Pain in the eye

Clinical manifestations of pain in the eye are extremely diverse. Pain in the eye can have the nature of mild itching and discomfort, and can be severe, pulsating, accompanied by nausea, until vomiting occurs. In a small child, the presence of pain in the eye can be judged by a pronounced injection of the eyeball, a narrowing of the eye or severe photophobia. The pain receptors of the eye and periorbital tissues originate from the trigeminal nerve and the V pair of cranial nerves. Individual intraocular structures differ in the number of painful nerve endings per unit area. For example, the cornea is provided with a large number of nerve endings located subepithelially, while the conjunctiva is practically free of pain receptors. In this regard, the pain in the eye, arising in the various structures of the eyeball, can have significant differences in intensity.

[1], [2], [3], [4], [5], [6]

For what reason does the eye hurt?

In some diseases, pain in the eye, despite the sensation of its appearance in the eye, is in fact due to the appearance of other disorders, for example certain forms of migraine.

Cornea

Most often, the pain in the eye is associated with the pathology of the cornea, in particular with lesions localized in its subepithelial zone. So, trauma, infection, as well as metabolic and dystrophic processes can cause very severe pain.

Conjunctiva

Isolated conjunctival diseases rarely cause severe pain in the eye, although they may be accompanied by itching, burning sensation and discomfort. With severe pain accompanying the conjunctival disease, it is necessary to search for the concomitant pathology of the cornea, sclera or intraocular disorder.

Sclera

The inflammatory process in the episclera and sclera can be accompanied by a pronounced local injection of the vessels and pain.

Disorders of tear fluid production

Pain in the eye can occur due to a decrease in the production of tear fluid. But in children, such conditions are much less common than in adults. Reducing the formation of tear fluid in children, usually accompanies congenital syndromes (Riley-Day syndrome), is the result of inflammatory diseases of the orbit (pseudotumor) or a symptom of graft rejection reaction.

Obstruction of the nasolacrimal canal

Acute dacryocystitis occurring in children under 6 months of age is due to congenital obstruction of the nasolacrimal canal. Concomitant lacrimation can be combined with pain.

Glaucoma

In children, pain in the eye occurs both with congenital and with acquired glaucoma. Painful sensations in such cases are due to the secondary pathology of the cornea, especially its epithelium.

Iris

Many forms of irites are accompanied by photophobia and pain. However, in a number of cases irites are asymptomatic (eg, juvenile rheumatoid arthritis). For the posterior uveitis with the involvement of the vitreous body, vascular membrane and retina in the pathological process, the pain sensations are not characteristic.

The optic nerve

Isolated diseases of the optic nerve and retina, as a rule, are not accompanied by pain. Pain in the eye, observed with neuritis, is due to the involvement of the optic nerve shell in the inflammatory process. Neuritis in children is a rare phenomenon.

Eyelids

Acute inflammatory diseases of the eyelids can be accompanied by pain. Painful sensations are especially characteristic for aseptic and infectious cellulites.

central nervous system

The pathology of the orbit and the central nervous system can be manifested by pain in the eyeball. The primary pathological focus is often located in the cavernous sinus, brainstem, III or VI pair of cranial nerves.

Fictional pain in the eye

Although imaginary loss of vision occurs much more often, a fictitious pain in the eye is also a common complaint. However, the diagnosis is established only after excluding a possible pathology.

[7], [8]

Diagnosis of pain in the eye

The cause of pain can not be detected until a complete examination of the eyeball. Particular attention is paid to the cornea and the state of its epithelium, it may be necessary to stain the cornea with fluorescein or Bengal pink. In cases of a combination of pain with severe photophobia and blepharospasm, there is a need for a survey under anesthesia or sedatives. It is irreplaceable anesthesia and when examining a child with suspicion of glaucoma, when an important element of the examination is the measurement of intraocular pressure. Occasionally, for the evaluation of extraocular pathology or periorbital tissue diseases, it is advisable to perform neuroradiography.

[9], [10], [11], [12], [13], [14]

Treatment of pain in the eye

The tactics of treating pain in the eye depends on the cause of their occurrence.

• Erosion of the cornea: bandage.
• Glaucoma: normalization of intraocular pressure.
• Irit: dilated pupil and anti-inflammatory measures.