Pain may occur around the eye, in the eye, or behind the eye. Sharp eye pain that worsens with blinking or that is accompanied by a sensation of "something in the eye" is often caused by a corneal disorder, such as an abrasion, foreign body, ulcer, or infection. Severe, deep, aching pain in the eye may be caused by acute closed-angle glaucoma, especially if accompanied by significantly blurred vision, a red eye, and a "steamy" appearing cornea. A deep, boring pain in the eye can be a symptom of scleritis, a potentially serious inflammation of the thick fibrous coat of the eye, or uveitis, an inflammation of the inner structures of the eye. In some of these disorders, pain is worse with exposure to light (photophobia).
Sensitivity to bright light occurs normally during extremely sunny conditions or when coming out of a dark environment into bright sunlight. Such sensitivity can also be caused by drugs used to dilate the pupils (mydriatics). However, pain resulting from bright light (photophobia) can be a symptom of a migraine headache or a number of eye disorders, for example, those that involve inflammation or infection within the front part of the eye (uveitis), a corneal disorder (such as keratitis), or an eye injury. It may also be due to meningitis (which is also typically accompanied by a severe headache and neck stiffness—see Meningitis: Acute Bacterial Meningitis).
Doctors first try to differentiate light sensitivity from photophobia. The cause of light sensitivity or photophobia can usually be determined by the person's symptoms and an eye examination. A slit-lamp examination is particularly useful for detecting disorders that cause photophobia. Light sensitivity and photophobia can be minimized by protecting the eyes from light (for example, by wearing sunglasses). When photophobia is the result of inflammation within the eye, dilating eye drops can help to relieve pain.
Itching may result from allergy and is usually accompanied by watering of the eyes (tearing). Inflammation of the eyelids (blepharitis) and dry eyes may also cause itching. Much less commonly, itching may result from infection or infestation with lice or other parasites. Abnormalities that cause itching can usually be diagnosed by a slit-lamp examination. Until the cause of itching is relieved, applying a cool washcloth may provide some relief.
The sensation of dryness of the eyes can be caused by a variety of conditions, including inadequate tear production, accelerated tear evaporation, or, less commonly, refractive surgery, vitamin A deficiency, or Sjögren's syndrome. Dry eyes may also be a result of aging.
Tear production may be measured, particularly if Sjögren's syndrome is suspected. Doctors may also try to determine whether tears evaporate too quickly. They place a tiny amount of yellow dye (fluorescein) in an open eye and measure how long it takes for tears to evaporate. During the day, dry eyes can be relieved with the use of eye drops that substitute for a person's tears (artificial tears). At night, an ointment can be used before bed to relieve morning dryness.
Last full review/revision December 2006 by Kathryn Colby, MD, PhD