What causes eyeball pain?

Pain in the eyeball and periorbital or retrobulbar area is one of the symptoms that characterizes an inflammatory process affecting a tissue or an entire organ: it can be mild, moderate, or severe (stabbing/invalidating pain) and can affect anyone, without distinction between men, women, children, or the elderly.

The pain may be referred directly to the eyeball or extend to the orbital region (the part of the face that surrounds the eyeball) and from there also involve the entire face or only part of it. "The pain can also be a retro-bulbar that is, felt by the patient inside the eye and not on the surface, as is the case with corneal abrasion and foreign body sensation in the eye," Dr. Capone explains.

All cases of eyeball pain, regardless of the intensity of pain felt by the patient, may present with the following symptoms and signs visible during the specialist examination with the ophthalmologist: 

• red eyes;
• swollen eyelids;
• itchy eyes;
• profuse tearing;
• persistent discomfort;
• sharp pain;
• sensation of sand or foreign body in the eye;
• blurred vision;
• headache;
• nausea;
• general malaise.

When to go to emergency room?

"Symptoms should never be underestimated," warns the ophthalmologist, "and in case of acute eye pain, it is necessary to go to the emergency room. It would be better to be able to go to an ophthalmic emergency room (specializing in eye care) to rule out pathological causes such as creating permanent and disabling damage to vision. 

In the case of an accident due to accidental contact with chemicals (e.g., household cleaning detergents and sprays, etc.), rinse the eye thoroughly with fresh water (so that any residue of the substance that caused the irritation can be removed quickly) and then go to the eye doctor or to an ophthalmic emergency room to perform a thorough evaluation."

"The causes of eyeball pain are multiple and can result from: 

• ophthalmic and non-ophthalmic conditions;
• trauma (blow/trauma to the eye or scratch caused by foreign bodies);
• exposure to irritants (chemical or physical) that, without appropriate personal protective equipment (PPE), such as sunglasses and professional eye protection masks, can damage the eyes and visual function even permanently". 

Ophthalmic pathologies

Ophthalmic conditions that cause eyeball pain are: 

• conjunctivitis, which are dysfunctions of the surface of the eye especially when they involve the cornea (keratoconjunctivitis);
• dry eye syndrome, a condition separate from conjunctivitis, which in its various degrees can manifest pain in the eyeball;
• corneal abrasion (scratching of infant to mother's eye while nursing, bumping with fingernails or objects, etc.);
• presence of foreign body in the eye (for example, a splinter);
• inflammation of the trigeminal nerve with tearing, itching and pain in the eyes, blurring and decreased vision accompanied or not by headache (migraine), neck pain, nausea and vomiting.

Acute attacks of glaucoma refer to ophthalmic diseases of non-traumatic origin.

Here is the ranking of the most frequent causes of eyeball pain based on statistics and doctor's experience: 

• Blepharitis
• Eye trauma (burns and corneal abrasion)
• Chalazion
• Corneal abrasion/ulceration
• Uveitis
• Dacryocystitis
• Acute attack of glaucoma
• Retrobulbar optic neuritis

Non-ophthalmic pathologies 

Non-ophthalmic conditions that may present with eyeball pain, however, are:

• sinusitis;
• headache and migraine;
• dengue (mosquito-borne disease);
• herpes simplex and ophthalmic herpes zoster.

In addition to examinations with the equipment, whether traditional or state-of-the-art, used in ophthalmology to assess visual function, the scale that measures eyeball pain is one of the diagnostic tools used by physicians during the first eye examination or emergency visit to the eye care emergency room. 

This is a self-assessment scale of eye discomfort that, through numbers from 1 to 10, allows the patient to describe to the physician the intensity of perceived eye pain: from minimal and tolerable pain, an annoyance rather than actual pain (value 1), to maximum and unbearable pain that can worsen the patient's quality of life and may be accompanied by nausea and vomiting and inability to carry out simple tasks (value 10).

Treatment depends on the cause of the eyeball pain. Dr. Capone explains:

"In all cases it is recommended: 

• not to rub the eyes;
• not to attempt to remove on your own what has entered the eye (grain of sand, eyelash, dust, splinter of wood/glass/metal/plastic, etc.). 

In case of corneal abrasion, the doctor might prescribe: 

• specific antibiotic-based eye drops;
• analgesics (to relieve pain);
• rest from vision for several days until healing (it may be necessary to keep the eyes closed with bandages or gauze for a limited period)."