Causes of Eye Pain and Treatment Options

Eye pain is a common symptom, and there are many potential causes, ranging from serious ones, like acute angle-closure glaucoma and optic neuritis, to less serious ones, like conjunctivitis, styes, or dry eye. Certain characteristics, such as the quality of your pain (burning, sharp, aching, etc.) or associated symptoms (sensitivity to light, headache, etc.) can help your doctor narrow down the differential rapidly and efficiently.

Your primary care doctor may be able to treat your eye pain on his own, often by recommending or prescribing an eye drop and/or a self-care strategy. At other times, your provider will refer you (usually that same day) to an ophthalmologist for a more detailed examination.

Your eye, which sits in a bony socket called the orbit, is a complex organ consisting of several unique structures such as the the sclera (the white part), iris (the colored part of your eye), pupil (black spot in the middle), and cornea (the clear outer layer of the eye).

Diseases that affect any eye structure or structure connected to your eye (for example, the optic nerve) may lead to pain.

Eye pain can be distracting and debilitating. The upside is that most of the common causes can be cured or managed well. Below are some of the more common eye pain diagnoses, which are generally considered not to be serious:

Stye

A stye, or a hordeolum, is a red, tender bump resembling a pimple located on the outside or inside of the eyelid. Often developing over a few days, styes generally result from an inflamed or infected eyelid oil gland. In addition to pain, a stye may cause tearing and eyelid swelling.

Corneal Abrasion

A corneal abrasion is a scratch on the surface of the cornea, which is the clear, dome-like structure on the front part of the eye. Corneal abrasions may occur on their own or as a result of an injury or trauma (e.g., from a torn contact lens or the presence of a foreign body).

The eye pain from a corneal abrasion can be quite severe, making it virtually impossible to read, drive, go to work, or even sleep. Besides pain, people often report a sensitivity to light.

Dry Eye Syndrome

The cornea of your eye is filled with nerves that give the eye and brain feedback. So when the surface of the eye dries out—due to decreased tear production and/or increased tear evaporation—eye irritation, often described as a gritty, burning, or sharp sensation, can develop. In addition to eye discomfort, a person with dry eye syndrome may notice red eyes and a sensitivity to light.

Conjunctivitis (Pink Eye)

Conjunctivitis is an irritation or inflammation of the conjunctiva—a thin membrane that lines the outside of your eyeball and the inside of your eyelid. Allergies or an infection with a virus or bacteria are the most common culprits.

Besides burning pain or soreness in the eye, conjunctivitis is often associated with a watery discharge (viral or allergic conjunctivitis) or a sticky, pus-filled discharge (bacterial conjunctivitis). Allergic conjunctivitis also causes itchy eyes and puffy eyelids.

Sinus Headache

A sinus headache results from inflammation or infection within one or more of your sinuses, which are cavities located behind your nose, between your eyes, and within your cheekbones and lower forehead. Besides pain or pressure felt behind the eyeballs, a person may experience a fever, nasal discharge, ear discomfort, and/or tooth pain.

These eye pain diagnoses occur less commonly; however, some of them require urgent or emergent ophthalmologic evaluation and treatment.

Acute Angle-Closure Glaucoma

Most cases of glaucoma create no symptoms at all. However, with acute angle-closure glaucoma, the iris suddenly blocks the drainage angle—the area where the cornea and iris meet to allow fluid to drain out of the eye. If the drainage angle is blocked, pressure builds up rapidly within the eye, causing sudden and intense eye pain and swelling.

In addition to pain, people with this condition often complain of eye redness and often see halos and rainbows around lights due to swelling. This condition is very serious and requires emergent treatment to prevent loss of vision.

Keratitis

Keratitis, also known as a corneal ulcer, refers to swelling of your cornea. In addition to eye pain, redness and blurry vision may occur. While infections (e.g., bacterial, viral, fungal, or parasitic) may cause keratitis, it may also develop from a fingernail scratch or from wearing contact lenses too long. If not treated right away, blindness may result.

Scleritis

Scleritis simply translates to inflammation of the sclera. Often associated with an underlying autoimmune disease, the pain of scleritis is severe, boring, and felt deep within the eye. In addition to pain, swelling and redness of the sclera is also common. Blurry vision (and possibly a partial or complete loss of vision), tearing, and an extreme sensitivity to light may occur.

Hyphema

Often occurring from an eye injury, a hyphema is when blood collects between the cornea and the iris at the front of the eye. The blood will cover all or part of the iris and pupil. Besides eye pain and bleeding in the eye, blurry vision and light sensitivity may also be present.

It's important to not confuse a hyphema with a subconjunctival hemorrhage—a benign condition that results from a broken blood vessel. With a subconjunctival hemorrhage, blood will appear in the white of the eye (sclera) but will not be painful.

Optic Neuritis

Optic neuritis refers to swelling of the optic nerve, a cable-like structure that connects the eye to the brain. Although optic neuritis can occur from several causes, it is most commonly linked to multiple sclerosis. Besides pain upon moving the eye, blurry vision, loss of color vision (dyschromatopsia), and a "blind spot" (scotoma) may occur.

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.

Anterior Uveitis

Anterior uveitis is an inflammation of the anterior chamber—a fluid-filled compartment at the front part of the eye. The inflammation occurs as a result of an infection, autoimmune disease, or eye injury. Anterior uveitis causes an aching, eye pain, along with intense light sensitivity and blurry vision.

Orbital Cellulitis

Orbital cellulitis is a serious infection of the muscles and fat that surround the eye. This condition causes pain with eyeball movement, along with eyelid swelling and drooping and sometimes, a fever.

Orbital cellulitis is more common in children and often develops from a bacterial sinus infection. Prompt treatment is required to prevent vision loss and spread of the infection to the brain.

Cluster Headache

A cluster headache is a rare, extremely painful headache disorder that is more common in men. The sharp, burning, or piercing pain of a cluster headache usually occurs around or above one eye and/or in the temple area. In addition to severe pain, a person experiences one or more autonomic symptoms, such as eyelid swelling or drooping and redness or tearing of the eye.

As described above, sometimes eye pain can originate from something very simple, while other times, it can be quite serious. This is why it's important to see your doctor if your eye pain continues for more than a couple of hours.

The diagnosis of eye conditions requires a medical history and eye examination. For more serious diagnoses, imaging and blood tests may be required.

A medical history is the first step in evaluating your eye pain. Although not exhaustive, here is a list of potential questions your doctor may ask you:

• Are you experiencing any vision loss? (If yes, you will need an urgent ophthalmology referral.)
• Have you experienced any trauma to your eye? (If yes, you will need an urgent ophthalmology referral.)
• Are you experiencing associated symptoms like a headache, sensitivity to light, fever, or nasal or eye discharge?
• Do you wear contact lenses? If so, your doctor may inquire about your wearing schedule, overnight wear habits, and hygiene regimen.
• Do you feel like there is a foreign body in your eye?
• Do you have any other health conditions?

In addition to a medical history, your doctor will perform an eye exam. There are many different tests involved in this; depending on your doctor's suspicion, he may perform one or all of them. Some examples of eye tests include:

• Visual acuity test
• Fluorescein staining (for corneal abrasion)
• Tonometry eye pressure test (for glaucoma)
• Retinal exam (for uveitis and optic neuritis)
• Slit lamp examination (for uveitis and scleritis)

Imaging tests are indicated to confirm a few eye pain diagnoses. For example, a computed tomography (CT) scan is done for suspected orbital cellulitis, while a magnetic resonance imaging (MRI) is done for suspected optic neuritis.

Certain imaging tests may also be ordered to determine if an underlying whole-body illness is being considered, especially with a new diagnosis of anterior uveitis or scleritis.

Blood tests are not often used for the diagnosis of eye pain unless an underlying systemic illness is suspected. However, blood cultures and a complete blood count (CBC) will be ordered when evaluating orbital cellulitis.

Treatment of eye pain centers around what exactly is causing the eye pain. In some cases, it can be remedied in a short office visit with your primary care physician. In other cases, you may need to see an ophthalmologist.

Sometimes you can’t get to the doctor’s office right away. Trying the following self-care strategies can help soothe your pain until your appointment. These same remedies may also be recommended by your doctor once serious eye conditions are ruled out.

For a Sty

Applying a warm, wet compress to the affected eye for 10 minutes, three to four times a day can ease your discomfort and coax the stye into draining on its own. Be sure to not squeeze or pop the stye, though, as this can spread the infection.

For Dry Eyes

You may consider one or more of these strategies:

• Try not to blink a lot, especially when performing visually-concentrated tasks like reading or using the computer.
• Place a humidifier in your bedroom or home office.
• Minimize exposure to air conditioning or heating.
• Consider glasses that have protective shields on the sides to protect your eyes from dry air and wind.

For a Foreign Body

You may consider placing an eye patch or taping the eyelid shut with medical tape until you see your doctor. By reducing the ability to blink, you will minimize the likelihood of more scratches occurring. Be sure, though, not to tape the eye shut for more than a few hours, as bacteria can flourish in dark, warm environments.

For Viral or Allergic Conjunctivitis

Place a cool, wet compress on your eye to ease the discomfort

Your doctor may prescribe different types of medications to both alleviate your pain and treat the underlying problem, if present.

Non-steroidal anti-inflammatory (NSAID) eye drops may be prescribed to soothe your eye pain. While these work quite well, they should not be prescribed for the long term due to a potential for cornea problems.

Allergy eye drops, available both over-the-counter and by prescription, can relieve the redness, itchiness, and puffiness of allergic conjunctivitis.

While not a cure, artificial tears are used to manage dry eyes. Artificial tears come in different formulations (e.g., liquid, gel, ointment) and are available over the counter. When "chilled" or placed in the refrigerator for an hour, they can often be extra-soothing.

For people with severe or persistent dry eyes, an ophthalmologist may consider prescribing medication, like topical cyclosporine or lifitegrast.

Antibiotic eye drops are usually prescribed to treat bacterial conjunctivitis and bacterial keratitis.

Glaucoma eye drops—of which there are several kinds—work to lower the pressure in your eye. For acute angle-closure glaucoma, eye drops along with an oral or intravenous medication (called acetazolamide) will be given to reduce the pressure immediately.

Oral antibiotics may be used to treat a few different eye pain diagnoses, such as:

• A stye that does not resolve on its own or becomes infected
• A bacterial sinus infection

Intravenous antibiotics, which are antibiotics given through your vein, are indicated for the treatment of orbital cellulitis.

Steroid eye drops (or pills) are used to treat more serious eye pain diagnoses, like anterior uveitis.

High-dose corticosteroids, administered orally or intravenously, are indicated to treat optic neuritis.

Sometimes surgery is required to treat your eye pain diagnosis. For instance, in the case of acute angle-closure glaucoma, once the initial eye pressure is reduced, laser therapy or less commonly, surgery, is needed to drain the fluid from the eye. For severe keratitis, if the cornea is majorly scarred or thinned, a corneal transplant may be needed.

While not all eye pain diagnoses can be prevented, some can. Here are a few examples of eye preventive care strategies:

To prevent styes and conjunctivitis, it's important to wash your hands often, especially before applying eye makeup or putting in contact lenses. It's also a good idea to remove your eye makeup every night using a fresh, clean towel.

Never share eye drops with anyone or touch the tip of a dropper to your eye, as this can transfer bacteria.

To prevent corneal abrasions, it's important to wear protective eyewear if you are engaging in an activity that risks eye injury (e.g., cutting wood or metal). Be sure to also clean your contact lenses well and not use them for longer periods of time than advised.

Getting to the bottom of your eye pain may be a straightforward process, or it may be more complicated, especially if a serious diagnosis is suspected. With that, be sure to seek a doctor's advice if you are experiencing eye pain (even if it's after hours or on the weekend). Your condition could be severe and require immediate treatment.