Pain in the eye

The clinical manifestations of eye pain are extremely varied. Eye pain may be mild itching and discomfort, or severe, pulsating, accompanied by nausea, and even vomiting. In a small child, the presence of eye pain can be judged by a pronounced injection of the eyeball, squinting of the eye, or pronounced photophobia. The pain receptors of the eye and periorbital tissues originate from the trigeminal nerve and the 5th pair of cranial nerves. Individual intraocular structures differ in the number of pain nerve endings per unit area. For example, the cornea is supplied with a large number of nerve endings located subepithelially, while the conjunctiva is practically free of pain receptors. In this regard, eye pain arising in various structures of the eyeball can have significant differences in intensity.

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What causes eye pain?

In some diseases, eye pain, although it may feel like it is occurring in the eye, is actually due to other disorders, such as certain forms of migraine.

Cornea

Most often, eye pain is associated with corneal pathology, in particular with damage localized in its subepithelial zone. Thus, trauma, infection, as well as metabolic and dystrophic processes can cause very severe pain.

Conjunctiva

Isolated conjunctival diseases rarely cause severe eye pain, although they may be accompanied by itching, burning, and discomfort. When severe pain accompanies a conjunctival disease, it is necessary to look for concomitant pathology of the cornea, sclera, or intraocular disorder.

Sclera

The inflammatory process in the episclera and sclera can be accompanied by severe local vascular injection and pain.

Disorders of tear production

Eye pain may occur due to decreased tear production. However, such conditions are much less common in children than in adults. Decreased tear production in children usually accompanies congenital syndromes (Riley-Day syndrome), is the result of inflammatory diseases of the orbit (pseudotumor), or is a symptom of transplant rejection.

Obstruction of the nasolacrimal duct

Acute dacryocystitis, which occurs in children under 6 months of age, is caused by congenital obstruction of the nasolacrimal canal. Accompanying lacrimation may be combined with pain.

Glaucoma

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

Iris

Many forms of iritis are accompanied by photophobia and pain. However, in some cases, iritis is characterized by an asymptomatic course (for example, juvenile rheumatoid arthritis). For posterior uveitis with involvement of the vitreous body, choroid and retina in the pathological process, pain is not typical.

Optic nerve

Isolated diseases of the optic nerve and retina are usually not accompanied by pain. Pain in the eye observed with neuritis is caused by the involvement of the optic nerve sheath in the inflammatory process. Neuritis in children is a rare occurrence.

Eyelids

Acute inflammatory diseases of the eyelids may be accompanied by pain. Painful sensations are especially characteristic of aseptic and infectious cellulitis.

Central nervous system

Pathology of the orbit and central nervous system can manifest itself as pain in the eyeball. The primary pathological focus is often located in the cavernous sinus, brainstem, III or VI pair of cranial nerves.

Imaginary eye pain

Although imaginary vision loss is much more common, imaginary eye pain is also a common complaint. However, the diagnosis is made only after possible pathology is excluded.

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Diagnosis of eye pain

The cause of pain cannot be identified until a full examination of the eyeball. Particular attention is paid to the cornea and the condition of its epithelium; staining the cornea with fluorescein or rose bengal may be required. In cases of pain combined with severe photophobia and blepharospasm, it is necessary to conduct an examination under anesthesia or sedatives. Anesthesia is also indispensable when examining a child with suspected glaucoma, when an important element of the examination is measuring intraocular pressure. Rarely, neuroradiography is advisable to assess extraocular pathology or diseases of the periorbital tissues.

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Treatment of eye pain

The tactics of treating eye pain depend on the cause of its occurrence.

• Corneal erosions: dressing.
• Glaucoma: normalization of intraocular pressure.
• Iritis: pupil dilation and anti-inflammatory measures.