Eye Pain: Causes, Diagnosis, & Treatments

The official medical term for eye pain is ophthalmalgia, a common occurrence in many local ocular and systemic conditions. While pain can be mild and resolve without treatment in many instances, some episodes of pain are severe and require immediate medical attention.

The intensity and nature of ocular discomfort usually vary depending on the part of the eye that is involved. Pain occurring primarily on the eye surface is known as ocular pain. Itchiness and burning sensations are some of the hallmarks of ocular pain. 

Aching that emanates from within the eye is called orbital pain. This kind of discomfort from deeper eye structures usually occurs as a throbbing, stabbing or gritty sensation. 

The type of pain you experience depends on the underlying conditions. For instance, if you have surface ocular pain, the causative factor is likely an infection, the presence of a foreign object or some kind of trauma.

Consequently, treatment will vary depending on the trigger agent. Rest and eye drops are enough to relieve ocular pain, while orbital aches might require intensive, invasive therapy.

Any eye pain associated with vision loss warrants a medical emergency regardless of the site and duration. Thus, you should contact an ophthalmologist immediately.

Common Causes of Eye Pain

Eye pain can occur in either one or both eyes, depending on the etiology. Typical triggers of ophthalmalgia are numerous, including less serious causes like irritation by environmental factors to severe issues like an intraocular bacterial infection.

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What Causes Ocular Pain?

Any discomfort on the surface of your eye might come from:

• A foreign body
• Conjunctivitis
• Dry eye
• Corneal laceration or abrasion
• An injury
• A stye

Foreign body

Any foreign object that enters the eye can cause irritation, pain, tearing, and redness. Inanimate objects like dirt as well as tiny insects can enter the eye leading to pain. The discomfort usually resolves when the foreign body is removed from the eye.

Conjunctivitis

The conjunctiva is the mucous membrane that covers the surface of the eyeball and underside of your eyelid. An allergic reaction or infection of this tissue layer can lead to inflammation that manifests as eye pain alongside other symptoms.

Viral conjunctivitis characterized by red and watery eyes with a burning sensation is the most typical type of pink eye. As a highly contagious condition, viral conjunctivitis occurs primarily in crowded settings.

Pink eye caused by bacteria comes with soreness and discharge. Hypersensitive individuals can also develop conjunctivitis from an exposure to allergens such as pollen.

Dry Eye

In the US, a population-based study out of Beaver Dam, Wisconsin found that 14% of individuals between the ages of 48 and 91 years reported symptoms, which included dryness and foreign body sensation.

National Organization for Rare Disorders

Constantly wearing contact lenses, being in air conditioning and taking certain prescription medications can lead to a lack of moisture in the eyes, which causes soreness and tearing. Medications such as antihistamines, opiates, and beta-blockers are known triggers of dry eye. Photophobia and a feeling of a foreign object in the eye could also point to a lack of moisture. 

Besides dry eyes, sleeping with or wearing expired contact lenses can cause irritation and infection of the eye, which will present with pain.

Corneal Laceration or Abrasion

A scratch or a scrape in the cornea produces the feeling of an object in the eye. The pain from corneal abrasion is usually mild. However, a corneal laceration with more severe pain is likely to occur when a sharp object enters your eye.

Injury

Different injuries such as chemical and flash burns can cause considerable eye pain. Exposure to intense sources of light, including arc welding and tanning booths, might result in eye pain similar to a chemical burn.

Blepharitis and Eye Stye

Infection of the oil-secreting eye glands causes pain with subsequent stye or chalazion formation. A stye, which is a bump on the eyelid, is painful and sensitive to touch.

What Causes Orbital Pain?

When pain originates from within the eye globe. Potential causes include:

• Glaucoma
• Optic neuritis
• Microvascular cranial nerve palsy
• Hyphema 

Glaucoma

Fluid buildup in the eye leads to elevated intraocular pressure that damages the optic nerve. The risk of blindness in individuals with glaucoma is quite high, especially in the acute type. Unlike other kinds of glaucoma, acute angle-closure causes severe pain and is a medical emergency. Other symptoms of glaucoma include nausea and headache. 

Optic Neuritis 

The optic nerve conducts impulses from the retina at the back of your eye to the brain and allows you to see. When this nerve inflames due to viral, bacterial infection, or autoimmune disease, eye pain accompanied by visual disturbances occurs. Mumps and measles are the commonest viruses that cause optic neuritis. 

Microvascular Cranial Nerve Palsy

Microvascular Cranial Nerve Palsy occurs when the blood supply to the nerves that control eye movement is blocked. As a result, the eyes ache accompanied by double vision.

Hyphema 

An injury that tears the pupil or iris causes accumulation of blood in the anterior chamber of the eye known as hyphema. This condition is both painful and interferes with vision. 

Other causes of orbital pain include sinusitis, uveitis and, to a lesser extent, migraines. 

Symptoms That Accompany Eye Pain

Eye pain often presents with other associated symptoms, including:

• Sensitivity to light (photophobia)
• Headaches
• Visual disturbances such as double vision and blindness
• Tearing and red eyes 
• Eye discharge
• The sensation of a foreign body in the eye

Diagnosis of Eye Pain

The diagnosis of ophthalmalgia relies on a comprehensive medical history, physical examination, and functional tests.

The diagnosis of ophthalmalgia relies on a comprehensive medical history, physical examination, and functional tests. The doctor will use a Snellen’s chart to evaluate your vision while examining the other eye functions like extraocular eye movement. Penlight test also helps to identify associated photophobia. In suspected glaucoma, intraocular pressure measurement is essential. 

When to See a Doctor

Any eye pain should be evaluated immediately and carefully. But some conditions are more serious than others. When you experience eye pain associated with the following symptoms, you need to see an ophthalmologist or optometrist as soon as possible: 

• Vomiting 
• Blurring vision and other vision changes like halos around lights
• Bulging eyes 
• Impaired eye movement
• Signs of systemic infection- fever, chills
• Eye pain due to trauma or chemical burns

Treatments

Treatment of eye pain depends on the cause. Basic treatments are:

• Home care
• Eyeglasses
• Eye drops
• Corticosteroids

Home care

Home care can mean several tactics. A big one is rest: simply giving your eyes a break by staying away from digital screens (computers, tablets and smart phones) for a period.

Another do-it-yourself treatment that works is applying warm compresses for short periods. Doctors advise about 15 minutes of compresses relieves pain associated with blepharitis and a stye.

Glasses

Wearing glasses instead of contact lenses might also help reduce the pain, especially when associated with contact lens use. For eye pain caused by foreign objects, flushing with tap water will eliminate the pain. 

Eye Drops

Doctors prescribe antibiotic eye drops when microbial organisms are the cause of your eye pain, as in conjunctivitis. Antihistamines relieve ophthalmalgia associated with allergies.

In severe cases of inflammation, corticosteroids offer significant symptomatic relief. 

You can ease some eye pain through proper eye hygiene, especially when wearing glasses and contact lenses.

References

1. Eye pain. (November 2019). University of Florida Health.

2. Evaluation of the Painful Eye. (June 2016). American Family Physician Journal.

3. Eye Pain. (March 2018). Cleveland Clinic.

4. Conjunctivitis: A Systematic Review of Diagnosis and Treatment – Abstract. (October 2013). Journal of the American Medical Association.

5. Prevalence of Diagnosed Dry Eye Disease in the United States Among Adults Aged 18 Years and Older. (October 2017). American Journal of Ophthalmology.

6. Glaucoma. (2022). American Optometric Association.

7. What is Hyphema? (May 2021). American Academy of Ophthalmology.

8. What is optic neuritis? (2022). Johns Hopkins Medicine.

9. What Is Corneal Laceration? (January 2022). American Academy of Ophthalmology.