OCULAR SYMPTOMS 

Eye Pain

Introduction: Eye Pain

Eye pain can originate from many different places within the eye, orbit (the boney eye socket), and around the orbit. Almost any eye problem that causes some discomfort can also cause eye pain, if the condition is bad enough. (For example, a dry eye problem usually causes a gritty eye sensation. But severe dry eye will cause eye pain.) This page discusses four conditions that are known to cause severe eye pain. Many of the conditions causing severe eye pain are associated with underlying medical conditions.

Other conditions capable of causing eye pain that are discussed on other pages of this Symptom and Diagnosis section are listed below with possible distinguishing features.

Conditions:

For eye anatomy explanations, go to ANATOMY

Acute Iritis

Iritis usually refers to a group of ocular inflammatory diseases affecting the iris, ciliary body, and choroid. This is the "uveal tract", and another term for iritis is "uveitis". In acute iritis, the structures near the front of the eye become inflammed. This inflammation is similar to arthritis, except that in arthritis a joint is inflammed. Inflammation affecting the iris and ciliary body usually lead to symptoms of eye pain, sensitivity to light, pain with focusing, blurred vision, eye redness, and sometimes floaters. These symptoms occur because the iris and ciliary body both contain muscles which act to control the pupil size and focusing. Anything causing these muscles to work will cause pain. One, or both eyes can be affected.

There are several symptoms of iritis which are fairly specific to it. One is "contralateral photosensitivity". This means that the eye with iritis will feel pain even if light is shined into the OTHER eye only. Furthermore, the eye redness in iritis is usually a "flush" of redness in a ring around the cornea.

The ophthalmologist can diagnose iritis because inflammatory cells can actually be seen floating around in the front part of the eye. Treatment is with ocular steroids, usually in the form of eyedrops. It is important to shake most steroid eyedrop bottles well, since the medication can often sink to the bottom of the bottle. It is also important not to stop these eyedrops suddenly without "tapering off" of the medication. A sudden stopage of the medication when there is still low-grade (but assymptomatic) iritis can result in a severe flare up of the disease. Thus follow-up visits are important. Oral steroids and other medications (such as dilating eyedrops) are sometimes used as well.

Iritis can be associated with several medical conditions. Cases of recurrent iritis, especially severe iritis, and iritis involving both eyes may indicate reason to search for an underlying medical condition. In women, sarcoidosis is commonly found, but may be of no significance. In men, arthritic conditions such as ankylosing spondylitis (a back arthritis) and Reiter's syndrome may be found. Some infectious diseases such as syphillis, herpes, and toxoplasmosis can cause iritis. Iritis can be associated with inflammatory bowel disease and with arthritis associated with psoriasis.

Corneal ulcer (infection)

Corneal ulcer (or infectious keratitis) can cause severe eye pain. A corneal infection occurs when bacteria are able to gain entry to the cornea through a scratch or breakdown in the corneal surface. With the use of extended wear disposable contact lenses, corneal ulcers have become more and more common. Symptoms include eye pain, redness, tearing, foreign body sensation, sensitivity to light, and blurred vision. In some contact lens users, the cornea may become somewhat insensitive to pain, and only symptoms of redness and irritation may appear.

A corneal ulcer is a serious, vision threatening problem. Some bacteria can be extremely aggressive, and the cornea can actually perforate (leading to endolphamitis, or infectious within the eye.) Treatment may include culturing of the corneal infection, and antibiotics eyedrops are used very frequently (sometimes every 1/2 hour.) The eye may need to be re-examined on a daily basis to insure that the treatment to being successful. Contact lenses should not be used during this time.

Acute glaucoma

Most people with glaucoma have "open-angle glaucoma". This type of glaucoma causes no symptoms except for a gradual loss of vision. Acute angle-closure glaucoma is a rare, but severe form of glaucoma. In this condition the eye pressure becomes extremely high rapidly. This can lead to symptoms of eye pain, redness, tearing, seeing rainbows around lights, blurred or lost vision (black-out), nausea, and vomiting. Treatment to break the attack of glaucoma includes eyedrops to lower the pressure, and often oral medication as well. In some cases, IV medication has to be used. A laser surgical procedure can often break the attack and prevent future attacks. For more information on glaucoma and acute angle-closure glaucoma, see the section on GLAUCOMA.

Scleritis

 

Scleritis is a fairly rare disorder involving inflammation of the wall of the eye (the sclera). It is often associated with serious medical problems, usually auto-immune or vascular problems (rheumatoid arthritis, polyarteritis nodosa, lupus). In scleritis, symptoms of severe, "boring" eye pain occur.

The white part of the eye may appear red, swollen, and there may be a nodule present which is painful to touch. Scleritis can be associated with iritis, and in some cases with swelling under the retina leading to visual loss. Treatment is usually with oral medication, and eyedrop medication as needed. Treatment of the underlying medical problem may be necessary.

Other Conditions causing eye pain found on other pages: