Merck Manual

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Some Causes and Features of Eye Pain

Some Causes and Features of Eye Pain

Cause

Common Features*

Diagnosis†

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

Corneal scratch (abrasion)

Symptoms that begin after an eye injury, 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

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

Epidemic keratoconjunctivitis (Pink Eye—inflammation of the conjunctiva, the membrane that lines the eyelids and covers the front of the eye, and the cornea caused by an adenovirus)

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

Herpes simplex keratitis (infection of the cornea caused by the herpes simplex virus)

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

Herpes zoster ophthalmicus (shingles that affects the face and eye, caused by the varicella-zoster virus)

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

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

Anterior uveitis (inflammation of the anterior chamber—the fluid-filled space between the iris and cornea)

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

Endophthalmitis (infection inside the eye)§

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 or a serious eye injury

A doctor's examination

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

Optic neuritis (inflammation of the optic nerve), which can be related to multiple sclerosis§

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

Orbital cellulitis (infection of the tissue within the eye socket, or 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

CT or MRI

Orbital pseudotumor (a noncancerous accumulation of inflammatory and fibrous tissue in the eye socket)§

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

CT or MRI

Sometimes biopsy

Scleritis (inflammation of the white of the eye called the sclera)

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

Usually only a doctor's examination

Sometimes, ultrasound or CT

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 CT

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

Sometimes CT

* 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 or an examination by an ophthalmologist is always done, it is only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination, without any testing. In other words, additional tests may not be needed.

‡ 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.