Etiology

Eye pain can have a variety of causes, broadly categorized based on whether the pain originates on the surface of the eye or within the eye (orbital/intraocular).


1. Surface Eye Pain (Ocular)

Often described as sharp, burning, or gritty, typically due to irritation or inflammation:

  • Dry eyes – inadequate tear production or poor tear film quality.

  • Foreign body – dust, eyelash, or other debris on the cornea/conjunctiva.

  • Corneal abrasion – scratch on the corneal surface, often from trauma or contact lenses.

  • Conjunctivitis – viral, bacterial, or allergic inflammation of the conjunctiva.

  • Blepharitis – inflammation of the eyelid margins.

  • Contact lens complications – overwear, poor hygiene, or lens-related abrasions.

  • Chemical exposure – acid or alkali burns (ocular emergency).


2. Deep Eye Pain (Orbital/Intraocular)

More often described as aching, throbbing, or pressure-like, and can be more serious:

  • Uveitis (iritis) – inflammation of the uveal tract; associated with photophobia, blurred vision.

  • Scleritis – severe, deep inflammation of the sclera; often associated with autoimmune diseases.

  • Glaucoma (acute angle-closure) – sudden increase in intraocular pressure; presents with severe pain, headache, nausea, blurred vision, and halos.

  • Optic neuritis – pain worsens with eye movement; often linked to multiple sclerosis.

  • Orbital cellulitis – infection involving tissues behind the orbital septum; associated with swelling, fever, and decreased eye movement.

  • Sinusitis – especially ethmoid or frontal sinus infections; can refer pain to the eye area.

  • Trauma – blunt or penetrating injuries can cause globe rupture, hyphema, or retrobulbar hemorrhage.


3. Referred Pain

Sometimes, pain is referred to the eye from adjacent structures:

  • Migraine or cluster headaches – can cause retro-orbital pain.

  • Trigeminal neuralgia – sharp, electric-like pain, occasionally affecting the eye area.

  • Temporomandibular joint (TMJ) dysfunction – can refer pain around the orbit.


Red Flags (Urgent Evaluation Needed)

  • Sudden severe pain with vision loss

  • Pain with nausea/vomiting (suggesting acute glaucoma)

  • Pain with eye movement + vision loss (suggesting optic neuritis)

  • Eye pain with systemic symptoms like fever or proptosis (suggesting orbital cellulitis)


 

Eye Pain

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