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ULY CLINIC

9 Septemba 2025, 05:40:26

Eye Pain (Ophthalmalgia)

Eye pain is a variable sensation around or in the eye, described as burning, throbbing, aching, stabbing, or foreign body sensation. Causes range from ocular surface injuries to systemic or neurologic disorders, and timely assessment is essential to prevent vision loss.

Pathophysiology

Eye pain results from stimulation of sensory nerve endings in the cornea, conjunctiva, sclera, orbit, or surrounding structures. Common mechanisms include trauma, infection, inflammation, increased intraocular pressure, neoplasms, or neurologic disorders.

Emergency Interventions

Chemical Burns: Remove contact lenses, irrigate eye with ≥1 L normal saline over 10 min; evert lids and remove particles.
Acute Angle-Closure Glaucoma: Immediate IOP-lowering medications; if ineffective, urgent laser iridotomy or surgical peripheral iridectomy is required.

Clinical assessment

History Taking

Onset, duration, and severity of pain
Pain character: ache, sharp, burning, foreign body sensation
Associated symptoms: photophobia, tearing, redness, discharge, headache, nausea
Recent trauma, surgery, or ocular procedures
Systemic symptoms (neurologic or vascular signs)

Physical Examination

External Eye Assessment:

Inspect eyelids: ptosis, incomplete closure, edema, erythema, hematomas, lesions
Examine lid margins: debris, scaling, unusual secretions, spasms
Retract lids: assess conjunctiva for redness, follicles, blisters, chemosis
Sclera: note color changes
Cornea: shine light to detect scars, abrasions, ulcers
Anterior chamber: assess depth, clarity
Iris: color, shape, texture
Pupils: size, equality, reaction to light

Avoid manipulation if trauma suspected. Test visual acuity and extraocular movements. Characterize any discharge.

Medical Causes

Table 1: Eye Pain – Key Causes, Clinical Features, and Distinguishing Signs

Cause	Pain Characteristics	Other Findings / Key Clinical Signs
Acute angle-closure glaucoma	Sudden, severe, excruciating	Blurred vision, halos, nausea, vomiting, fixed moderately dilated pupil, rapidly decreasing visual acuity
Blepharitis	Burning, both eyelids	Itching, sticky discharge, lid ulceration, eyelash loss, conjunctival injection
Burns (chemical/UV)	Sudden severe (chemical), delayed (UV)	Eyelid/facial erythema, blistering, photophobia, blurred vision, inability to open lids
Chalazion	Localized tenderness	Swelling upper/lower lid, conjunctival injection, small red lump
Conjunctivitis	Mild burning (allergic), pain if cornea involved (bacterial/fungal)	Discharge type varies (ropey, purulent, thick), conjunctival injection, photophobia if cornea involved
Corneal abrasion	Foreign body sensation	Tearing, photophobia, conjunctival injection
Corneal ulcer	Severe pain	Purulent discharge, sticky eyelids, photophobia, impaired visual acuity; bacterial: irregular gray-white ulcer; fungal: dense central cloudy ulcer
Dacryocystitis	Pain near tear sac	Tenderness, excessive tearing, purulent discharge, eyelid erythema and swelling
Episcleritis	Deep eye ache	Photophobia, tearing, conjunctival edema
Erythema multiforme major	Severe	Entropion, trichiasis, purulent conjunctivitis, photophobia, decreased tear formation
Foreign body	Sudden severe	Tearing, photophobia, miosis, foreign body sensation, dark corneal speck, conjunctival injection
Hordeolum (sty)	Localized, progressive	Eyelid erythema and edema
Iritis (acute)	Moderate-severe	Severe photophobia, blurred vision, small nonreactive pupil, dramatic conjunctival injection
Lacrimal gland tumor	Unilateral pain	Impaired visual acuity, exophthalmos
Migraine headache	Eye ache	Nausea, vomiting, blurred vision, photophobia, phonophobia
Ocular laceration / intraocular foreign body	Mild-severe	Unilateral, impaired visual acuity, eyelid edema, conjunctival injection, abnormal pupil response
Optic neuritis	Pain with eye movement	Tunnel vision, severe vision loss, sluggish direct light response
Scleritis / Sclerokeratitis	Severe, deep ache, burning	Conjunctival injection, bluish-purple sclera, photophobia, tearing
Subdural hematoma	Eye ache after trauma	Headache, neurologic deficits
Trachoma	Eye pain	Tearing, photophobia, discharge, eyelid edema, conjunctival follicles
Uveitis (anterior/posterior/lens-induced)	Sudden/severe	Conjunctival injection, photophobia, pupil changes, blurred vision, impaired acuity
Contact lenses / ocular surgery	Mild to severe ache	Foreign body sensation, varying duration

Special Considerations

Dark, quiet environment with eyes closed may help relieve pain.
Prepare patient for diagnostic studies: tonometry, orbital imaging, slit-lamp exam.

Patient Teaching

Adherence to drug therapy and eye protection is essential.
Immediate medical attention is warranted for severe or sudden eye pain.

Pediatric Pointers

Trauma and infection are leading causes.
Observe nonverbal cues (eye rubbing, squinting, refusal to open eyes).

Geriatric Pointers

Glaucoma is common after age 40; often bilateral with peripheral vision loss.

References

Eagle RC Jr. Eye Pathology: An Atlas and Text. Philadelphia: Lippincott Williams & Wilkins; 2011.
Gerstenblith AT, Rabinowitz MP. The Wills Eye Manual. Philadelphia: Lippincott Williams & Wilkins; 2012.
Huang JJ, Gaudio PA. Ocular Inflammatory Disease and Uveitis Manual: Diagnosis and Treatment. Philadelphia: Lippincott Williams & Wilkins; 2010.
Roy FH. Ocular Differential Diagnosis. Clayton, Panama: Jaypee–Highlights Medical Publishers; 2012.