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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One of the most frequent “emergency” visits in my office is due to a conjunctival hemorrhage. This is what it looks like:

Conjunctival Hemorrhage

Conjunctival Hemorrhage

Conjunctival Hemorrhage

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 to the eye.

Some possible associations are anti-coagulant therapy such as warfarin, Plavix or even aspirin. Vomiting and coughing can cause this too.     Why does it happen? The causal event is blood leaking out of a small blood vessel under the conjunctiva. You can think of it as a bruise.

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If you got a bruise anywhere in your body you probably would not pay much attention to it.    However, because the red blood is outlined by the white of the eye it is very noticeable.    Often it is not the patient but a friend or relative that first notices it. Another reason it is so dramatic is that the space between the conjunctiva and the white of the eye, the sclera, is so small that a tiny drop of blood is spread over a large area and appears larger than it truly is.    It usually takes about a week for this to resolve. While resolving it can actually spread and appear as if it it getting larger. It can look yellow as it is being resorbed.<!–adsensestart–>

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