Eye Pain

Eye pain is often described as burning, sharp, shooting, dull, gritty, a feeling of "something in my eye," aching, pressure, throbbing, or stabbing. Sometimes eye pain 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 specialist who deals only with eyes).


Eye Pain Causes

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

    Ocular pain is eye pain coming from the 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, or there is no pain at all. Itching, redness, and drainage are typical symptoms associated with conjunctivitis.


        Corneal abrasions and corneal ulcerations are also common causes of eye pain. The cornea is the transparent surface of the eye. Abrasions occur from scratches to the surface of the cornea, such as from 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 you the sensation that something is in your 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 tanning booths, when improper eye protection is worn. Even an intense sunny day can cause a flash burn.


        Blepharitis 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. Both cause a lump you can see or feel within the eyelid formed by a blocked oil gland. This lump causes irritation to the eye, can be very painful to the touch, and is seen 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.

        Glaucoma can cause orbital pain, although most cases of glaucoma 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 deep eye pain.


        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 visual 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.


        Migraines are a very common cause of orbital eye pain associated with headaches.


        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 a common eye problem that leads people to seek medical attention.



Eye Pain Symptoms

Pain is a variable measure. Each person may interpret pain differently.

    Eye pain and other symptoms often described by those experiencing eye problems are summarized below:


        Pain in or around the eye


        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

    Your doctor or an ophthalmologist may see these 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 (within 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


When to Seek Medical Care

If you have eye pain, seek advice from your doctor or an ophthalmologist. It is difficult over the phone for a health-care provider to grade the severity of eye pain or make a diagnosis without examining you.

Because of the specialized nature of eye examination equipment, most eye problems are usually handled best in your 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 your 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 your ophthalmologist or in the emergency department immediately.


Questions to Ask the Doctor

    Is there any sign of damage to the eye?


    Is there any sign of permanent vision loss?


    What type of follow-up is necessary to make certain my eye heals properly?



Exams and Tests

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 asked include when the pain started, the location of pain, the duration of pain, the characteristics of pain, anything that makes the pain better or worse, what you were doing when the symptoms began, history of contact lens use, and previous eye injuries or surgeries.


    Other important questions are whether you have allergies to medications, your current medications, past medical history, past surgeries, family history, and social history (including your work and travel habits as well as any history of alcohol, tobacco, or illegal drug use).


    The physical examination pertaining to the eyes may consist of checking your 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 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 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 your 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 black light will be used in conjunction with the fluorescein to check for these problems.


Eye Pain Treatment

Self-Care at Home

Seek medical attention if you have 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 your eye with water.


    If you think a foreign body is in your eye, do not rub your 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 your 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 your eyes, take over-the-counter pain relievers such as ibuprofen or acetaminophen, and avoid bright light.


Medical Treatment

Treatment at your ophthalmologist's office or at an emergency department will vary widely, from giving you instructions to apply warm compresses on a sty or a chalazion to taking you 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 the same as bacterial conjunctivitis, because it may be difficult to tell the difference between bacterial versus viral infections. Allergic conjunctivitis is normally treated with antihistamines, such as 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 great amounts of water to wash out the eye and anesthetic eye drops 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: You 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 chalazion does not go away in three to four weeks, your ophthalmologist may open it up so the infection can drain out.


    Glaucoma: 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 your pupils to dilate (get bigger) and with topical steroid eyedrops. In severe cases of iritis, oral steroids may be used.


    Optic neuritis: Gradual loss of vision and painful eye movement are normally signs of a disease throughout the body, which needs 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 migraines 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.