Light Sensitivity (Photophobia)

Photophobia, or light sensitivity, is discomfort or pain caused by light exposure. While some sensitivity to bright light is normal, excessive photophobia can significantly impact daily activities and may indicate underlying eye or neurological conditions.

What Photophobia Feels Like

People with photophobia may experience:

• Squinting or closing eyes in normal lighting
• Discomfort in sunlight or bright artificial light
• Pain or headache triggered by light
• Need for sunglasses indoors
• Difficulty with computer screens or phones
• Preference for dim environments
• Tearing when exposed to light
• Brow ache from constant squinting

Common Causes

Eye Surface Problems

Dry eye syndrome

• Surface irritation increases light sensitivity
• Burning, gritty sensation
• Fluctuating vision
• Common with screen use, contact lenses

Corneal abrasion/injury

• Damaged surface very sensitive to light
• Sharp pain, tearing
• Usually from trauma or contact lens

Corneal infection

• Significant photophobia
• Pain, redness, discharge
• Contact lens wearers at risk

Eye Inflammation

Uveitis (iritis)

• Inflammation inside the eye
• Significant photophobia
• Aching pain, blurred vision
• Red eye, especially around cornea
• May be associated with autoimmune diseases

Neurological Causes

Migraine

• Photophobia during and between attacks
• Often the most bothersome symptom
• May be accompanied by phonophobia (sound sensitivity)
• Visual aura in some
• May have associated headache

Meningitis

• Severe photophobia
• Headache, stiff neck, fever
• Medical emergency

Subarachnoid hemorrhage

• Sudden severe headache ("worst ever")
• Photophobia, neck stiffness
• Medical emergency

Blepharospasm

• Involuntary eyelid closure
• Light often triggers spasms
• See benign essential blepharospasm

Other Causes

Light-colored eyes

• Less pigment = more light sensitivity
• Baseline sensitivity, not pathological

Pupil dilation

• After eye exam or from medications
• Allows more light in

Certain medications

• Tetracyclines, sulfonamides
• Some antihistamines
• Various others

Albinism

• Lack of pigment in eyes
• Lifelong light sensitivity

Post-concussion syndrome

• Photophobia common after head injury
• May persist for weeks to months
• Often associated with double vision and blurred vision

When to Seek Care

How Photophobia Is Diagnosed

Eye Examination

• Visual acuity testing
• Slit lamp examination—detailed view of eye surface and front structures
• Pupil examination—checking for abnormalities
• Intraocular pressure—checking for glaucoma
• Dilated fundus exam—viewing back of eye

If Neurological Cause Suspected

• Neurological examination
• MRI brain—if concerning features
• Visual field testing—if visual pathway involvement suspected
• Lumbar puncture—if meningitis suspected

Treatment Options

Treatment depends on the underlying cause:

For Dry Eye

• Artificial tears
• Warm compresses
• Prescription anti-inflammatory drops
• Environmental modifications

For Uveitis

• Steroid eye drops
• Dilating drops (reduce pain)
• May need systemic treatment
• Treat underlying cause if identified

For Migraine

• Acute migraine medications
• Preventive medications if frequent
• FL-41 tinted lenses (may help some patients)
• Managing triggers

General Measures

Protective eyewear

• Sunglasses outdoors (wrap-around style helpful)
• FL-41 or rose-tinted lenses
• Transition lenses
• Avoid very dark sunglasses indoors (can worsen adaptation)

Environmental modifications

• Adjust screen brightness
• Use warm/dim lighting
• Position to avoid glare
• Use shades or blinds

Gradual light exposure

• Avoid constantly staying in darkness
• Gradual exposure helps maintain adaptation
• Too much avoidance can worsen sensitivity

Frequently Asked Questions

Is photophobia a sign of something serious?

It can be. While many causes are benign (dry eye, migraine), photophobia with fever, severe headache, or neck stiffness could indicate serious conditions like meningitis. New or severe photophobia deserves evaluation.

Why do migraines cause light sensitivity?

The exact mechanism isn't fully understood, but involves both peripheral (eye) and central (brain) pathways. Light can activate pain pathways during migraine and worsen headache. Many migraineurs have some baseline light sensitivity between attacks.

Do dark sunglasses help?

Outdoors in bright light, yes. However, wearing very dark sunglasses indoors or constantly can actually worsen photophobia by preventing your eyes from adapting to normal light levels. Moderate tinting (like FL-41 lenses) may be more helpful.

Can photophobia be permanent?

It depends on the cause. Photophobia from dry eye or migraine is typically manageable. Sensitivity from albinism or certain eye conditions may be lifelong but can be managed with protective measures.

What are FL-41 lenses?

FL-41 is a specific rose/amber tint that filters certain wavelengths of light shown to trigger photophobia and migraine. Studies suggest they may help some people, particularly those with migraine or blepharospasm.

References