Eye Pain Causes and Treatment

Eye pain can be both distracting and debilitating. The cause of eye pain can sometimes be difficult to diagnose. If eye pain is due to an injury, then the cause is pretty obvious. However, if you wake up in the morning with eye pain, it can be quite disturbing. What is important is to determine if the pain has onset suddenly or gradually gotten worse.

Is the pain very sharp or like a dull ache? Does the pain feel like it is coming from the surface, around the eye, behind the eye or from the eyelid? Here are a few common causes of eye pain.

Pain in the eye can originate from several different parts of the eye:
• Cornea: The clear window in the front of your eye that focuses light
• Sclera: The whites of your eyes
• Conjunctiva: The ultra-thin covering of your sclera and the inside of your eyelid
• Iris: The colored part of your eye, with the pupil in the middle
• Orbit: A bony cave (eye socket) in your skull where the eye and its muscles are located.
• Extraocular muscles: They rotate your eye.
• Nerves: They carry visual information from your eyes to your brain.
• Eyelids: Outside coverings that protect and spread moisture over your eyes.
 

Mild Causes of Eye Pain

Stye - A stye, or hordeolum, usually starts out as a pretty sore eyelid that is tender to the touch.

It can be quite painful when it begins. Although the appearance of a stye can be unsightly at times, it is usually harmless. A stye is a small bump on the outside or inside of the eyelid. A stye develops from an eyelash follicle or an eyelid oil gland that becomes clogged from excess oil, debris or bacteria.

Styes can be a complication of but also seem to be brought on by stress.

Corneal abrasion - A corneal abrasion is a scratch on the surface of the cornea, the clear dome-like structure on the front part of the eye. Usually, an injury causes a corneal abrasion, removing the top layer of the cornea. However, if the injury is more severe and damages the second layer of the cornea, a recurrent corneal erosion occurs. The abrasion can heal but some time later, months or even years, patients often wake up in the middle of the night or in the morning with intense eye pain. The injury reopens and has a difficult time healing.

Foreign body - Sometimes a piece of dust, sand or debris can fly into the eye. Most times our blinking mechanism and tears do a good job of flushing out the debris, but sometimes the foreign body can get lodged underneath the eyelid. Every time you blink, the debris can scratch your cornea, repeatedly. Even a piece of glitter can become lodged under the eyelid or on the cornea and create severe eye pain.

Dry eye - Having dry eyes can create eye pain. The cornea is filled with nerves that give the eye and brain feedback. When the surface of the eye dries out enough, the cornea can develop sore areas called keratitis.

This can often feel like a very brief, sharp pain in the eye. It often comes and goes but can also be constant.  

Headache and sinus pain - Headaches and sinus problems are a very common cause of pain or pressure behind the eye. Most of us have experienced this and usually the condition if fairly benign and resolves after a headache or sinus problem are treated. However, sinus infections have been known to be so severe that the infection invades the surrounding tissue outside of the sinus cavity. As a result, sinus infections should not be ignored.

Contact lens problems - Wearing contact lenses every day (or for extended periods of time) can cause the eyes to ache and appear red.

Some people develop contact lens-induced dry eyes, which makes it difficult to wear contact lenses comfortably. Be aware that wearing contact lenses for a long period of time may cause blurry vision, pain, and redness due to a lack of oxygen passing through to the eye.

Serious Causes of Eye Pain

Acute angle closure glaucoma - Most cases of glaucoma create no symptoms at all. However, a more rare type of glaucoma called acute angle closure glaucoma often comes on suddenly and creates intense eye pain. Patients often complain of eye redness and often see halos and rainbows around lights due to swelling. In this type of glaucoma, the drain pipe of the eye becomes closed and fluid that fills the eye cannot drain properly. Pressure builds up in the eye rapidly and causes eye pain and swelling. This condition requires immediate treatment or loss of vision can occur.

Optic neuritis - Optic neuritis is an inflammation of the optic nerve. Although optic neuritis can occur from several causes, it has been linked to multiple sclerosis. Interestingly, patients complain of a decrease in vision but also pain upon eye movement. Pain occurs with eye movement because the optic nerve is like a cable that connects the eye to the brain. As the eye moves back and forth, the nerve gets moved back and forth and when inflamed, pain can occur.

Uveitis - Uveitis is an inflammation of the anterior chamber, the front fluid filled compartment at the front part of the eye. Uveitis most often occurs in one eye and causes acute eye pain. Also, patients complain of intense light sensitivity. Uveitis can be successfully treated with steroids in most cases. However, if uveitis lingers for a long period of time, other complications can occur such as glaucoma.

Treatment of Eye Pain

Treatment of eye pain centers around what exactly is causing the eye pain. It is imperative that you see an optometrist or ophthalmologist to determine the source of the eye pain. In some cases, it can easily be remedied in a short office visit. For example, one of the most common causes of eye pain is a foreign body that gets embedded under the upper eyelid. Every time you blink, the foreign body under the lid scratches the front surface of the cornea. Doctor’s can see this easily under an instrument called a slit lamp biomicroscope. The sign that they see under the microscope is called foreign body tracking. The doctor easily flips the eyelid and removes the offending agent and the patient quickly lets out a sigh of relief.

Sometimes you can’t get to the doctor’s office right away. Try the following remedies until you can make it to your appointment:

• Cold compresses: Cold compresses can bring quick relief of pain and swelling to a painful eye. You can use a cold washcloth, or an ice pack commonly used for sports injuries. Cold compresses are great for relieving pain associated with eye allergies.
• “Chilled” artificial tears: Over the counter artificial tears are available at your local drug store. Doctors recommend artificial tears most often for dry eye. Throw your bottle of artificial tears in the refrigerator for an hour. Depending on the condition, “chilled” artificial tears sometimes reduce pain as much or better than prescription pain killing eye drops.
• Warm compress: The pain-relieving effects of warmth or heat is well known in health care. Ever have a back ache and lay up against a heating pad. It is amazing how fast the pain goes away. For many eye conditions, such as styes, warm compresses reduce pain quickly. Warm compresses are good for eye-related sinus pain also.
• Eye patch: Sometimes pain is alleviated when you immobilize the eyelid. Place an eye patch or tape the eyelid shut with medical tape. As in our example above, if you have a foreign body in your eye, reducing the ability to blink will minimize the scratches. Taping the eye shut for more than a few hours is frowned upon in some medical communities. Bacteria can flourish in dark, warm environments like an eye with a pressure patch. Do not leave it patched for more than a couple hours without seeing an eye doctor.
• Darkened room: Brighter lights can cause you to be very light sensitive in conditions such as a corneal abrasions or uveitis.

Once you get to the eye doctor’s office, your doctor may use an anesthetic topical eye drop called proparacaine or tetracaine to numb your eye. This works in seconds and can bring about pain resolution quickly. However, it does not last long. Although great for the short-term, these eye drops should never be prescribed directly for a patient. Repetitive instillation of topical anesthetics can cause “anesthetic abuse keratopathy.” Longer term use of these drops can cause your corneal to melt and possibly create permanent scarring and even blindness. Doctors can also prescribe NSAID or non-steroidal anti-inflammatory, eye drops that help to control eye pain. These work quite well, but they too, should not be prescribed for the long term. Although safer than an anesthetic eye drop, NSAIDs can also cause cornea problems if prescribed for the wrong co ndition or for a period that is too long.Other medication can also be prescribed to treat the underlying condition that causes the eye pain. As stated above, sometimes eye pain can originate from something very simple, while other times, it can be quite serious. If eye pain continues for more than a couple hours, you should see an eye doctor.

A Word From VeryWell

Eye pain can come from a variety of sources. It's a good idea to seek an eye doctor's advice if your eye pain persists. Even if after hours or on the weekend, do not be bashful about calling your doctor immediately. Your condition could be severe and require immediate treatment.

Sources: 

1. Kunimoto, Derek Y, Kunal D Kanitkar, Mary Makar, Mark Friedberg and Christopher Rapuano. The Wills Eye Manual, Office and Emergency Room Diagnosis and Treatment of Eye Disease, Fourth Edition. Lippincott Williams & Wilkins, 2004.

2. Tyler, Julie, Principles of Ocular Pain Control, , Julie Tyler, OD, Review of Optometry. January 2016.