Eye Pain and Light Sensitivity

Ocular Symptoms and Conditions: Eye Pain and Light Sensitivity

Ocular pain can originate from many different places: from the eye itself, from the orbit (the bony eye socket), from around the orbit, and even referred from remote areas of the head and neck. 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 Discussed on this Page:

• Acute Iritis
• Corneal Ulcer (infection)
• Acute Glaucoma
• Scleritis
• Endophthalmitis
• Other conditions causing eye pain or light sensitivity found on other pages

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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 inflamed. This inflammation is similar to arthritis, except that in arthritis a joint is inflamed. 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 in the aqueous humor, which the clear fluid in the front part of the eye. Treatment is with ocular steroids, usually in the form of eye drops. It is important to shake most steroid eyedrop bottles well, since the medication can often settle and become concentrated in the bottom of the bottle. It is also important not to stop these eye drops suddenly without "tapering off" of the medication. A sudden stoppage of the medication when there is still low-grade (but asymptomatic) 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 eye drops) are sometimes used as well for treatment of iritis.

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. Sarcoidosis is a commonly found cause of iritis in adults, more frequently in women. Arthritic conditions such as ankylosing spondylitis (a back arthritis) and Reactive Arthritis may be found. These tend to be more common in men than women. Some infectious diseases such as syphilis, herpes, and toxoplasmosis can cause iritis. Iritis can be associated with inflammatory bowel disease and with arthritis associated with psoriasis.

Corneal Ulcer (infection)

A corneal ulcer (or ulcerative keratitis) can cause severe eye pain. A corneal infection occurs when bacteria or fungus 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 endophthalmitis, or infection within the eye.) Treatment may include culturing of the corneal infection, and antibiotic eye drops 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 is 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 eye drops 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.

Endophthalmitis

Endophthalmitis is a serious infection within the eye usually involving the anterior and posterior segments of the eye.  The infection is usually bacterial, but cases of fungal and parasitic infections can occur.  Most cases occur postoperatively after any type of intraocular surgery including cataract and glaucoma surgery.  Penetrating trauma and intraocular foreign bodies also carry a high risk of intraocular infection.  Endogenous endophthalmitis occurs when bacteria present within the blood break into the eye and start and infection.  This can occur with contaminated central lines and dialysis shunts, for example.  Rarely, endophthalmitis can result from a perforating cornea ulcer where the infection then spreads into the eye.

Symptoms of endophthalmitis include progressively increasing severe eye pain and profoundly decreasing of vision over a short period of time (hours or days).  The pain can be incapacitating and usually results in emergency management at any time of the day or night.  The eye is usually severely red and the lids may be swollen.  In surgical causes of endophthalmitis, the infection usually begins between a few days and 1 week after surgery.  Traumatic endophthalmitis may have a more rapid onset.  There are cases of more slowly progressing, chronic endophthalmitis that may not cause pain or severe loss of vision.

Management of acute endophthalmitis requires a rapid diagnosis and appropriate treatment or referral.  Most cases of endophthalmitis are managed by vitreoretinal specialists who will take a sample of fluid from the eye for culture and inject antibiotics or antifungal agents into the eye on an emergent basis.  In cases of light perception vision only, vitrectomy is recommended in addition to culture and antibiotic injection.  Cases of endophthalmitis can lead to a complete loss of vision and even the eye if not treated rapidly.  However, it is possible to retain good vision if treatment is timely and successful.

Other Conditions causing eye pain or light sensitivity found on other pages:

A link to each condition is listed along with other hallmark features of the condition.

• Cellulitis (infection) of eyelid skin - eyelid swelling, tenderness.
• Cellulitis (infection) of the orbit - eye pain, protrusion, double vision, redness.
• Corneal problems such as dry eye, corneal abrasion, corneal foreign body, and retained foreign body under the eyelid.
• Dacryocystitis - infection of the tear drainage system leading to pain and tearing.
• Ectropion (out-turning) of eyelid - scratchy sensation, pain, tearing.
• Entropion (in-turning) of eyelid - scratchy sensation, pain, tearing and discharge.
• Headache may be interpreted as eye pain.
• Optic neuritis - may lead to pain with eye movement.
• Thyroid related eye disease - scratchy sensation, double or blurred vision, protruding eyes.
• Trichiasis (in-turning of eyelashes) - scratchy sensation, pain, tearing.