|
Surface pain is experienced as scratchiness or a foreign body sensation and is most often caused by disorders of the eyelids, conjunctivae, or cornea. Deeper pain, often described as aching or throbbing, may be serious and demands investigation. Causes of deep eye pain include glaucoma, uveitis, scleritis, endophthalmitis, orbital cellulitis, and orbital pseudotumor. Rarely, uncorrected refractive error and accommodative dysfunction cause dull pain. Migraine and sinusitis occasionally cause referred eye pain.
Pain associated with headache, nausea or vomiting, and halos suggests closed-angle glaucoma. Pain associated with photophobia and ciliary flush suggests uveitis. A boring pain that awakens a patient from sleep suggests scleritis. Pain with markedly reduced vision and a history of recent eye surgery suggests endophthalmitis.
A cloudy (eg, translucent) cornea with a pupil dilated to 5 to 6 mm and high intraocular pressure suggest closed-angle glaucoma. Findings of anterior chamber cell and flare on slit-lamp examination are diagnostic of uveitis. Scleral edema is suggestive of scleritis. Purulent discharge, WBCs in the anterior chamber (hypopyon), and vitreal inflammation with history of recent eye surgery suggest endophthalmitis. Pain, exophthalmos, and intraorbital inflammation on CT suggest orbital pseudotumor.
Patients should undergo tonometry and gonioscopy if appropriate. Slit-lamp examination can demonstrate anterior scleral edema (anterior scleritis), whereas B-mode ultrasound can demonstrate posterior scleral edema (posterior scleritis). CT is indicated to investigate suspected orbital pseudotumor. Aspiration and culture of vitreous fluid is used to diagnose endophthalmitis.
Treatment is management of underlying conditions, but mild analgesics (eg, NSAIDs, acetaminophen ) may be useful. When diagnostic testing excludes serious disorders, patients with refractive errors or accommodative dysfunction may respond to corrective lenses.
Last full review/revision November 2005
Content last modified November 2005
| 
