Index
Although eye pain is often accompanied by redness or swelling, pain can also occur in a calm eye.
Pain in one eye may be the first sign of a condition that threatens vision, a more benign ophthalmologic disease, or a non-ophthalmologic condition.
Acute narrow-angle glaucoma is an emerging condition that endangers vision that requires immediate treatment and referral to an ophthalmologist.
Although most non-ophthalmologic conditions that cause eye pain do not need immediate treatment, giant (temporal) cell arteritis requires urgent treatment with corticosteroids.
Other vascular conditions, such as carotid artery disease, cavernous sinus thrombosis, and transient ischemic attack or stroke, rarely cause eye pain but should be considered.
Pain can also be caused by paranasal sinuses or neurological conditions, such as trigeminal neuralgia, migraine and cluster headaches, and increased intracranial pressure.
The differential diagnosis of ocular pain is extensive and requires a systematic and complete approach.
Pain in an eye without redness or injection is uncommon, but it can be a severe condition. There are five anatomical areas to consider when determining the etiology: ocular, orbital, cranial, neurological, and vascular.
The first step is to determine if the pain comes from the eye and if it is caused by a condition that threatens vision.
Eye problems
Most people have eye problems at some time or another. Some are minor and will disappear on their own or are easy to treat at home. Others need specialist care.
Whether your vision is not what it used to be or was never so good, there are things you can do to restore the health of your eyes.
See if any of these common problems sound familiar. Moreover, always check with a doctor if your symptoms are terrible or do not go away in a few days.
Visual fatigue: anyone who reads for hours, works at a computer, or drives long distances knows about it. It happens when he abuses his eyes. They get tired and need to rest, like any other body part.
If your eyes feel tight, give them some free time. If you are still tired after a few days, check with your doctor to ensure it is not another problem.
Red eyes: your eyes are injected with blood. Why? Its surface is covered with blood vessels that expand when irritated or infected. That gives your eyes the red aspect.
The exhaustion of sight can cause it, as also a long night with lack of sleep or allergies. If the cause is an injury, have it checked by your doctor.
Red eyes could be a symptom of another eye condition, such as conjunctivitis (conjunctivitis) or damage caused by the sun by not wearing glasses over the years. Consult your doctor if the eye drops without a prescription, and the rest do not clear up.
Night blindness: is it difficult to see at night, especially while driving? Is it challenging to find the way in dark places, like cinemas?
That sounds like night blindness. It is a symptom; it is not a problem in itself. Myopia, cataracts, keratoconus, and lack of vitamin A cause a type of night blindness that doctors can correct.
Some people are born with this problem, or it can develop from a degenerative disease that involves the retina and that, in general, can not be treated. You should be very careful in low-light areas if you have it.
Vague eye or amblyopia: occurs when a watch does not develop properly. Vision is weaker in that eye and tends to move “lazily” while the other eye remains fixed. It is found in babies, children, and adults and rarely affects both eyes.
The treatment should be sought immediately for babies and children.
Lifelong vision problems can be avoided if a lazy eye is detected and treated during early childhood. Treatment includes corrective or contact lenses and using a patch or other strategies to make a child use the lazy eye.
Crossed eyes (strabismus) and nystagmus: You might have strabismus if your eyes are not aligned when you look at something. You can also hear it called crossed eyes or blue eyes.
This problem will not go away on its own. You will need an ophthalmologist or eye doctor to correct it.
With nystagmus, the eye moves or “bounces” all the time by itself. You have no control.
There are many treatments, including vision therapy, to strengthen your eyes. Surgery is also an option. Your doctor will examine your eyes to see what treatment might work best for you.
Color blindness: when you can not see specific colors or can not distinguish between them (usually red and green), you can be color blind. When the colored cells in your eye (the doctor will call them cone cells) are absent or do not work.
When it is more serious, it can only be seen in shades of gray, but this is rare. Most people who have it are born with it but can get it from certain drugs and diseases later in life.
Your doctor can tell you what is wrong. Men are much more likely to be born with it than women.
Your eye doctor can diagnose it with a simple test. There is no treatment if you are born with it, but special lenses and contacts can help some people differentiate between specific colors.
Uveitis: This is the name of a group of diseases that cause inflammation of the uvea. That is the eye’s middle layer, which contains most blood vessels.
These diseases can destroy the ocular tissue and even cause the loss of the eyes. People of all ages can have it. The symptoms may disappear quickly or last a long time.
People with immune system diseases such as AIDS, rheumatoid arthritis, or ulcerative colitis may be more likely to have uveitis. Symptoms may include:
- Blurry vision
- Eye pain
- Redness of eyes
- Sensitivity to light
Consult your doctor if you have these symptoms and they do not go away in a few days. There are different types of treatment for uveitis, depending on the type you have.
Presbyopia: this happens when you lose the ability, despite reasonable distance vision, to see the near objects and the fine print.
After age 40 or older, you may have to keep a book or other reading material away from your eyes for easy reading. Something like your arms is too short.
Reading glasses, contact lenses, laser eye surgery, and other procedures can be used to restore good reading vision.
Eye Conditions
Narrow-angle glaucoma: is one of the most common causes of acute pain in the eye. The annual incidence of narrow-angle glaucoma ranges from one to 30 per 1,000 people.
People with narrow-angle glaucoma classically present with headache or eye pain, changes in vision, and nausea and vomiting. Although the eye is usually inflamed, inflammation may be absent.
In people with a shallow anterior chamber, the sudden increase in intraocular pressure can be precipitated by anything that dilates the pupil, such as anticholinergics, adrenergic stimulation, or dimmed light.
Although classic narrow-angle glaucoma is easy to identify, variability in presentation and the possible absence or minimization of visual changes can make diagnosis difficult.
Patients often describe having a visual halo, and subtle conjunctival injections or corneal edema can be observed on examination. The affected pupil may be non-reactive and slightly dilated.
Referral to an ophthalmologist for definitive evaluation and treatment is guaranteed.
Corneal Diseases: The most common causes of eye pain are corneal infections, abrasions, and foreign bodies. These conditions are usually associated with redness and injection.
However, patients with foreign bodies or minor abrasions may initially have pain in the eyes and only a minimal injection. Keratitis (inflammation of the cornea) can produce intense pain due to the rich innervation of the cornea.
Viral infections (for example, herpes simplex virus), bacterial infections, exposure to ultraviolet light or chemicals, and inflammatory conditions can cause keratitis.
The treatment of corneal abrasions usually includes oral analgesics and topical antibiotics, although the corneal patch should be avoided. If keratitis is suspected, immediate referral to an ophthalmologist is recommended.
Primary intraocular tumors: (choroidal melanoma) and metastatic tumors rarely cause ocular pain. However, the orbital extension of cancer can affect the trigeminal nerve, which causes pain.
Intraocular tumors can also cause inflammatory reactions or increased intraorbital pressure, which can cause pain. The most common primary cancers that lead to intraocular metastases are breast, lung, and gastrointestinal cancers.
Optic neuropathy: typically presents as a decrease in visual acuity, particularly color vision, and pain in the eyes, especially with the movement of the eyes.
In patients younger than 40 years, demyelinating conditions such as multiple sclerosis are the most common causes of optic neuritis, and urgent referral to a neurologist and ophthalmologist is necessary.
Because older patients who present with possible optic neuritis are more likely to have giant cell arteritis (temporal), a globular sedimentation rate or a C-reactive protein level should be obtained.
If clinically suspected optic neuropathy, corticosteroid therapy, and immediate referral are recommended, pending the test results.
Dry eye: can cause pain in the eye, foreign body sensation, tearing, photophobia, and occasional redness.
The causes include the use of medications such as, for example, antidepressants and angiotensin-converting enzyme inhibitors; systemic diseases such as, for example, dry keratoconjunctivitis, Sjögren’s syndrome, rheumatoid arthritis; trauma and environmental factors such as air conditioning.
Orbital conditions: orbital inflammation, infection, and tumor invasion can cause pain in the eyes.
The findings suggest an orbital cause of ocular pain includes optic neuropathy, limitation or pain with visual movement, diplopia, proptosis, enophthalmos, amaurosis evoked by the gaze, or facial pain and paresthesia.
Orbital vascular lesions may produce intermittent symptoms with movements such as coughing, straining, or flexion. If an orbital lesion is suspected, images with ultrasound, computerized tomography, or magnetic resonance imaging are recommended, and referral to an ophthalmologist is recommended.
Cranial conditions: cavernous sinus thrombosis is caused by the spread of infection. It can cause eye pain by irritation of the third cranial nerve, other oculomotor nerves, or occasionally the ophthalmic branch of the trigeminal nerve.
Cavernous sinus thrombosis should be suspected with a rapid onset of unilateral periorbital swelling, photophobia, chemosis, proptosis, headache, or cranial nerve palsy. The condition usually spreads to the contralateral eye within 48 hours.
Tolosa-Hunt syndrome is an idiopathic granulomatous and inflammatory condition of the cavernous sinus that causes pain in the eyes and face. The key to diagnosis is resolution within 72 hours of starting corticosteroid therapy.
Paranasal sinusitis can also cause pain in the silent eye. The pain of the frontal sinus disease classically extends diffusely on the forehead, the maxillary sinus pain extends to the cheek and the lower orbit, and the ethmoidal pain and sphenoid sinusitis extend to the orbits orbits orbits apex of the skull.
Sphenoid sinusitis should be referred to an otolaryngologist or neurosurgeon because it may be associated with severe neurological conditions.
Neurological Conditions
Cluster headaches are more common in young men and produce severe unilateral eye pain. Typically, the pain lasts 15 to 45 minutes but may persist for three hours.
The pain is debilitating and is usually located in the eye or directly behind it. The headaches tend to come in groups with multiple attacks throughout the day.
Migraine headaches are rarely associated with isolated eye pain, although migraine pain can radiate to the eye. Patients with migraine may have other ocular symptoms, such as scotomas, photophobia, blurred vision, loss of vision, ptosis, lacrimation, and diplopia.
Eye migraines and migraines with pain around the eye should be treated as typical migraines.
Trigeminal neuralgia: typically produces episodic, severe, and unilateral facial pain accompanied by numbness and sensory loss. Because the ophthalmic division of the trigeminal nerve provides sensation to the eye, the condition can also cause pain in the eyes. The pain tends to repeat itself and gets worse over time.
High Intracranial Pressure: Any condition that causes high intracranial pressure, such as cerebral aneurysm, brain tumors, other lesions, venous sinus thrombosis, and pseudotumor cerebri, can also cause eye pain and headache.
The Valsalva maneuver can often aggravate eye pain caused by elevated intracranial pressure.
Vascular conditions: Rarely, ocular pain is the initial symptom of subdural, epidural, subarachnoid, or intracerebral hemorrhage and is caused by pain receptors within the arteries innervated by the ophthalmic branch the trigeminal nerve.
Among patients with stroke in the internal or middle cerebral artery distribution, 25 percent have pain in the orbit or frontal region ipsilateral to infarction.
Any carotid artery disease (e.g., inflammation, emboli, thrombosis, dissection) can lead to monocular symptoms and signal an impending stroke. However, isolated eye pain would not be the only symptom.
Horner’s syndrome on the side of the arterial injury can also occur.
Giant cell arteritis typically manifests as sensibility over the temple in patients older than 50 and is often accompanied by mandibular claudication and diplopia.
Patients may also have eye pain, visual loss, or blurred vision due to orbital ischemia. A high rate of erythrocyte sedimentation (more than 50 mm per hour) or C-reactive protein level increases the likelihood of giant cell arteritis.
