Eye Pain

Eye Pain Facts

Eye pain is often described as burning, sharp, shooting, dull, gritty, a feeling of "something in my eye," aching, pressure, throbbing, or stabbing. Sometimes pain originating from the eye is confused with other symptoms, such as a headache, sinus pain, toothache, or a migraine.

Eye pain is a common reason for people to seek medical care from their doctor (or an ophthalmologist, a medical doctor specializing in the diagnosis and treatment of eye diseases).

What Causes Eye Pain?

Causes of eye pain fall into two broad categories: ocular pain and orbital pain.

  • Ocular pain is eye pain coming from the pain-sensitive outer structures of the surface of the eye.
    • Conjunctivitis is one of the most common eye problems. Conjunctivitis can be an allergic, bacterial, chemical, or viral inflammation of the conjunctiva (the delicate membrane lining the eyelid and covering the eyeball). Pinkeye is a nonmedical term usually referring to a viral conjunctivitis, because the conjunctiva gets inflamed and turns a pinkish color. Pain is usually mild with conjunctivitis, or there is no pain at all. Itching, redness, and drainage are typical symptoms and signs associated with conjunctivitis.
    • Corneal abrasions and corneal ulcerations are also common conditions that cause eye pain. The cornea is the transparent surface of the eye. Abrasions occur from scratches to the surface of the cornea, such as from trauma, a foreign body in the eye or overuse of contact lenses. Ulcerations occur from infections or abrasions. Foreign bodies, usually located on the cornea or in the conjunctiva, are objects or materials that give the sensation that something is in eye. Foreign bodies produce eye pain similar to that of corneal abrasions.
    • Chemical burns and flash burns are significant causes of eye pain. Chemical burns come from eye exposure to acid or alkaline substances, such as household cleaners or bleach. Flash burns occur from intense light sources, such as arc welding or the ultraviolet rays of tanning booths, when improper eye protection is worn. Even an intense sunny day can cause a corneal flash burn.
    • Blepharitis is a condition that causes eye pain when an inflammation of the eyelid is caused by plugged oil glands at the eyelid edges.
    • A sty or a chalazion causes eye pain because of local irritation. Either of these conditions cause a lump you can see or feel within the eyelid. The lump is a result of a blocked oil gland within the eyelid. This lump causes irritation to the eye, can be very painful to the touch, and can occur in both children and adults.
  • Orbital pain is described as a deep, dull ache behind or in the eye. This pain is often caused by diseases of the eye.
    • Acute angle closure glaucoma can cause orbital pain, although most cases of glaucoma are of the open-angle variety and are painless. Glaucoma is caused by an increase in intraocular pressure, or internal eye pressure, which can ultimately lead to defects in vision and even blindness if left untreated. Intraocular pressure can increase because of a blockage of outflow or increased production of aqueous humor (the fluid that bathes the inner eye). This is typically seen in older adults.
    • Iritis is an inflammation of the iris, or colored part of the eye, that causes one to feel deep eye pain, usually accompanied by blurred vision and light sensitivity.
    • Optic neuritis is an inflammation of the optic nerve. The optic nerve connects to the back of the eye. The cause of this inflammation can be from multiple sclerosis, viral infections, or bacterial infections and can cause symptoms such as pressure behind the eye along with vision changes and eye pain.
    • Sinusitis, which is a bacterial or viral infection of the sinuses, can cause a sensation of orbital or eye socket pain. Pain coming from the sinus cavities can be interpreted as eye pain.
    • Migraines are a very common cause of orbital eye pain associated with headaches.
    • Tooth pain resulting from problems with the upper teeth may present as pain in the orbit or below the eye.
    • Traumatic events, such as a penetrating injury to the eye, a blow to the eye with a foreign object, and motor-vehicle collisions, are causes of significant eye pain and injury. Scratches to the cornea typically associated with traumatic events are very painful. These are common eye problems that lead people to seek medical attention.

What Symptoms and Signs May Be Associated With Eye Pain?

Pain is a variable measure. Each person may interpret pain differently. Discomfort in the temple area or the forehead is often due to tensing of the facial muscles after use of the eyes for close work. This is commonly known as eye strain and is usually not associated with any eye disease.

Other symptoms often described by those experiencing pain in and around the eye include the following:

  • Partial or complete loss of vision
  • Extreme light sensitivity
  • Tearing
  • Double vision
  • Halos (colored circles or halos around lights)
  • New floaters (spots, strings, cobwebs, or shadows seen before the eyes)
  • Limitation of normal eye movement
  • Pain with movement of the eye in different directions
  • Sensation of flashes or streaks of light
  • Severe headache associated with eye pain

All of these symptoms should be evaluated by an ophthalmologist or other medical professional.

A doctor or an ophthalmologist may see the following signs as evidence of eye problems:

  • Redness of the white of the eye (conjunctiva)
  • Redness that flares out and surrounds the colored part of the eye (iris)
  • Irregularly shaped pupil
  • Bulging or protrusion of the eye
  • Swelling or redness of the surrounding eye tissue, including the eyelids
  • Blood or pus inside the front of the eye (over the colored part of the eye)
  • Eye discharge, excessive tearing, crusting, or eyelids stuck together (especially upon awakening)
  • A scratch to the cornea or eyeball
  • Tenderness of the inner corner of the eye or side of the nose
Eye injuries with red eye

Causes of Eye Injuries

Chemical exposures and burns

A chemical burn can occur in a number of ways but is most often the result of a liquid splashing into the eye. Many chemicals, such as soap, sunscreen, and even tear gas, are primarily irritants to the eye and do not usually cause permanent damage. However, acids and alkalis are highly caustic and may cause severe and permanent damage to the ocular surface.

When Should Someone Seek Medical Care for Eye Pain?

If one has eye pain, seek advice from a health care provider or an ophthalmologist. It is difficult over the phone for a health care professional to grade the severity of eye pain or make a diagnosis without examining the patient.

Because of the specialized nature of the equipment necessary for eye examination, most eye problems are usually handled best in an ophthalmologist's office. If your ophthalmologist is not available, go to a hospital's emergency department. If the emergency department has the necessary eye equipment, an ophthalmologist may see you in the emergency department after hours.

  • Any eye pain related to burns (chemical or flash) needs immediate treatment.
  • Eye pain associated with loss of vision, loss of eye movement, painful eye movement, eye swelling, eye discharge, and severe headache are all significant findings that need to be evaluated by an ophthalmologist or in the emergency department immediately.
  • Any eye pain related to a traumatic event such as an object puncturing the eye, a blow to the eye with a foreign object, or a motor vehicle collision with injuries affecting the eye needs to be evaluated by an ophthalmologist or in the emergency department immediately.

Questions to Ask the Doctor About Eye Pain

  • Is there any sign of damage to the eye?
  • Is there any possibility of permanent vision loss?
  • What type of follow-up is necessary to make certain my eye heals properly?

How Do Health Care Professionals Diagnose Eye Pain?

Medical evaluation of eye pain begins with a thorough history and physical examination. The history consists of questions documenting the symptoms in detail.

  • Important questions that should be asked and answered include when the pain started, the location of pain, the intensity of the pain, the duration of pain, the characteristics of pain, anything that makes the pain better or worse, what activities was one engaged in when the symptoms began, history of contact lens use, and previous eye injuries or surgeries.
  • Other important questions are whether one has allergies to medications, one’s current medications, past medical history, past surgeries, family history, and social history (including work and travel habits as well as any history of alcohol, tobacco, or illegal drug use).
  • The physical examination pertaining to the eyes may first consist of checking vision, visual inspection of the eye and its surrounding tissue, and examining eye movements, visual fields (peripheral vision), and the pupil's reaction to light.
  • The ophthalmologist may use instruments to get a better look at the internal structures of the eye.
    • An ophthalmoscope, which is a special tool for visualizing the eye, is used to examine the back of the eye and to view the optic disc and blood vessels.
    • A slit lamp is a microscope used to view the surface of the eye up close and in detail to evaluate for possible corneal abrasions and ulcerations. It is also used to look into the anterior chamber, which is the area between the surface of the eye and the pupil.
    • Eye pressure can be checked using a tonometer on the slit lamp or a device known as a Tono-Pen. These two instruments are used if glaucoma is suspected.
    • The ophthalmologist may also put an anesthetic drop into the eye for both diagnostic and therapeutic purposes. This test helps to determine if the eye pain comes from the surface of the eye or from deeper structures in the eye. In most cases, pain can be relieved by the topical anesthetic if it originates from the surface of the eye.
    • A dye called fluorescein may be put into the eye to detect abrasions, ulcerations, or any corneal defect. A special blue light will be used in conjunction with the fluorescein to check for these problems.

What Are Home Remedies for Eye Pain?

Seek medical attention if one has eye pain.

  • Most commonly, home care consists of flushing the eye with water. With exposure to a foreign body or chemical to the eye, it is important to thoroughly flush the eye with lukewarm tap water or commercially prepared eyewash solution. See the home care section under eye injury for techniques on how to flush the eye with water.
  • If one suspects a foreign body in the eye, do not rub the eye. This can seriously damage the eye by causing more damage to the surface as the foreign body is moved around with rubbing. Do not attempt to remove a foreign body from the eye or someone else's eye. Treatment other than gentle eye irrigation is generally not recommended and should be reserved for medical professionals and eye doctors.
  • For mild cases of eye discomfort, rest the eyes, take over-the-counter pain relievers such as ibuprofen (Advil) or acetaminophen (Tylenol), and avoid bright light.

What Is the Treatment for Eye Pain?

Treatment at the ophthalmologist's office or at an emergency department will vary widely, from giving one instructions to apply warm compresses to a sty or a chalazion to taking one into emergency surgery for acute glaucoma.

  • Conjunctivitis: The bacterial form is treated with antibiotic eyedrops, eye ointment, and pain medication. Viral conjunctivitis (pinkeye) is typically treated in a similar manner as bacterial conjunctivitis, because it may be difficult to tell the difference between bacterial versus viral infections. Allergic conjunctivitis is normally treated with antihistamines, in the form of drops with or without oral agents such as diphenhydramine (Benadryl) or non-sedating antihistamines.
  • Corneal abrasions and ulcerations: These are treated with antibiotic eye drops (to prevent infection), eye ointment, and pain medication.
  • Foreign body in the eye: There are different techniques to remove foreign bodies: irrigation with eye wash, removal with a cotton tip applicator, removal with a small needle, or removal with an ophthalmologic drill. After foreign body removal, there may be an abrasion or a rust ring (rust from a metal foreign body), which would be treated separately.
  • Chemical eye burns and corneal flash burns: Chemical eye burns are treated immediately with anesthetic eye drops and great amounts of water to wash out the eye until normal levels of acid or alkali of the eye are reached. The acid or alkali levels will be checked with a special paper called pH paper. After thorough washing is complete and the pH is normal, evaluation by an ophthalmologist is required for further treatment, depending on the extent of the chemical burn. Flash burns are treated as many small abrasions with antibiotic eyedrops, eye ointment, and pain medication. Typically, follow up with an ophthalmologist is recommended.
  • Blepharitis: The patient will be instructed to scrub the eyelid edges with mild shampoo like baby shampoo on a soft washcloth twice a day to remove excess oil.
  • Styes or chalazions: These can initially be treated conservatively by placing warm compresses, such as a washcloth that has been warmed with hot water, on the eye or eyes for 15 to 20 minutes, four times a day. An antibiotic ointment can be applied. If the hordeolum (stye) becomes more painful, the ophthalmologist may open it up so the infection can drain out. If a chalazion does not go away in 3 to 4 weeks, it may be removed surgically through an incision on the inside of the eyelid.
  • Glaucoma: Acute glaucoma has many treatment options depending on the type, severity, and duration of the attack. Severe glaucoma can be a true eye emergency with permanent eye damage occurring within several hours. Treatment typically begins with eye drops containing a topical beta-blocker (for example, timolol [Timoptic]), a topical steroid drop, and a pupillary constricting eyedrop; other medicines may be given intravenously or in pill form. If these treatments fail to decrease intraocular eye pressure, surgery may be considered.
  • Iritis: This condition may be treated with eyedrops that cause the pupils to dilate (get bigger) and with topical steroid eyedrops. In severe cases of iritis, oral steroids or other anti-inflammatory agents may be used.
  • Optic neuritis: Gradual loss of vision and painful eye movement are consistent with a diagnosis of optic neuritis. All cases need to be diagnosed and treated. Most commonly, a thorough work-up needs to be performed with both ophthalmologists and neurologists to determine the cause of optic neuritis.
  • Sinusitis: When sinusitis is determined to be a bacterial infection, it can be treated with antibiotics.
  • Migraines: When migraine headaches cause eye pain, both can be treated with routine over-the-counter medications, such as ibuprofen (Motrin) and acetaminophen (Tylenol), as well as with prescription migraine medications.
  • Traumatic events to the eye: Penetrating injuries to the globe of the eye are always best managed by ophthalmologists and require immediate evaluation in the emergency department.

Is Any Follow-up Needed After Treatment of Eye Pain?

Follow-up care usually depends on the severity of the eye problem.

Signs and symptoms to look for are the same as the signs and symptoms of any of the eye injuries or diseases. Return to the ophthalmologist or the emergency room if increased eye pain, any sight problems, increased eye discharge or redness, or swelling around the eye occurs.

Is It Possible to Prevent Eye Pain?

Prevention of common causes of eye pain starts with eye protection.

  • Wear goggles while working with hand tools, power tools, industrial chemicals, or when there is a chance of getting chemicals, debris, or small particles in the eye.
  • Wear safety glasses while playing sporting activities, such as basketball, racquetball, and tennis. Also, appropriate headgear should be worn, such as a safety helmet at work when needed, a helmet for playing baseball, and a face mask for playing hockey.
  • When using potent chemicals, such as cleaning fluids, ammonia, and detergents, read the instructions carefully. Also, when using spray chemicals, it is important to point the nozzle away from the eyes at all times.
  • Children at play often sustain eye injuries. These injuries can result from spring-loaded toys that shoot darts and other objects, plastic swords, and BB guns. Young children can also injure their eyes as a result of fireworks mishaps. Close parental supervision can often prevent these injuries.
  • Prevent eye injuries while performing gardening and lawn care activities by picking up rocks and sticks before mowing and watching for low-hanging branches and trees while mowing.
  • If one wears contact lenses, use proper routine eye care to prevent contact lens-related eye injuries. People who wear contact lenses should follow their eye doctor's instructions carefully for removing, applying, and washing their contact lenses.

What Is the Prognosis of Eye Pain?

The prognosis for corneal abrasions is good.

Pain associated with corneal ulcers, infections, chemical burns, and penetrating eye injuries has a much more guarded outlook.

Blepharitis tends to be a chronic problem and eyelid hygiene should be maintained.

Where Can People Find More Information on Eye Pain?

American Academy of Ophthalmology
655 Beach Street
Box 7424
San Francisco, CA 94120
Phone: 415-561-8500

Eye Pain Pictures

Picture of corneal abration
Picture of a corneal abrasion

Picture of corneal ulcer
Picture of a corneal ulcer

Picture of chalazion
Picture of a chalazion

Picture of corneal burn
Picture of a corneal burn

Reviewed on 9/11/2017

REFERENCES:

Gelston, C.D. "Common Eye Emergencies." Am Fam Physician 88.8 Oct. 15, 2013: 515-519.

Gerstenblith, Adam T., and Michael P. Rabinowitz. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 6th Ed. China: Lippincott Williams & Wilkins, 2012.

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