Eye Pain

Pain in or around the eye has many causes, from minor irritation to serious conditions requiring urgent care. Learn what different types of eye pain may indicate.

7 min read

Eye pain is a broad symptom. It can feel sandy, sharp, bruised, deep, pressure-like, or located behind the eye. The exact quality matters because corneal abrasion, migraine, optic neuritis, and acute angle-closure glaucoma can all be described simply as "eye pain."

Key Takeaways

The kind of pain matters-gritty surface pain is a different clue than deep pain behind the eye
Pain with eye movement raises concern for optic nerve inflammation
Severe one-sided pain with red eye, halos, nausea, or vision loss is an emergency
Contact lens wear plus pain deserves extra caution because corneal infection can move fast

Woman with eyes closed pressing her hand against her eye and temple area with a red glow indicating severe periorbital eye pain - illustrating the appearance of acute eye pain from conditions such as acute glaucoma, optic neuritis, or orbital inflammation — Severe Eye Pain - Periorbital and Orbital Pain Clinical Illustration

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

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

Go to the ER immediately if eye pain occurs with:

Acute angle-closure glaucoma signs - severe one-sided eye pain, a fixed mid-dilated oval pupil, cloudy cornea, halos around lights, and nausea/vomiting. This is a same-day emergency: untreated angle closure can cause permanent vision loss within hours. See acute angle-closure glaucoma and laser peripheral iridotomy.
Sudden severe pain with nausea or vomiting
Significant vision loss
Very red eye with cloudy cornea
History of eye surgery and new pain
Pain after trauma
Suspected chemical exposure
Fever with eye pain and swelling (orbital cellulitis)

Same-day ER for age over 50 with new headache or eye/temple pain PLUS any of the following - possible giant cell arteritis:

Jaw pain when chewing (jaw claudication)
Scalp tenderness (especially over the temples)
Brief loss of vision in one eye that comes and goes
New unexplained shoulder or hip stiffness

Untreated giant cell arteritis can cause irreversible blindness quickly, sometimes within 24-48 hours. Clinicians commonly check ESR/CRP and may start high-dose steroids before biopsy when GCA suspicion is high. See giant cell arteritis.

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 (tonometry)-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, a few basics are reasonable:

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. Dry eye, strain, and mild irritation are common. Severe pain, vision loss, a very red eye, contact lens-related pain, or nausea with halos should be evaluated promptly.

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

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