When a patient complains of eye pain asking the right questions often helps determine the cause of the pain. This makes the diagnosis and treatment easier. It is helpful to distinguish between eye pain caused by external factors such as a foreign body on the surface of the eye and internal pain caused by elevated intraocular pressure or internal ocular inflammation.

External Causes of Eye Pain

Material such as dust particles, metal fragments, cat hairs, and eyelashes feel like there is a particle in the eye. These are easy to find and remove. They can cause a scratchy feeling in the eye. Sometimes a foreign body is lodged under the inside surface of the upper lid and can only be removed by everting the upper lid. If the foreign body is embedded in the cornea it can cause a corneal abrasion.  A corneal abrasion feels like there is something in the eye. Dry eye can also cause external irritation and dry eye patients often complain of burning and feeling something in their eyes. Dry eye, superficial corneal or conjunctival foreign bodies rarely cause blurred vision or photophobia (light sensitivity). External irritation associated with photophobia and/or blurred vision suggest a more serious condition such as a corneal ulcer. A sty can also cause a foreign body sensation.

Internal Causes of Eye Pain

Episcleritis is an inflammation of the outer layer of the sclera, the white of the eye. This often presents with localized redness and tenderness to touch. Uveitis, an inflammation of the inner eye is associated with eye pain. The pain is usually felt inside the eye and does not feel like there is something in the eye. Inflammation of the front portion of the inner eye is called iritis and causes photophobia. Optic neuritis, an inflammation of the optic nerve, is associated with pain on eye movement.

Other Causes of Eye Pain

Migraine, sinus disease, and glaucoma can also cause eye pain. Even eye strain from wearing the wrong eyeglass or contact lens prescription can cause eye pain. Pain following eye surgery can be a sign of infection and requires immediate attention. Pain following trauma to the eye can also indicate a serious condition.

causes light sensitvity

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Eye pain, redness, light sensitivity and decreased vision can be caused by a corneal infection called an ulcer. A corneal ulcer is a collection of white blood cells in the cornea which is sometimes visible as a white dot in the cornea. You can get more information here. If you suspect that you have a corneal ulcer then do not delay getting an Ophthalmological evaluation. Prompt diagnoses and rapid treatment are key to successful treatment and raise the odds of preserving vision. This is an Ophthalmological emergency.

Modern antibiotic drops can treat bacterial corneal ulcers successfully if the diagnoses is made early and the drops started promptly. Corneal infections caused by a fungus or an organism such as an amoeba can be devastating and may require a corneal transplant.

REMEMBER

• Avoid sleeping in contact lenses,
• always wash hands prior to handling contact lenses,
• wash and replace contact lens cases, and sterilize the lenses in a good sterilizing solution.
• Replace the lenses on schedule.
• Do not try to “stretch” the wearing interval beyond the lens specifications.

The risk of getting a corneal ulcer is not worth it.

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WHAT IS GLAUCOMA?

Glaucoma is a disease of the optic nerve often associated with increased intraocular pressure (IOP).

Elevated IOP alone is not enough to make the diagnoses of glaucoma. Some patients may have glaucoma when their IOP is within normal limits. This is called Normal Tension Glaucoma (NTG). Conversely many patients have IOP elevation and never develop glaucoma. This is called Ocular Hypertension (OHT).

If you are confused by this, don’t worry, you are not alone. Most patients and many physicians have difficulty understanding glaucoma. We are used to concentrating on numbers. Hypertension is defined as blood pressure above 140/90. Diabetes is followed by measuring the blood sugar and the hemoglobin A1C (HgbA1C). So it is natural for the IOP measurement to be the focus of glaucoma diagnoses and treatment.

But glaucoma is different from hypertension and diabetes.  Aside from intraocular pressure measurements the function and structure of the optic nerve must be evaluated when evaluating glaucoma. Calling IOP measurements a “glaucoma test” and the use of IOP measurements in “glaucoma screenings” is inadequate and misleading.

The best way to evaluate a patient for glaucoma is:

1. - Obtain a complete medical history including a review of systems and family history concentrating on a family history of glaucoma and a history of migraine.
2. - Visual acuity, slit lamp exam, IOP measurement and careful examination of the optic disc are the minimum examination techniques required in glaucoma evaluation.

If the medical history is negative and the physical eye exam normal then this is an adequate “glaucoma screening.” IOP measurement alone is not good enough.

If the medical history is positive or the eye exam suspicious then further testing is necessary, such as ultrasonic pachymetry – measurement of corneal thickness, computerized visual field testing and photographic imaging of the optic disc. The optic disc is the portion of the optic nerve that is visible when looking at the ocular fundus, the inside of the eye.

I have only touched on the surface of glaucoma evaluation. More information is available here, here, here and here.

Noah Klein, MD

Noah Klein, MD, PC

August 13, 2009

January 3, 2010

This is another good link about glaucoma:

http://www.travatanz.com/High-Eye-Pressure.aspx

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Dr. Noah Klein

Noah Klein, MD, PC

August 4, 2009

Red eyes with itching, tearing, clear discharge and a foreign body sensation (feeling of something in the eye) can be caused by a virus. This is called viral conjunctivitis or “pink eye” and can be quite uncomfortable.It may be difficult to differentiate between a viral conjunctivitis and an allergic conjunctivitis. Here are some tips.

Viral conjunctivitis is likely if:

1. The patient recently had an upper respiratory infection (URI), a cold. If so then most likely the same virus has caused the conjunctivitis.
2. There is a tender pre-auricular lymph node on the same side as the conjunctivitis.  If yes then a virus is the likely cause. This lymph node is just in front of the tragus of the ear. The tragus is the bump before the external auditory canal (the ear opening).
3. The pink eye started in one eye and then went to the other eye, but in a milder form. This is characteristic of viral conjunctivitis.
4. The patient had contact at work or home with someone who has a pink eye. If so then the viral infection which is very contagious has spread from that other person.

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Allergic conjunctivitis is likely if:

<!–noadsense–>

• The patient has a history of allergy and it is now allergy season.
• Symptoms are relieved by anti-histamine drops or pills.
• Aside from itching and red eye none of the above criteria exist.

<!–noadsense–>

Treatment

Unfortunately, aside from relieving symptoms, there is no treatment for viral conjunctivitis. It should resolve in 7-10 days just like the common cold. Antibiotic drops do not cure a viral conjunctivitis and nothing but good hygiene can prevent it from spreading to others. Lubricating eye drops and cool compresses help the symptoms.

<!–noadsense–>

Most of the time the condition resolves with no permanent effects. Rarely, a few weeks after the infection is gone the patient experiences photophobia (light sensitivity), foreign body sensation and possible blurred vision. Corneal infiltrates cause this and the patient must be evaluated by an ophthalmologist right away. These may require treatment.

• Conjunctival Hemorrhage - Blood in the Eye One of the most frequent "emergency" visits in my office is due to a conjunctival hemorrhage. This is what it looks like: /caption] Although this looks dramatic and scary it is quite harmless most of the time especially if not accompanied by any discomfort and without a history of trauma......
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