Pain in the eye
Pain in the eye occurs with burns, traumatic injuries, inflammatory diseases, allergic reactions, increased intraocular pressure (IOP). Painful sensations in the eyes can accompany neurological pathology: neuritis, neuralgia, migraine. To determine the cause of eye pain, biomicroscopy, non-contact tonometry, ophthalmoscopy, ultrasound, and orbit radiography are performed. Analgesics are used to eliminate the pain syndrome. Etiotropic treatment depends on the underlying pathology.
Causes of eye pain
Eye burn
Eye injuries
Conjunctivitis
Keratitis
Uveit
Ophthalmohypertension
Neurological disorders
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of eye pain
Eye burn
A burn, regardless of the type (chemical, thermal), leads to a sharp pain, the intensity of which increases with time. The patient cannot open his eyes on his own. Concomitant manifestations are photophobia, increased lacrimation, swelling of the eyelids and conjunctival chemosis. With a severe degree of burn, hyperemia is replaced by paling of the eye tissues.
Eye injuries
Eye injury entails acute pain. The patient is unable to open his eyelids without the help of a doctor. The surrounding tissues are edematous, hyperemic. The symptoms are extremely pronounced in violation of the integrity of the cornea. The following types of traumatic eye injuries are most common:
Foreign bodies. They can be located on the ocular surface or have intraocular localization. In the practice of an ophthalmologist, foreign bodies of the conjunctiva, eyelids and cornea are more common. The location of foreign particles under the upper eyelid injures the cornea when blinking, causing pain.
Erosion of the cornea. The appearance of erosive defects is often caused by microtraumatization when applying makeup, hitting with a branch. Symptoms are especially noticeable after waking up and are represented by soreness, hyperemia, lacrimation, blurred vision and photophobia.
Conjunctivitis
Redness and soreness of the eye are common signs of conjunctival inflammation, regardless of etiology. Therefore, it is very important to pay attention to the specific symptoms of individual forms. Differential diagnosis should first of all be carried out among such types of conjunctivitis:
Bacterial. Pain syndrome of moderate intensity, most pronounced in the morning. Purulent discharge may appear, which have a yellow color and a viscous consistency. Patients note “gluing of eyelashes” and the inability to open their eyes after sleep.
Allergic. Inflammation of the conjunctiva is accompanied by itching, pain, lacrimation. Discomfort increases upon contact with the allergen. Large follicles of the “cobblestone pavement” type are often formed in the conjunctival arch.
Adenoviral. This conjunctivitis is characterized by increasing chemosis, hyperemia and pain. The course of the disease is prolonged (3 or more weeks). Often, the pathological process spreads to the cornea.
Keratitis
The leading symptom of keratitis is severe pain, which is combined with conjunctival hyperemia, edema of surrounding tissues and photophobia. Common causes of corneal inflammation: contact with infectious patients, non-compliance with personal hygiene rules. The main forms of keratitis:
Herpetic. Accompanied by acute pain, blepharospasm, photophobia. Conjunctiva and soft tissues of the eyelids are edematous and hyperemic. Pathognomonic signs are tree–like defects on the surface of the cornea and a decrease in its sensitivity.
Bacterial. The disease is characterized by an acute onset. The clinical picture includes pain, pericorneal or mixed injection of conjunctival vessels, photophobia. Mucopurulent discharge is characteristic of keratoconjunctivitis.
Adenoviral. Patients note a decrease in visual acuity, pain and swelling of surrounding tissues. Corneal lesion is represented by “coin-shaped” subepithelial opacities that persist for a long time (from 2-3 months to 1-1.5 years).
Uveit
Uveitis is an inflammation of the vascular membrane (uveal tract). Depending on the localization of the pathological process, anterior (iridocyclitis) and posterior uveitis are distinguished. Symptoms are pain, decreased visual acuity, redness of the eye. It is possible to develop anisocoria, lacrimation, photophobia. With iridocyclitis, patients often note blurred vision.
Ophthalmohypertension
An increase in intraocular pressure above 30 mmHg can lead to pain in the eye, which radiates to the head. Due to diurnal fluctuations in IOP, the pain is most pronounced in the morning. Concomitant manifestation is congestive conjunctival injection. When looking at the light source, rainbow circles appear. A similar clinic is observed in angle-closure glaucoma.
Neurological disorders
Pain syndrome is a frequent sign of pathology of the central nervous system. In most cases, pain in the eye is associated with intracranial hypertension, in which patients’ vision deteriorates, diplopia, photophobia and a veil in front of the eyes may appear. At the same time, a decrease in intracranial pressure leads to positional pain, photophobia and double vision. Also , pain in the eye occurs with the following pathologies:
Trigeminal neuralgia. Short-term attacks of intense pain syndrome or prolonged burning pain on the affected side are typical. The soreness is clearly limited to the innervation zone. The clinic increases with irritation of trigger points.
Supraorbital neuralgia. The affected area is limited to the supraorbital region, the brow arch and the lower part of the forehead. The pain is paroxysmal or permanent. Lacrimation is determined only on the side of neuralgia.
Neuritis of the optic nerve. Patients complain of pain, which increases with eye movements. The clinical picture is represented by deterioration or blurring of vision. The anterior part of the eyeball is unchanged.
Ophthalmoplegic migraine. This is one of the forms of associative migraine characterized by transient paresis of one or more oculomotor nerves. The pain in the eye extends to the corresponding half of the head and is combined with diplopia, ptosis, anisocoria.
Diagnostics
Severe pain in the eye leads to blepharospasm, which makes ophthalmological examination difficult. Instillations of analgesics are recommended to alleviate the patient’s condition, after which they begin to diagnose. It is important to assess the condition of the eyelids, the shape of the eye slit and the position of the eyes. Then specific studies are performed:
Visometry. Visual acuity is determined at the beginning of the examination of the patient. In the absence of objective vision, it is necessary to study the light projection. Visometry is performed with and without correction for distance.
Non-contact tonometry. Penetrating wounds of the eye are often accompanied by hypotension. With iridocyclitis, intraocular pressure increases. It is important to compare IOP in both eyes, as well as measure the central thickness of the cornea.
Biomicroscopy of the eye. First, a detailed examination of the anterior segment of the eyeball is performed with a mandatory inversion of the upper eyelid. Next, fluorescein staining and inspection with a cobalt filter are performed, which allows you to visualize small erosive defects.
Ophthalmoscopy. Examination of the fundus is carried out after cycloplegia, if intraocular pressure is compensated. An ophthalmologist evaluates the transparency of optical media and the condition of the retina down to the jagged line.
Ultrasound of the eyes. Ultrasound examination is used in the presence of difficulties in visualizing the structures of the eyeball due to myosis, corneal edema, hyphema or hemophthalmos. The advantage of this method is the ability to detect X-ray negative foreign bodies.
Radiography. It is carried out with severe injuries in order to exclude damage to the bone walls of the eye socket. A special Komberg-Baltin prosthesis makes it possible to determine the localization of intraocular X-ray contrast foreign bodies.
Eye examination by an ophthalmologist
Eye examination by an ophthalmologist
Treatment
Help before diagnosis
In case of a burn or injury, an ambulance must be called immediately. Before the arrival of the doctor in case of a burn, it is necessary to thoroughly rinse the eyes with running water at room temperature. This will minimize the effect of the active substance. For washing at home, it is strictly forbidden to use acids or alkalis for the purpose of neutralization.
In case of injury, it is necessary to ensure functional rest, eliminate visual load and eye movements. To do this, it is recommended to apply a binocular bandage. Self-removal of a foreign body can lead to the expansion of the wound canal and additional traumatization. In inflammatory diseases, it is important to follow the rules of personal hygiene and avoid uncontrolled use of antibacterial agents.
Conservative therapy
Therapeutic tactics depend on the etiology of eye pain. The appointment of etiotropic and pathogenetic agents is justified. One should not give preference to physiotherapeutic and folk remedies for the purpose of relieving pain syndrome. Conservative treatment may include:
Analgesics. Analgesic drops are used at the diagnostic stage, as well as before performing subconjunctival injections. With severe pain syndrome, oral analgesics are indicated, because local remedies inhibit the regeneration process.
Antibiotics. With the bacterial nature of the pathology, instillations of antibacterial agents are shown based on the result of an analysis for antibiotic sensitivity. Empirically, broad-spectrum drugs are used. The average course of treatment is 7-10 days.
Antiseptics. They are prescribed in the presence of small foreign bodies located under the eyelids or in the conjunctival arches, if there are no signs of inflammation or deep damage to the tissues of the eye. Frequent instillations (every 2-3 hours) are justified in viral conjunctivitis.
Reparants. These drugs contribute to the regeneration of the cornea. Stimulators of tissue repair are indicated for erosions, post-traumatic defects, postoperative wounds. The duration of application varies from 10 days to 1 month.
Antihistamines. With allergic conjunctivitis, pathogenetic therapy is reduced to the appointment of histamine blockers. However, it is necessary to determine the type of allergen and start etiotropic therapy with an allergist.
Surgical treatment
Penetrating wounds of the eye require primary surgical treatment of the wound with suturing of the defect. In the presence of a foreign body, its microsurgical removal is indicated at an early date. Also, surgical care should be provided if it is not possible to medically achieve the target intraocular pressure in glaucoma.
