Pain in the eye occurs with burns, traumatic injuries, inflammatory diseases, allergic reactions, increased intraocular pressure (IOP). Painful sensations in the eyes may accompany neurological pathology: neuritis, neuralgia, migraine. To determine the cause of pain in the eye, biomicroscopy, non-contact tonometry, ophthalmoscopy, ultrasound, and orbital radiography are performed. Analgesics are used to relieve pain. Etiotropic treatment depends on the underlying pathology.
Causes of pain in the eye
Eye burn
A burn, regardless of the type (chemical, thermal), leads to sharp pain, the intensity of which increases with time. The patient cannot open his eyes on his own. Concomitant manifestations are photophobia, increased lacrimation, eyelid edema, and conjunctival chemosis. In severe burns, hyperemia is replaced by blanching of the eye tissues.
Eye injury
Injury to the eyes causes severe pain. The patient is unable to open the eyelids without the help of a doctor. The surrounding tissues are edematous, hyperemic. Symptoms are extremely pronounced in violation of the integrity of the cornea. The most common types of traumatic eye injuries are:
- 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 due to microtraumatization when applying makeup, hitting with a branch. Symptoms are especially noticeable upon awakening and are represented by soreness, flushing, lacrimation, blurred vision, and photophobia.
Conjunctivitis
Redness and soreness of the eye are common signs of inflammation of the conjunctiva, regardless of etiology. Therefore, it is very important to pay attention to the specific symptoms of individual forms. Differential diagnosis in the first place should be carried out among these types of conjunctivitis:
- Bacterial. Pain syndrome of moderate intensity, most pronounced in the morning. Purulent discharge may appear, which are yellow and viscous. Patients note "gluing eyelashes" and the inability to open their eyes after sleep.
- Allergic. Inflammation of the conjunctiva is accompanied by itching, pain, lacrimation. Discomfort is aggravated by contact with the allergen. In the conjunctival fornix, large follicles of the "cobblestone" type are often formed.
- adenovirus. This conjunctivitis is characterized by increasing chemosis, hyperemia and pain. The course of the disease is protracted (3 or more weeks). Often the pathological process extends to the cornea.
Keratitis
The leading symptom of keratitis is severe pain, which is combined with conjunctival hyperemia, swelling of surrounding tissues, and photophobia. Common causes of inflammation of the cornea: contact with infectious patients, non-compliance with the rules of personal hygiene. The main forms of keratitis:
- Herpetic. Accompanied by acute pain, blepharospasm, photophobia. The 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 conjunctival vascular injection, photophobia. Mucopurulent discharge is characteristic of keratoconjunctivitis.
- adenovirus. Patients note a decrease in visual acuity, pain and swelling of the surrounding tissues. Corneal lesions are represented by "coin-shaped" subepithelial opacities that persist for a long time (from 2-3 months to 1-1.5 years).
Uveitis
Uveitis is an inflammation of the choroid (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. Perhaps the development of anisocoria, lacrimation, photophobia. With iridocyclitis, patients often notice blurred vision.
Ophthalmohypertension
Increased intraocular pressure above 3 mm. rt. Art. can lead to pain in the eye that radiates to the head. Due to diurnal fluctuations in IOP, pain is most pronounced in the morning. A concomitant manifestation is congestive conjunctival injection. When looking at a light source, rainbow circles appear. A similar clinic is observed in angle-closure glaucoma.
Neurological disorders
Pain syndrome is a common symptom of the pathology of the central nervous system. In most cases, pain in the eye is associated with intracranial hypertension, in which patients have impaired vision, diplopia, photophobia, and a veil before the eyes may appear. At the same time, decreased intracranial pressure leads to positional pain, photophobia, and double vision. Also, pain in the eye occurs with the following pathologies:
- Trigeminal neuralgia. Typical short-term bouts of intense pain or prolonged burning pain on the side of the lesion. Soreness is clearly limited to the zone of innervation. The clinic increases with irritation of trigger points.
- Supraorbital neuralgia . The affected area is limited to the supraorbital region, the superciliary arch and the lower part of the forehead. The pain is paroxysmal or persistent. Lacrimation is determined only on the side of neuralgia.
- Optic neuritis. Patients complain of pain that increases with eye movements. The clinical picture is represented by deterioration or blurred 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. Pain in the eye extends to the corresponding half of the head and is combined with diplopia, ptosis, anisocoria.
Diagnostics
Severe eye pain leads to blepharospasm, making ophthalmic examination difficult. To alleviate the patient's condition, instillations of analgesics are recommended, after which they proceed to the diagnosis. It is important to assess the condition of the eyelids, the shape of the palpebral fissure and the position of the eyes. Further specific studies are carried out:
- Visometry. Visual acuity is determined at the beginning of the examination of the patient. In the absence of object vision, it is necessary to study the light projection. Visometry is carried out with and without distance correction.
- Non-contact tonometry. Penetrating eye injuries are often accompanied by hypotension. With iridocyclitis, intraocular pressure rises. It is important to compare IOP in both eyes and also to measure the central corneal thickness.
- Biomicroscopy of the eye. First, a detailed examination of the anterior segment of the eyeball is carried out with a mandatory eversion of the upper eyelid. This is followed by fluorescein staining and examination with a cobalt filter, which allows visualization of small erosive defects.
- Ophthalmoscopy. Examination of the fundus is carried out after cycloplegia, if intraocular pressure is compensated. The ophthalmologist evaluates the transparency of the optical media and the state of the retina up to the dentate line.
- Eye ultrasound. Ultrasound examination is used when there are difficulties in visualizing the structures of the eyeball due to miosis, corneal edema, hyphema or hemophthalmia. 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 orbit. A special Comberg-Baltin prosthesis makes it possible to determine the localization of intraocular radiopaque foreign bodies.
Eye examination by an ophthalmologist
Treatment
Help before diagnosis
In the event of a burn or injury, call an ambulance immediately. Before the arrival of a doctor in case of a burn, it is necessary to thoroughly rinse the eyes with running water at room temperature. This will minimize the impact 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, exclude visual load and eye movements. For this, it is recommended to apply a binocular bandage. Self-removal of a foreign body can lead to expansion of the wound channel and additional trauma. In inflammatory diseases, it is important to follow the rules of personal hygiene and avoid the uncontrolled use of antibacterial agents.
Conservative therapy
Therapeutic tactics depend on the etiology of pain in the eye. The appointment of etiotropic and pathogenetic agents is justified. Do not give preference to physiotherapy and folk remedies in order to relieve pain. Conservative treatment may include:
- Analgesics . Anesthetizing drops are used at the diagnostic stage, as well as before performing subconjunctival injections. With a strong pain syndrome, oral analgesics are indicated, since local agents inhibit the regeneration process.
- Antibiotics . With the bacterial nature of the pathology, instillations of antibacterial agents are indicated based on the result of the analysis for antibiotic sensitivity. Broad-spectrum drugs are empirically used. The average course of treatment is 7-1 days.
- Antiseptics . They are prescribed in the presence of small foreign bodies located under the eyelids or in the region of the conjunctival fornix, if there are no signs of inflammation or deep damage to the tissues of the eye. Frequent instillations (every 2-3 hours) are justified for viral conjunctivitis.
- Reparants . These drugs contribute to the regeneration of the cornea. Tissue repair stimulants are indicated for erosions, post-traumatic defects, postoperative wounds. Duration of application varies from 1 day to 1 month.
- Antihistamines . In allergic conjunctivitis, pathogenetic therapy is reduced to the appointment of histamine blockers. However, the type of allergen should be determined and etiotropic therapy should be started by an allergist.
Surgery
Penetrating eye wounds require primary surgical treatment of the wound with suturing of the defect. In the presence of a foreign body, its microsurgical removal is indicated in the early stages. Also, surgical care should be provided if it is not possible to achieve the target intraocular pressure in glaucoma with medication.