If your eyes hurt and you have these symptoms, don’t take it lightly!

Author: Yang Diya, glaucoma and cataract specialist at Beijing Tongren Hospital, Capital Medical University

Reviewer: Tian Bei, Chief Physician, Beijing Tongren Hospital, Capital Medical University

Many people experience eye pain and often think that it will get better after a good night’s sleep and rest. However, this may cause them to miss the best time for treatment, leading to irreversible blindness and lifelong regret.

Below we will explain and analyze several common eye pain conditions and sort them according to the severity of the disease, hoping that it will be helpful to everyone.

Glaucoma pain:

Glaucoma patients have problems with the water circulation system in their eyes. Fluid is produced but not discharged, causing fluid to accumulate in the eye, swelling of the eye, increased intraocular pressure, and severe pain. Ultimately, the high intraocular pressure compresses the optic nerve and causes irreversible blindness.

The pain caused by glaucoma is not limited to the eyeball itself, but may also be accompanied by severe headaches, orbital pain, nausea and vomiting, and often severe vision loss. Once the above symptoms appear in the eyes, be sure to go to the ophthalmology emergency department for an intraocular pressure test as soon as possible. If glaucoma is confirmed, timely medication or surgery can completely avoid blindness. If the best time for treatment is missed, it may lead to irreversible blindness.

Intraocular inflammatory pain:

If the intraocular tissue becomes inflamed due to bacterial infection or autoimmune disease, it may cause redness, swelling, heat and pain in the eyes. At the same time, due to the production of a large number of inflammatory cells, very obvious symptoms of blurred vision will appear.

If a patient who has recently undergone intraocular surgery experiences severe eye pain, red eyes, or decreased vision, the possibility of endophthalmitis should be highly suspected. The patient should contact the surgeon promptly for active examination and treatment to avoid more serious consequences.

If severe red eyes, eye pain, and decreased vision occur due to recent severe fatigue, depression, etc., especially when accompanied by joint pain, uveitis (iritis) should be highly suspected. Some patients may also have increased intraocular pressure and glaucoma, which can lead to aggravated eye pain. These patients need to be diagnosed by a professional ophthalmologist and take the correct medication to get relief. Uveitis may recur, so it is recommended that patients consult a rheumatologist in a timely manner after the eye inflammation is basically under control to rule out the possibility of systemic autoimmune diseases.

Corneal injury pain:

The cornea is a transparent curved membrane located on the surface of the eyeball, in front of the black eyeball. It has a large number of nerve endings on its surface and is the most sensitive tissue in the body. The saying "you can't tolerate any sand in your eyes" describes the cornea's high sensitivity to pain.

When foreign objects enter the surface of the eye or the cornea is directly mechanically damaged, it will stimulate the corneal nerve endings and cause severe pain, which manifests as difficulty opening the eyes. It will also stimulate the eyes to release a large amount of tears to flush the cornea and conjunctiva, expel the foreign objects in time and repair corneal damage.

If the surface of the eyeball is invaded by viruses, bacteria or other microorganisms, causing corneal inflammation, more serious corneal irritation symptoms will occur, accompanied by a large amount of secretions. At the same time, the cornea may lose transparency, causing severe vision loss. Eye pain caused by keratitis often lasts for a long time, and regular visits to an ophthalmologist are required to check and adjust medication. Some severe corneal inflammation may leave permanent vision damage.

Scleral inflammatory pain:

The sclera is the white part next to the black eyeball and is the main part of the outer wall of the eyeball. The sclera is dense and once an inflammatory reaction occurs, it will cause obvious and severe pain, accompanied by obvious tenderness and congestion in the painful area.

Figure 1 Original copyright image, no permission to reprint

Scleral inflammation is generally an autoimmune inflammation, which often requires hormone treatment and screening for systemic rheumatic and immune diseases.

Painful eyelid and conjunctival lesions:

Various diseases of the eyelids and conjunctiva can cause eye pain. For example, in children, trichiasis is mainly manifested by frequent blinking and rubbing of the eyes, while in adults, it manifests as eye pain, photophobia, tearing, and foreign body sensation. Under the influence of long-term friction of eyelashes, the eyeball will cause conjunctival congestion, shallow corneal opacity, new blood vessel growth, corneal epithelial keratinization, and even corneal ulcers in severe cases, leading to blindness.

Figure 2 Original copyright image, no permission to reprint

If a small bump grows on the eyelid, is red and painful, and you can feel a nodule with tenderness when you touch the eyelid, it may be a stye. A stye is an acute inflammatory lesion of the eyelid glands, an acute suppurative inflammation, with typical symptoms of local redness, swelling, heat and pain in the eye, and is usually divided into two categories: external stye and internal stye.

If the above symptoms occur, you should seek medical attention immediately. The doctor will make a diagnosis based on the patient's clinical manifestations, such as local redness, swelling, heat, pain, tenderness, and palpable nodules. If the symptoms are mild, local antibiotic eye drops and eye ointments can be used for treatment; if the symptoms are severe, oral antibiotics are required. At the same time, pay attention to your diet, do not eat spicy and irritating foods, eat a light diet, and keep your bowels open.

If your eyes are painful and itchy, with a burning sensation, and your eyelashes and skin flakes fall off when you rub your eyes, it may be scaly blepharitis. Scaly blepharitis is an infection caused by the excessive secretion of the sebaceous glands and meibomian glands of the eyelids, resulting in sebum overflow. It is a subacute or chronic inflammation of the eyelid skin or the roots of hair follicles. This disease is often associated with bacterial infection and meibomian gland dysfunction, and is prone to occur in cases of visual fatigue or long-term use of inferior cosmetics.

Patients with scaly blepharitis will have silvery crusts or purulent secretions at the base of the eyelashes and the eyelid margin area. After removing these secretions or crusts, ulcers can be observed at the base of the eyelashes. If the condition is not controlled for a long time, it may lead to consequences such as thickening of the eyelid margin, entropion or ectropion.

Scaly blepharitis can be diagnosed based on the presenting symptoms, physical examination, and slit lamp examination. Further scrapings or bacteriological examinations of secretions can be performed to confirm the diagnosis. The treatment is mainly based on cleaning. Use non-irritating soap or facial cleanser to remove the secretions and scabs on the eyelid margin, or clean it with normal saline or 2% sodium bicarbonate. In severe cases, antibiotic eye ointment can be applied topically, but it should not be used for a long time. In particularly severe cases, in addition to antibiotic eye ointment, oral antibiotics may be required. For some ulcerative blepharitis, it is best to apply hot compresses after cleaning, and then apply antibiotic eye ointment topically after the hot compress until the symptoms disappear.

Systemic diseases causing eye pain:

Systemic diseases involving the eyes may also cause eye pain. For example, optic neuritis is caused by demyelinating lesions of the optic nerve, which can cause severe vision loss and pain when the eyeballs turn. Exophthalmos caused by thyroid disease may also cause eye pain symptoms. Tumors in the brain, orbit or eye may cause severe eye pain. For this type of eye pain, the primary disease often needs to be treated to relieve the eye pain symptoms.

Eye pain due to visual fatigue:

Among all eye pain conditions, the mildest should be eye pain caused by visual fatigue, but this is also the most common eye pain. When the eyes stare at close objects for a long time without rest, it may cause spasm of the ciliary muscles in the eyes, resulting in ciliary muscle-related eye pain, and may cause headaches or nausea. However, this visual fatigue pain is often relieved quickly by resting.

Some patients with visual fatigue may also experience more severe dry eye syndrome, which manifests as stinging and burning sensations in the eyeballs, as well as temporary vision loss and irritating tearing. These symptoms can be alleviated by using artificial tears or more active anti-dry eye treatments without serious sequelae.