pain, double vision, halos, marked pain on eye movement, severe headache with repeated vomiting, facial or limb sensory change, unilateral limb weakness, or slurred speech requires prompt assessment.

After warning signs are separated, clinicians can compare whether eye and jaw pain occur on the same side and vary together with jaw movement or clenching, and whether temple or masticatory-muscle discomfort is present.

Does eye or facial pain mean trigeminal neuralgia?

A broad phrase such as facial neuralgia is not the same as the specific diagnosis of trigeminal neuralgia.

The latter requires assessment of brief, severe electric-shock attacks, duration from seconds to minutes, light-touch triggers such as washing, brushing, or talking, and distribution along trigeminal divisions.

The headache and bilateral eye pain in this case were not diagnosed as trigeminal neuralgia.

Key lessons

Pain can exist despite normal opening and no jaw sound

At the first visit, eating and opening were maintained and no sound was present, yet bilateral TMJ pain and intermittent throbbing occurred. Opening range and sound alone do not determine pain.

Each relapse looked different

The sequence was bilateral pain, right-sided pain, bilateral pain with headache and eye pain, later catching and opening difficulty, and finally a vague aching sensation. Each episode required fresh assessment.

Eye pain was recorded in only one relapse

Eye pain was absent from the first and final relapse records and appeared with the bilateral episode about nine months later. Symptoms from different dates should not be merged.

Response does not prove cause

Disappearance of headache and eye pain the next day is important course information, but not direct proof that the TMJ caused them.

No return visit and direct follow-up are different

Some episodes had no later treatment visit, so recovery could not be assumed. After the final relapse, a separate follow-up directly confirmed no current discomfort, without guaranteeing permanent resolution.

Summary

The first bilateral TMJ episode occurred with preserved eating and opening and no joint sound. One injection was followed by minimal discomfort and the first course ended.

Right TMJ pain returned about two months later and was managed without injection.

About nine months later, bilateral aching returned with headache and bilateral eye pain; duplicate celecoxib was avoided, and the patient reported disappearance of head and eye pain the day after injection.

Jaw catching, chewing difficulty, and reduced opening later returned. About seven months later, vague aching prompted another short course. A later follow-up confirmed no current discomfort.

The case shows that TMJ pain can recur with different locations, functional changes, and associated symptoms. One episode of eye pain improving after care cannot establish a TMJ cause or predict another person's response.

References

Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Journal of Oral & Facial Pain and Headache. 2014;28(1):6–27. DOI: 10.11607/jop.1151.

Schiffman E, et al. Diagnostic criteria for headache attributed to temporomandibular disorders. Cephalalgia. 2012;32(9):683–692. DOI: 10.1177/0333102412446312.

The US National Institute of Dental and Craniofacial Research guidance on TMD was used for general evaluation boundaries.

Lee SY, Kang DH, Lee D, Kim H. From TMJ to 3D Digital Smile Design with Virtual Patient Dataset for diagnosis and treatment planning. Journal of the Korean Academy of Esthetic Dentistry. 2021;30(2):71–90. DOI: 10.15522/jkaed.2021.30.2.71.

Frequently asked questions

Can TMJ pain occur with good opening and no sound?

Yes. Opening and sounds are important but do not determine pain alone. Location, duration, movement, and joint and muscle tenderness are also assessed.

Does improvement after one injection mean care is permanently finished?

No. A course may end when symptoms are low, but recurrence can still occur. Reassessment is needed rather than automatically repeating the same treatment.

Can eye pain accompany a TMJ relapse?

It can occur at the same time, but eye disease and warning signs must be considered first. Co-occurrence and treatment response do not prove causation.

Should the previous treatment be repeated at every relapse?

No. Current pain location, opening, sound, muscle findings, and new symptoms are reassessed first.