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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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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