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Light-intolerance of the eyes
Last reviewed: 04.07.2025

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In blinding light, we squint our eyes, and their pupils involuntarily narrow: this is how the reflex works, protecting the light-sensitive receptors of the retina from "photon overstimulation". But a painfully heightened reaction - photophobia - is caused by light of normal intensity, not exceeding either the average photosensitivity of the receptors of the visual analyzer, or the level of natural adaptation of the eyes to brightness.
Photophobia (or photophobia) in ICD-10 is classified as a subjective visual disorder with the code H53.1.
Causes of photophobia of the eyes
When considering the causes of photophobia of the eyes, specialists associate them with both ophthalmological diseases and many others. What diseases cause photophobia?
Almost half of all cases involving ophthalmology have photophobia and conjunctivitis – acute bacterial, viral or allergic inflammation of the mucous membrane of the eye – as one of its main causes. Severe photophobia with hyperemia, lacrimation and itching is typical of allergic conjunctivitis, which occurs with hay fever; photophobia and eye irritation are part of the clinical picture in epidemic hemorrhagic conjunctivitis.
When a foreign body gets into the eye and irritates the cornea, erosion of its superficial epithelium may occur, causing severe pain in the eye and photophobia. In case of eye injuries with damage to the iris, ciliary body or retina, as well as due to inflammation of the retina (retinitis), pain in the eyes is felt, as well as redness of the eyes and photophobia.
In acute infectious or chronic keratitis (inflammation of the cornea), allergic and bacterial keratoconjunctivitis, and in cases of eye damage by Herpes simplex virus with the development of ophthalmic herpes, patients complain of photophobia and lacrimation.
Photophobia is noted as one of the signs of eye disease:
- in cases of infectious uveitis (development of an inflammatory process in the uveal tract of the eye), with iridocyclitis (anterior uveitis) - inflammation of the iris and ciliary body of the choroid, and also if the choroid and retina of the eye become inflamed (and posterior uveitis or chorioretinitis is diagnosed);
- for eye dystrophy (macular dystrophy);
- when intraocular pressure rises sharply in glaucoma.
Lacrimation, “sand in the eyes” and photophobia are characteristic manifestations of red eye syndrome, and with xerophthalmia (dry eye syndrome) – photophobia and itching in the eyes.
Photophobia is caused by a deficiency of vitamin B2 (riboflavin) – ariboflavinosis develops, as well as vitamin B3 (niacin) – with the development of pellagra.
As a postoperative consequence of laser in situ keratomileusis (LASIK), patients experience photophobia for about 24 hours after laser vision correction.
Symptoms of photophobia occur - in the form of reflexive closing of the eyelids; increased lacrimation; redness of the eyes; burning, stinging or pain in the eyes, the appearance of headaches - with computer vision syndrome
Risk factors
All of the listed diseases and conditions are considered risk factors for the development of painful photosensitivity of the eyes, as identified in ophthalmology. Diseases that are not etiologically directly related to the eyes should also be taken into account (see below).
Pathogenesis
Despite the prevalence of this symptom, in many cases the pathogenesis of its development remains unclear.
As noted in the Journal of Neuro-Ophthalmology, attempts to identify disturbances in the process of photoreception (in the work of ion channels on the membranes of photosensitive cells) or to establish clear patterns in the reduction of the sensitivity limit of the retina in certain diseases have not clarified the mechanism of the painfully increased reaction to light of normal brightness.
Although among the ganglion cells (neurons) of the retina, which generate nerve impulses and transmit them to the brain through their axons, it was possible to discover particularly photosensitive ganglia (IPRGC), which directly react to light due to the presence of a pigment with increased photosensitivity (melanopsin) in them. The results of the experiments showed that the activity of these neurons, when stimulated by light, is easily transmitted to neurons of the trigeminal nerve, which causes dilation of the blood vessels of the eyes.
Today, understanding the pathogenetic features of disorders associated with photophobia comes down to recognizing the main role of sympathetic innervation of the cornea, which determines its extremely high sensitivity.
It is also recognized that the increased nervous excitability of the eye structures is additionally ensured by the absence of the myelin sheath on the orbital branches of the trigeminal nerve (optic, ciliary, supraorbital, superior lacrimal) extending into the cornea and on the axons of the retinal ganglion cells in places where they pass through it to the posterior pole of the eye, intertwining into the optic nerve.
By the way, the optic nerves, through which afferent impulses reach the visual zone of the cortex of the occipital lobes of the brain, like the olfactory nerves, differ from other cranial nerves in their increased sensitivity, since they consist of white brain matter.
It is not excluded that the pathogenesis of photophobia involves disturbances in the conduction of impulses either along the oculomotor nerve, or at the level of cholinergic synapses of preganglionic parasympathetic fibers, or even in the zone of receptive fields of bipolar neurons of the retina.
More information in the article – The visual analyzer pathway
It is impossible not to mention the reflex mechanism of increased lacrimation, which in most cases accompanies photophobia. By activating the production of tear fluid, the eyes are not only cleansed, but also protected from the development of infectious inflammation - thanks to the lysozyme (hydrolase antibacterial enzyme) and lactoferrin (globular glycoprotein that forms tissue immunity) contained in it.
Photophobia as a symptom of a disease not related to ophthalmology
Photophobia is noted as a symptom of the disease when infected with the deadly Rabies virus (rabies virus), when botulinum neurotoxin enters the body and botulism develops, and when tick-borne borreliosis (Lyme disease) occurs.
Hyperemia of the eyes, lacrimation, stinging in the eyes and photophobia are common with influenza: viral virions enter not only the mucous membrane of the nasopharynx, but also the conjunctiva of the eyes.
For the same reason, lacrimation and photophobia almost always appear with ARVI or a runny nose and photophobia with a cold, since there are also no “territorial” restrictions for the airborne spread of rhinoviruses.
Photophobia and fever may occur not only with respiratory infections, but also as a result of inflammation of the brain (encephalitis) or its membranes (meningitis). And photophobia and headache are among the symptoms of subarachnoid hemorrhage in TBI or rupture of a cerebral artery aneurysm.
Many disorders in the functioning of the autonomic nervous system (sympathetic and parasympathetic) can cause photophobia in VSD - neurocirculatory dystonia or somatoform autonomic dysfunction, as well as during headache attacks with migraine and tension cephalgia syndrome. During prolonged attacks, complaints of photophobia in the morning are noted; due to cerebrovascular disorders, most patients with these neurological pathologies combine headaches of varying intensity, pressing sensations in the eye sockets, nausea and photophobia.
Photophobia in neurosis is similar in etiology – a neurotic or somatoform disorder that develops for psychogenic reasons. That is, organic diseases are absent, and psychosomatic photophobia occurs – when hyperreaction to light is combined with general weakness and increased fatigue, dizziness, unstable blood pressure and episodically occurring cardiac arrhythmia, sweating, nausea, etc.
Photophobia and eye pain with lacrimation may be associated with thyrotoxicosis and diffuse toxic goiter. More information in the material – Endocrine ophthalmopathy
Neurologists note various combinations of photophobia symptoms with damage to the branches and ganglia of the trigeminal nerve - neuralgia of the nasociliary nerve or its ganglion (Charlin or Oppenheim syndrome), as well as pterygopalatine gangliolitis (Sluder syndrome).
Photophobia in a child
In addition to the usual acute conjunctivitis in children, in early childhood photophobia in a child is possible in the presence of hereditary pathologies: pigment xeroderma, ichthyosis, tyrosinemia type 2 (Richner-Hanhart syndrome), Chediak-Higashi syndrome. Read also - Conjunctivitis in newborns and Eye diseases in children
Fever, papular-vesicular rash on the skin and photophobia in chickenpox are the result of inflammation of the skin and mucous membranes when affected by the Varicella zoster herpes virus. Skin rashes, itching in the eyes, lacrimation and increased reaction of the eyes to light are also observed when infected with the Rubella virus with the development of measles rubella.
Rash, very high temperature and photophobia in measles, as well as other signs of this infectious disease are the result of infection with Measles morbillivirus (family Paramyxoviridae) and intoxication of the body during the replication of its RNA. More details in the publication - Eye damage in chickenpox, measles, rubella
And the development of epidemic enterovirus pemphigus (exanthema) in children – with severe headache and muscle pain, vomiting, fever, rash, inflammation of the conjunctiva and photophobia – is caused by the ECHO virus (Picornaviridae family).
Photophobia when taking medications
First of all, increased sensitivity to light may be accompanied by local application of ophthalmological drugs. For example, there may be irritation and hyperemia of the conjunctiva, burning and painful sensations, lacrimation and photophobia from Kornegel (used for burns, erosion and inflammation of the cornea), from the antiherpetic drops Idoxuridine and Trifluridine, as well as Vidarabine gel.
Swelling and redness of the eyelids, lacrimation, burning, eye pain and photophobia from Restasis – eye drops containing the immunosuppressant cyclosporine and used for dry keratoconjunctivitis with reduced tear production – develop in one case out of ten.
Tacrolimus (Advagraf, Prograf), which prevents transplant rejection, also has an immunosuppressive effect. Photophobia from Tacrolimus, along with more serious visual impairment, is on the list of its side effects.
Another immunosuppressant is the parenterally administered drug Humira (Adalimumab), used to treat rheumatoid and psoriatic arthritis. Humira's many side effects include allergic reactions, headaches, and photophobia.
Exceeding the dose of thyroxine analogues prescribed to patients with hypothyroidism, hypertrophy of the thyroid gland or after its removal may lead to the appearance of signs of thyrotoxicosis. Therefore, photophobia is possible with an overdose of Euthyrox (Levothyroxine, L-Thyroxine, Eferox).
It should also be borne in mind that photophobia can be provoked by an overdose of retinol (vitamin A).
Photophobia in combination with other side effects can be caused by such drugs as: local anesthetic Lidocaine; m-cholinergic receptor blockers (Atropine, Cyclomed, Ipratronium), antispasmodic Dicyclomine (Combispasm); Besalol tablets (due to the content of belladonna extract); vasodilator α-adrenergic receptor blocker Doxazosin (Cardura); quinolone antibiotic Norfloxacin; antitumor drugs-antimetabolites (Fluorouracil, Thymazine, etc.).
The tranquilizer Buspirone (Spitomin) can increase intraocular pressure, disrupt accommodation and cause photophobia. Side effects - redness of the eyes and photophobia - are noted after the use of iodine-containing radiocontrast agents.
Diagnosis of photophobia
Diagnostics of the symptom, as expected, is carried out within the framework of identifying the causes that cause it. Ophthalmologists necessarily check the visual acuity of patients, examine the eyes with a slit lamp.
Instrumental diagnostics are performed using ophthalmoscopy and tonometry. In more complex cases, differential diagnostics with a wider range of equipment (X-ray, electroretinography, EEG, ultrasound of the eye orbit and periorbital area, MRI of the brain), the appointment of tests (to identify the etiology of endocrine ophthalmopathy), examinations and consultations with specialized specialists come to the rescue.
Also read – Eye examination
Treatment of photophobia
If photophobia due to flu, acute respiratory viral infection or chickenpox passes quickly - largely due to the disinfecting properties of abundantly secreted tear fluid, then treatment of photophobia separately from the eye diseases that cause it is impossible.
The main drugs in ophthalmology are eye drops, but special drops for photophobia, that is, for one, albeit polymorphic symptom, have not yet been synthesized. Therefore, treatment is prescribed depending on the diagnosed disease.
For example, eye drops Diclofenac (0.1%) are used to treat eye inflammations (except herpesvirus) in adults.
3% eye drops Tobrex (Tobradex) and 0.3% drops Floxal (Ofloxacin, Uniflox) contain antibiotics (respectively - tobramycin and ofloxacin) are effective in inflammatory processes in the cornea, conjunctiva, retina, uveal tract. In cases of bacterial, viral or fungal lesions of the eye structures, doctors recommend drops Okomistin (with miramistin).
In case of allergic conjunctivitis or retinitis, Cromoghexal (2% drops) can be used. And Taurine drops are used as a restorative agent acting at the cellular level on damaged tissues in case of trauma and dystrophy of the cornea and retina, in case of corneal erosion and keratitis, eye lesions caused by herpes, etc.
See also - Eye drops for conjunctivitis
For any etiology of photophobia, the course of treatment should include vitamins A, C and group B.
Prevention
Recommendations for the prevention of eye diseases are not much different from generally accepted provisions on hygiene, proper nutrition, and work and rest schedules: if the work involves eye strain, this is especially relevant, as is the requirement to limit the use of computers and gadgets with small screens for children and adolescents.
It is also useful to wear glasses for photophobia, which can be high-quality sunglasses.