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.
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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:
The patient recently had an upper respiratory infection (URI), a cold. If so then most likely the same virus has caused the conjunctivitis.
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).
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.
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:
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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.
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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.
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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.
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Dry eye is a very common cause of contact lens problems and contact lens intolerance. It causes wearers to feel as if there is something in their eyes, a foreign body sensation in their eyes, as if there is grit or dirt in the eye, and eye pain when wearing soft contact lenses.
Mild dry eye conditions can often be alleviated by contact lens moisturizing drops, but it is important to pick the right one. If moderate or severe dry eye syndrome exists then wearing soft contact lenses will be impossible without treatment of dry eye.
Even patients with very dry eyes can be helped with new treatments. A complete cure for dry eye with very comfortable contact lens is possible.
Some patients come in with contact lens irritation, unable to wear contact lenses. They have been to several other eye doctors Ophthalmologists or Optometrists. I treat them step by step starting with changing the contact lens solution (see here), inserting punctal plugs, and if needed prescription eye drops which can cure the underlying dry eye syndrome. I am as patient as the patients are. If they stick with my treatment program a vast majority of them become happy contact lens wearers. I help patients who have been told they cannot wear contact lenses anymore.
The cure for dry eye is also the road to successful LASIK refractive eye surgery.
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Many patients present to my office complaining of eye redness, eye irritation, and a foreign body sensation (feeling of grit or sand in the eye) when wearing their soft contact lenses. They feel this way even when they try on a brand new pair of contact lenses so they do not feel this is a problem with their contact lenses.
Often they’re right. The problem is not their contact lenses, it is their Contact Lens Solution! They are no longer able to tolerate a solution that they may have been using for months or even years. Even the solution that a fresh pair of lenses is stored in can be irritating.
Commercially available contact lens solutions provide excellent disinfection and lubrication for most people. But in order to do their job these contact lens solutions contain a lot of chemicals which can, over time, cause eye irritation, redness and foreign body sensation. This can occur at any point in time, either as soon as a patient starts using the solution or after a period of time. They come to my office with “Contact Lens Intolerance Syndrome(CLIS).”
I often advise patients with CLIS to use chemical free contact lens care. By switching to a hydrogen peroxide (H2O2) based disinfecting solution and employing a preservative free saline rinse just prior to inserting the lenses into the eye it is possible to BOTH sterilize the contact lenses and avoid all chemicals getting into the eye. Often this simple change in the contact lens care system solves the problem. Get instructions here.
If you feel you are not as comfortable as you should be with your contact lenses, seek professional eye care help with an EYEMD, an Ophthalmologist. I practice Ophthalmology in Manhattan, New York City. Noah Klein MD’s office telephone is 212-696-9013. Bring your contact lenses and contact lens solution along with any eye drops you use with you to the first visit.
If you are already using a chemical free system and still are not comfortable with your contact lenses, you may have a dry eye syndrome or a problem with the fit of the contact lenses. These can be treated very effectively with various strategies to alleviate or even cure dry eye conditions and changing the brand of contacts.
Of course, these issues apply only to mild low grade eye irritation. Acute pain, redness, light sensitivity and/or loss of vision could indicate a serious eye infection which requires emergency eye care with immediate attention from an Ophthalmologist.
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