Eye pain can originate in the eye, eye socket or surrounding structures. It can also be due to referred pain from another part of the body. It can be characterized in a variety of ways – gritty, sharp, dull, burning, shooting or stabbing pain or as the sensation of a foreign body in the eye.
The complex structure of the eye makes it susceptible to painful conditions. Membranes protect the eye and its structures, many of which have multiple nerve endings. The presence of so many receptors enables the eye to process information for sight. They also react quickly to protect the eye. A tiny particle of dirt can cause extreme pain or scar the surface of the eye.
Many conditions may cause eye pain. Some are serious, sight-threatening conditions such as a form of glaucoma. Others are the result of allergies, irritation, infections, trauma or conditions outside the eye, such as migraines, other headaches, sinusitis or certain forms of arthritis. Even ill-fitting or wrongly prescribed contact lenses or glasses can cause eye pain.
To determine the cause of the eye pain, an ophthalmologist (eye M.D.) or other physician will examine the eyes and may perform several visual tests.
Treatment for eye pain depends on its cause. It may include flushing the eye out with water, taking medications such as antibiotic eye drops or nonsteroidal anti-inflammatory drugs (NSAIDs), applying warm or cold compresses, or surgery.
Some causes of eye pain can be prevented. People should wear eye protection for certain household and yard chores, hobbies, sports and work activities. Avoidance of allergens, irritants and potentially harmful substances can avert irritation and eye pain. Hygiene that includes regular hand washing will minimize the transmission of germs from hands to eyes.
If pain does develop, it is best not to rub the eyes because this may worsen the condition. Finally, it is advisable to wear sunglasses with ultraviolet protection when outside.
About eye pain
Eye pain can originate in the eye, its surrounding structures or in other parts of the head or body. It can range from gritty or dull to burning or stabbing, or may feel as if a foreign body is lodged in the eye.
The eye is one of the most sensitive organs in the body. Parts of the eyes are covered with pain receptors, which are designed to protect these vital organs. The number and sensitivity of these pain receptors can cause them to react and send pain signals to the brain from such minor changes as a gust of cold air or a grain of sand.
The eyes rest in sockets in the skull called the orbits. An optic nerve and other nerves connect each eye to the brain. The eye is a sphere, held in place by muscles. The sphere has a bulge near the front, which is the visible portion of the eye. Most of the outer layer of the eye is the white portion, called the sclera. The remainder of the outer layer is the cornea, a sensitive clear tissue that covers the front of the eye.
The next layer under the cornea and sclera is the uvea or uveal tract. The uvea includes the iris (colored part of eye) under the cornea, the choroid (a membrane that supplies blood to the retina) and the ciliary body, a muscular area that controls the lens and intraocular pressure under the sclera. The pupil is the dark opening at the center of the iris that expands and contracts to allow light inside the eye.
The eyelids cover the eyes. Above and behind the sides of the eyelids are lacrimal glands, which produce tears that lubricate the eyes. After bathing the eyes, tears empty into the lacrimal sacs, along the bridge of the nose. A thin membrane called the conjunctiva covers the sclera and the inside of the eyelids.
Several other factors make the eye susceptible to pain. The complexity of the structure – a fluid–filled body partially enclosed by bones – exposes it to injury. The fact that the eye is one of the few body parts with an exposed mucous membrane makes it susceptible to infection.
The eyes are working during all of a person’s waking hours, which can result in overuse and eyestrain. Trauma can also cause eye pain. Finally, the eye’s proximity to other pain sites is also a factor. For instance, migraines and other types of headaches can produce referred pain to the eyes.
Other pain areas related to eye pain
Certain types of eye pain may be related to pain occurring in other parts of the body. For example, certain headaches, such as cluster headaches and migraines, may occur with eye pain. Dental pain or orofacial pain may also occur with eye pain. Sinus infections may cause pain in eyes as well as the sinuses.
In addition, eye pain may occur with other symptoms. Some of these symptoms include:
Complete or partial loss of vision
Extreme sensitivity to light (photophobia)
Halos (seeing colored circles or halos around lights)
Limited eye movement
Double vision
New floaters (spots, strings or shadows that float in front of the eyes)
Sensation of flashes or streaks of light
Potential causes of eye pain
There are numerous conditions that can cause eye pain. Some causes may be apparent, such as eyestrain or dust, an eyelash or another foreign body in the eye, or being splashed with an irritant. Other potential causes of eye pain may be divided into certain categories:
Allergies. An allergy is an excessive response by the body’s immune system to some substance. Many allergies produce eye pain because the conjunctiva (mucous membrane that lines the eyelid) contains mast cells. Allergens trigger mast cells to release a substance called histamine, which enlarges blood vessels and causes itching and watery eyes.
Injuries and burns. Any trauma to an eye can cause pain. Chemical irritants, juices, shampoo or chlorine can all cause redness and pain. More serious chemicals can damage the cornea. Overexposure to light may cause painful eye burns. This may occur when people do not wear safety goggles for such activities as welding or using tanning booths. Even exposure to strong indoor light, such as stage lights, can dry the eyes. A blow to the eye can cause an orbital bone fracture, black eye and/or bruising of the eye socket.
Corneal abrasions. The cornea is extremely susceptible to painful abrasions. Its concentrated set of highly sensitive nerves can create extreme pain that may spread to other parts of the head, such as around the eye socket and upward to the forehead. If a corneal abrasion is superficial but becomes infected, it may lead to a corneal ulcer, which is a far more serious condition. Corneal abrasions may be caused by a foreign object in the eye or by contact lenses that are older, are poorly cleaned or do not fit well.
Infections. Infections may attack many parts of the eye and can cause inflammation. Some originate in the eye. Others may be the result of other conditions. Some common painful eye infections include:
Conjunctivitis. Bacterial or viral inflammation of the conjunctiva, the membrane that lines the eyelid and sclera. This inflammation reddens the sclera and may swell the eyelid. It is extremely contagious and is usually spread from one eye to the other by touching.
Stye (hordeolum). Gland inflammation that produces a bump on the edge of the eyelid.
Orbital cellulitis. Infection and/or inflammation of the tissues surrounding the eye (lids, eyebrow and cheek). Sometimes it has spread from the sinuses, though usually from the overlying skin.
Several viruses related to herpes may cause eye pain and keratitis (inflammation of the cornea). These include the varicella zoster virus, which causes chickenpox and shingles, and the herpes simplex virus 1, which causes cold sores on the mouth and lips. Risk factors for fungal keratitis such as Fusarium include trauma, an impaired immune system and, in rare cases, use of contact lenses, according to the American Academy of Ophthalmology.
Dry eye. This condition develops when the body is no longer able to produce enough tears to adequately moisten, protect and cleanse the eyes, or the tears made are not good ones, or the lids and orbit do not spread the tears well over the surface of the eye.
Common causes of dry eyes are the normal aging process and autoimmune conditions such as Sjogren’s syndrome. Certain medications may cause dry eyes, including oral contraceptives (birth control pills), antidepressants, antihistamines, decongestants, anti–anxiety agents, and diuretics or other blood pressure pills.
Blepharitis. Inflammation of eyelash follicles and skin causes crusty, swollen eyelids and burning and itching eyes.
Reiter’s syndrome. This type of arthritis causes uveitis, inflammation of the uvea.
Temporal arteritis. This condition involves inflammation of arteries in the body. It can present with inflammation and pain in the temporal artery in the scalp, where a biopsy can aid in diagnosis. Temporal arteritis often causes eye pain and may cause visual impairments such as blurred or double vision. It can cause a devastating optic neuropathy (arteritic anterior ischemic optic neuropathy) in the elderly.
Glaucoma. Most forms of this eye disease, which causes damage to the optic nerve, involve a gradual, painless loss of vision. However, there is also a less common type called angle-closure or narrow-angle glaucoma. The acute form of angle-closure glaucoma usually involves sudden, excruciating eye pain and can cause blindness within a day or two if not treated by laser or surgery. The chronic form of angle-closure glaucoma has less apparent symptoms but should also be treated promptly.
Growths or lumps. Some conditions that appear as bumps in the eye area may cause eye pain. A chalazion is a lump caused by a blocked oil gland that irritates the eye. Tumors in the soft tissues behind the eye may put pressure on nerves and cause eye pain. Eye cancer is rare, and only rarely and usually at an advanced stage does eye cancer cause pain.
Optic neuritis. An inflammation of the optic nerve is often due to multiple sclerosis, a progressive neurological disease. It can also result from other conditions, including Lyme disease, viruses, syphilis or tuberculosis.
Juvenile rheumatoid arthritis. This inflammatory joint condition often inflames the eyes. The child will often not experience eye pain, but vision loss oftenoccurs nonetheless.
Sarcoidosis. This is a disease in which inflammatory lumps (granulomas) develop in organs. Sarcoidosis can produce eye pain and lead to uveitis, cataracts or glaucoma.
Behcet’s disease. An autoimmune disorder that often involves inflammation inside the eye.
Fuch’s dystrophy. A slowly progressive eye disease in which the cornea swells painfully in late stages.
Stevens-Johnson syndrome. This skin disorder, also called erythema multiforme major, can also cause painful inflammation in the eyelids.
Ciliary muscle spasm.
Improper prescription for corrective lenses or improper use of cosmetic lenses.
Cranial neuralgias. In addition to causing facial pain, inflammation of the cranial nerves in the head can, in rare cases, cause eye pain as well.
Common tests for eye pain
Individuals experiencing eye pain are advised to contact an ophthalmologist, a physician who specializes in eye disorders. Trauma or acute conditions such as angle-closure glaucoma may require going to a hospital emergency room or clinic.
The physician will review a medical history, listen to a description of the pain and any other symptoms, and conduct a physical examination. The physician may check eye motion, examine the eyelids and the reaction of pupils to light, and assess visual acuity. Common eye tests include:
Funduscopy (ophthalmoscopy). Use of a lighted instrument to examine the back of the eye for damage.
Tonometry. An assessment of the pressure inside the eye.
If glaucoma or other eye diseases are suspected, several other painless eye tests may be performed, such as:
Perimetry (visual field test). Assessment of peripheral (side) vision.
Gonioscopy. Inspection of the eye’s surface with a special lens.
Other eye tests or examinations may take place to determine the cause of the pain. Depending on the suspected cause of the pain, imaging tests such as CAT scans may be used. Blood tests and other lab tests can help in diagnosing conditions such as infections, Reiter’s syndrome, juvenile rheumatoid arthritis or Sjogren’s syndrome.
Relief options for eye pain
Some painful eye conditions can be relieved with first aid, such as flushing the eye with water. Warm compresses or cool compresses may help some conditions.
Medical treatment should be considered for any painful eye condition not easily attributed to eyestrain or a common irritant such as soap. Although most causes of eye pain are easily treatable, certain conditions can lead to serious eye damage or blindness if left untreated.
If an underlying condition such as juvenile rheumatoid arthritis, herpes, Reiter’s syndrome or Behcet’s disease is causing the eye pain, that condition must be addressed.
The American Academy of Ophthalmology recommends the following measures in case of eye trauma:
Seek help from an ophthalmologist or emergency room. Even seemingly minor eye injuries can cause permanent loss of vision.
Do not rub the eye. To shield it, tape the bottom of a foam cup, or a similar item, against the surrounding facial bones.
Do not apply ointments or medication to the eye, which might not be sterile and could impede diagnosis. Avoid taking aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and other drugs that may worsen bleeding.
In case of a cut or puncture, shield the eye without pressure and get immediate medical attention. Do not wash the eye or try to remove an object stuck in the eye.
In case of a chemical burn, flush the eye immediately with clean water. Get emergency medical attention immediately.
In case of a blunt blow to the eye, apply a cold compress with no pressure. Seek medical attention if pain, a visual disturbance or a black eye occurs after any blow.
In case of small debris in the eye, flush out the eye with eyewash. If the grit does not come out, seek medical attention.
Various medications can help soothe eye pain. If the physician has prescribed eye drops, it is important to ensure the medication reaches the eye and is absorbed. Eyedrop medications that the physician may recommend to alleviate eye pain include:
Antibiotic eye drops. For bacterial infections such as bacterial conjunctivitis, antibiotic eye drops or an ointment for the eyes may be prescribed.
NSAIDs. These medications, usually taken as pills in non-ophthalmic disorders, but also available as eye drops, help to reduce inflammation and pain.
Artificial tears. For eye pain related to allergens or dry eyes, over–the–counter products may help remove mucus or dilute irritants in the eye.
Antihistamines or mast cell stabilizers. For pain related to allergies, antihistamines or mast cell stabilizers, which strengthen mast cells and keep them from bursting and releasing histamine and other chemicals, may be prescribed. The sign of allergy and histamine is itch, rarely pain.
Corticosteroids. These drugs reduce inflammation. Corticosteroids are very cautiously prescribed because they can make certain infections, such as herpes, worse. If they are prescribed, they should be used only for short–term relief and under supervision of a physician.
Glaucoma eye drops. These medications lower the pressure in the eye.
Several other treatments may be used for eye pain. Some are commonsense remedies, such as checking the fit or prescription of eyeglasses. Eyes sprayed with harmful liquids, such as those in household cleaners, should be flushed thoroughly with water for at least 15 minutes. Compresses may also relieve some eye pain. For instance, warm compresses may help styes or crusted eyelids And cold compresses constrict blood vessels and may reduce allergic reactions.
Surgery may be used for some causes of eye pain, such as dry eye. Punctal occlusion surgery is a procedure in which a plug is placed in one of two ducts between the eyelids and the nose to keep tears from flowing into the nose. Laser treatment or surgery to treat angle-closure glaucoma can prevent pain and blindness.
Prevention methods
Many forms of eye pain are not preventable, but people can take steps to reduce their risk. Regular, complete eye exams by an ophthalmologist can help people maintain the health of their eyes and find early signs of some diseases.
Goggles or other devices offer protection when taking part in chores, hobbies, sports and work that can expose the eyes to damage (e.g., trimming hedges, carpentry, paintball, welding). Allergens and irritants that cause eye pain should be avoided. Regular hand washing helps reduce contamination or infections by germs and allergens that can move from the fingers to the eye.
For any eye irritation, people are advised to avoid rubbing the eyes, because this often makes the condition worse. Sunglasses with ultraviolet protection can reduce the damaging effects of the sun.
The U.S. Food and Drug Administration and the American Academy of Ophthalmology have warned of eye pain, trauma and infection resulting from improper use of decorative contact lenses, including some cases of permanent blindness. U.S. law requires that cosmetic lenses, like corrective lenses, be fitted by and obtained through an eye care professional.
The U.S. Centers for Disease Control and Prevention reports that it is monitoring cases of Fusarium keratitis, a rare fungal infection of the cornea. One brand of contact lens solution was withdrawn from the market in April 2006 after reports of more than 100 cases of Fusarium keratitis.
Questions for your doctor regarding eye pain
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about eye pain:
What could be causing my eye pain?
Can my eye pain be due to a condition in another part of my body, such as a migraine?
What tests might I have to undergo, and what do they involve?
What do my test results show?
Is there a specific treatment for my eye pain?
If medication is recommended, how and when do I take it?
How can I prevent eye pain in the future?
What type of sunglasses should I wear?
Do I have any risk factors for serious eye conditions such as angle-closure glaucoma?
How can I tell if my eye pain can be treated at home or needs medical attention?
How often should I have an eye exam? What should it include?
