Eye Pain

Eye pain can range from a dull ache to sharp, stabbing pain. It may be felt in the eye itself, behind the eye, or in the surrounding area. Understanding the quality and location of eye pain helps identify the underlying cause.

Types of Eye Pain

Pain in the Eye (Ocular Pain)

• Surface irritation—burning, gritty, sandy
• Pressure or fullness
• Sharp, stabbing pain
• Throbbing ache

Pain Behind the Eye (Retrobulbar/Orbital Pain)

• Deep aching sensation
• Pressure behind the eye
• Pain with eye movement
• Radiating to forehead or temple

Pain Around the Eye (Periocular Pain)

• Brow ache
• Temple pain
• Cheek or facial pain
• Eyelid pain

Common Causes

Surface Eye Problems

Dry eye syndrome

• Burning, gritty, sandy sensation
• Worse with reading, computer use
• May water excessively
• See Eye strain and fatigue

Corneal abrasion

• Sharp pain, foreign body sensation
• Usually from injury or contact lens
• Light sensitivity
• Tearing

Corneal infection (keratitis)

• Pain, redness, light sensitivity
• Often contact lens related
• May have discharge
• Urgent evaluation needed

Foreign body

• Feeling something in the eye
• Worse with blinking
• May be visible or embedded

Inside the Eye

Acute angle-closure glaucoma

• Severe pain with nausea/vomiting
• Blurred vision, halos around lights
• Red eye, mid-dilated pupil
• Medical emergency

Uveitis (eye inflammation)

• Aching pain, light sensitivity
• Blurred vision
• Red eye
• May be associated with autoimmune conditions

Behind the Eye

Optic neuritis

• Pain with eye movement (characteristic)
• Vision loss, color desaturation
• May precede or accompany multiple sclerosis

Orbital inflammation

• Deep aching, swelling
• May have proptosis (eye bulging)
• Includes thyroid eye disease

Orbital cellulitis

• Pain, swelling, redness
• Fever
• Limited eye movement
• Medical emergency

Headache-Related

Migraine

• Pain behind or around eye
• Often one-sided
• Nausea, light sensitivity
• May have visual aura

Cluster headache

• Severe, stabbing pain around eye
• Tearing, nasal congestion on same side
• Occurs in clusters over weeks
• Extreme intensity

Tension headache

• Pressure around eyes and forehead
• Band-like sensation
• Usually bilateral

Referred Pain

• Sinus disease—pain over cheeks, forehead
• Dental problems—can refer to eye area
• TMJ dysfunction—jaw and facial pain
• Neck problems—can cause eye/head pain

When to Seek Emergency Care

What You'll Be Asked in Clinic

About the pain:

• Where exactly is the pain?
• What does it feel like (sharp, aching, burning, pressure)?
• When did it start?
• Is it constant or intermittent?
• Is it worse with eye movement?
• Any vision changes?
• Red eye, tearing, discharge?
• Light sensitivity?

About your history:

• Contact lens use?
• Recent eye injury or surgery?
• History of migraines or headaches?
• Autoimmune conditions?
• Sinus problems?

How Eye Pain Is Diagnosed

Eye Examination

• Visual acuity—checking vision
• Slit lamp exam—detailed view of front of eye
• Fluorescein staining—checking for corneal damage
• Intraocular pressure—checking for glaucoma
• Pupil examination—nerve function
• Dilated fundus exam—viewing back of eye
• Extraocular movements—checking pain with movement

Additional Tests

• MRI of orbits—if optic neuritis or orbital disease suspected
• CT scan—for orbital or sinus problems
• Blood tests—for inflammatory markers, autoimmune conditions

Treatment by Cause

Dry Eye

• Artificial tears
• Warm compresses
• Prescription drops (cyclosporine, lifitegrast)
• Environmental modifications

Corneal Abrasion

• Antibiotic drops (prevent infection)
• Pain management
• Usually heals in 24-48 hours

Optic Neuritis

• IV steroids may speed recovery
• MRI to evaluate for MS
• Neurology referral often indicated

Uveitis

• Steroid eye drops
• Dilating drops
• May need systemic treatment

Acute Angle-Closure Glaucoma

• Emergency pressure-lowering medications
• Laser iridotomy (creating drainage hole)
• May need surgery

Migraine/Headache

• Acute pain relief
• Preventive medications if frequent
• Lifestyle modifications

Self-Care for Minor Eye Pain

For mild discomfort without red flags:

• Artificial tears—for dryness/irritation
• Cool compress—for surface irritation
• Rest from screens—follow 20-20-20 rule
• Remove contact lenses—give eyes a break
• Avoid rubbing—can worsen irritation

Frequently Asked Questions

Is eye pain always serious?

No. Many causes of eye pain are minor (dry eye, strain, minor irritation). However, certain features—severe pain, vision loss, red eye—indicate potentially serious conditions requiring prompt evaluation.

Why does my eye hurt when I move it?

Pain with eye movement is concerning for optic neuritis—inflammation of the optic nerve. This needs evaluation, especially if accompanied by vision changes, as it can be associated with multiple sclerosis.

Can sinus problems cause eye pain?

Yes. The sinuses are located around the eyes, and sinusitis can cause pain and pressure around and behind the eyes. The pain often worsens when bending forward.

Is eye pain a sign of brain tumor?

Rarely. While brain tumors can occasionally cause eye symptoms, eye pain is an uncommon presentation. More typical symptoms would be headaches (often worse in morning), vision changes, or neurological symptoms.

When should I worry about eye pain?

Seek prompt evaluation for: severe pain, pain with vision changes, red eye with pain, pain after injury, pain with eye movement, pain with nausea/vomiting, or pain not improving with basic measures.

References