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Some Causes and Features of Eye Pain

Some Causes and Features of Eye Pain

Cause

Common Features*

Diagnostic Approach†

Disorders that affect the cornea primarily

Contact lens keratitis (inflammation of the cornea—the clear layer in front of the iris and pupil—caused by wearing contact lenses for long periods of time)

Usually affecting both eyes

Eye ache and a feeling of grittiness in the eye

Eye redness, tearing, and sensitivity to light

In people who wear contact lenses for long periods of time

A doctor's examination alone

Symptoms that begin after an eye injury or high-risk activity (for example, grinding metal), which may not be noticed in infants and young children

Pain in the affected eye when blinking and a foreign body sensation

Eye redness, tearing, and usually sensitivity to light

A doctor's examination alone

Often a grayish patch on the cornea that later becomes an open, painful sore

Eye ache and a foreign body sensation

Eye redness, tearing, and sensitivity to light

Sometimes in people who have had an eye injury or who have slept with their contact lenses in

A doctor's examination

Culture of a sample taken from the ulcer, done by an ophthalmologist

Usually in both eyes

Eye ache and a feeling of grittiness in the eye

Eye redness, tearing, and usually sensitivity to light

Often eyelid swelling and swollen, tender lymph nodes in front of the ears

Rarely temporary, severe blurring of vision

A doctor's examination alone

Usually affecting only one eye

Early: Symptoms that begin after an episode of conjunctivitis

Blisters on the eyelid, sometimes with crusting

Late or recurring: Eye redness and watering, eye pain, impaired vision, and sensitivity to light

Usually only a doctor's examination

Sometimes, testing for the virus in scrapings obtained from the surface of the cornea or from blisters around the eye

Usually affecting only one eye

Early: A rash with blisters and/or crusts on one side of the face, around the eye, on the forehead, and sometimes on the tip of the nose

Late: Eye redness, tearing, usually sensitivity to light, and eyelid swelling

Usually only a doctor's examination

Sometimes, testing for the virus in scrapings obtained from blisters around the eye

Welder’s (ultraviolet) keratitis (inflammation of the cornea caused by exposure to excessive ultraviolet light)

Usually affects both eyes

Symptoms that begin hours after exposure to excessive ultraviolet light (as is produced during arc welding, by a sunlamp, or by bright sun reflecting off snow, particularly at high altitudes)

Eye ache and a feeling of grittiness in the eye

Eye redness, tearing, and sensitivity to light

A doctor's examination alone

Other eye disorders

Severe eye ache and redness

Headache, nausea, vomiting, and pain with exposure to light

Disturbances in vision such as halos seen around lights and/or decreased vision

Tonometry (measurement of pressure inside the eye)‡

Examination of the eye's drainage channels with a special lens (gonioscopy), done by an ophthalmologist

Eye ache and sensitivity to light

Eye redness (particularly around the cornea)

Blurring or loss of vision

Often in people who have an autoimmune disorder or who recently had an eye injury

A doctor's examination alone

Affecting only one eye

Eye ache, intense eye redness, sensitivity to light, and severely decreased vision

Often in people who have had recent eye surgery, a serious eye injury, or bloodstream infection

A doctor's examination

Cultures of fluids inside of the eye, done by an ophthalmologist

Usually mild pain that may worsen when eyes are moved

Partial or complete loss of vision

Eyelids and corneas that appear normal

A doctor's examination

Often, MRI with contrast of the brain and orbit

Affecting only one eye

Bulging of the eye, eye redness, pain deep within the eye, and aches in and around the eye

Red and swollen eyelids

Inability to fully move the eye in all directions

Impaired vision or loss of vision

Fever

Sometimes preceded by symptoms of sinusitis (see below)

A doctor's examination

Usually, CT or MRIs of the orbit

Aches in and around the eye, which may be very severe

Often bulging of the eye

Often inability to fully move the eye in all directions

Swelling around the eye

A doctor's examination

Usually, CT or MRI of the orbit

Sometimes, biopsy

Very severe pain, often described as boring, and sensitivity to light

Watering of the eyes

Red or violet patches on the white of the eye

Often in people who have an autoimmune disorder

A doctor's examination

Sometimes, ultrasound or CT of the orbit

Rarely, biopsy

Other disorders that cause eye pain

In people who have had previous episodes of severe headaches

Cluster headaches: Headaches that

  • Occur in clusters

  • Occur at the same time each day

  • Cause severe, piercing, knife-like pain, a runny nose, and watery eyes

Migraines: Headaches that

  • May be preceded by temporary disturbances in sensation, balance, coordination, speech, or vision (such as seeing flashing lights or having blind spots), called the aura

  • Typically cause a pulsating or throbbing pain

  • Are accompanied by nausea, vomiting, and sensitivity to sounds, light, and odors

A doctor's examination

Sometimes, MRI or CT of the brain

Sometimes swelling around the eye but no other eye symptoms

A yellow or green thick nasal discharge (sometimes with bleeding), headache, or eye or facial pain that varies with head position

Fever, tenderness of the face, sometimes a productive cough during the night, and bad breath

A doctor's examination alone

Sometimes, CT of the sinuses

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. Disorders usually affect only one eye unless otherwise specified.

† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing. If an ophthalmologist's examination is specifically required, that is mentioned separately.

‡ Doctors almost always do a slit-lamp examination with fluorescein staining and measure the pressure inside the eye (called tonometry).

§ These causes are uncommon.

CT = computed tomography; MRI = magnetic resonance imaging.