Doctor's Notes on Eye Pain
Eye pain is pain or discomfort that originates within the structures of the eye or the surrounding structures, including the eyelids, conjunctival membranes, cornea, or muscles and nerves that control the eye. There are a number of different causes of eye pain, which can include corneal infections, corneal abrasions, conjunctivitis (pink eye), blepharitis (inflammation of the eyelids), glaucoma, optic neuritis, and sinusitis, among others. A foreign object in the eye is also a source of eye pain, along with trauma or injury to the eye area. Signs and symptoms associated with eye pain vary depending on the exact cause of the pain. These can include redness, swelling, bleeding, excessive tearing, vision disturbances, headache, nausea, and vomiting. Other associated symptoms can include the sensation of something in the eye, such as a gritty or irritated feeling.
Eye Pain Symptoms
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
- 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 Pain Causes
Causes of eye pain fall into two broad categories: ocular pain and orbital pain.
- 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 conjunctivitis caused by a respiratory virus, 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 primary infections of the cornea or infected abrasions.
- Keratopathies are conditions of the cornea and can be a cause of ocular pain.
- 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 from reflected ultraviolet light.
- 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.
- Acute angle closure glaucoma can cause ocular or 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 or orbital pain, usually accompanied by blurred vision and light sensitivity.
- Scleritis is a rare cause of severe eye pain and is often associated with systemic illness.
Orbital pain is described as a deep, dull ache behind or in the eye. This pain is often caused by diseases of the eye.
- 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 changes in vision and eye pain, especially on movement of the affected eye.
- 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 and cluster headaches are a very common cause of orbital eye pain.
- Painful ophthalmoplegia is the combination of orbital pain and eye muscle weakness. In addition to pain, there is double vision when both eyes are open. Causes include various inflammatory conditions of the orbit.
- 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.
Just like every other part of the body, eyes age and do not work as well as we get older. Poor diet, excess sun exposure, toxins, infections, and physical and emotional stressors cause wear and tear on the body, including our eyes. This wear and tear produces free radicals, unstable molecules that harm us at the cellular level. The eyes are prone to damage by free radicals. This damage may result in you having vision problems or suffering from age-related macular degeneration or other eye disorders, but you can help protect your eyes by making healthy food choices.
Antioxidants like vitamin C, vitamin E, vitamin A, beta-carotene, zinc, lutein, zeaxanthin, and omega-3 fatty acids protect against free radical damage that can harm your eyes. You can find these nutrients by eating colorful fruits and vegetables that will protect your eyes and boost your overall health. We’ll take a look at these on the following slides.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.