Eye Pain

Aka: Eye Pain

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II. History

  1. Eye Foreign Body Sensation
    1. Corneal involvement (e.g. Corneal Abrasion, sicca syndrome)
  2. Eye scratchy or gritty Sensation
    1. Conjunctivitis
  3. Contact Lens Wear
    1. Risk of infectious Keratitis
  4. Photophobia
    1. Corneal involvement (e.g. Keratitis, Corneal Abrasion)
    2. Uveitis
    3. Migraine Headache
    4. Acute Angle-Closure Glaucoma (Narrow Angle Glaucoma)
  5. Headache
    1. Acute Angle-Closure Glaucoma (Narrow Angle Glaucoma)
    2. Scleritis (esp. Rheumatologic Conditions)
    3. Migraine Headache
    4. Cluster Headache
    5. Optic Neuritis (esp. Multiple Sclerosis, also causes Vision Loss)
    6. Orbital Cellulitis
  6. Vision Loss with Eye Pain (emergent ophthalmology evaluation needed)
    1. Acute Angle-Closure Glaucoma (Narrow Angle Glaucoma)
    2. HSV Keratitis
    3. Optic Neuritis
    4. Orbital Cellulitis
  7. Autoimmune Conditions
    1. Scleritis
    2. Uveitis
    3. Optic Neuritis

III. Exam

  1. Increased Intraocular Pressure (esp. >40-50 mmHg)
    1. Acute Angle-Closure Glaucoma (Narrow Angle Glaucoma)
  2. Extraocular Movement pain
    1. Optic Neuritis
    2. Orbital Cellulitis
    3. Scleritis
    4. Acute Angle-Closure Glaucoma (Narrow Angle Glaucoma)
  3. Eyelid Swelling
    1. Hordeolum
    2. Orbital Cellulitis (or Preseptal Cellulitis)
  4. Eyelid Vesicles
    1. Herpes Simplex Keratitis
    2. Herpes Zoster Ophthalmicus
  5. Photophobia on penlight test (light applied from 6 inches for 2 seconds)
    1. Uveitis
    2. Keratitis
  6. Fluorescein uptake
    1. Uveitis
    2. Keratitis
  7. Pupil defects
    1. Optic Neuritis
      1. Afferent pupil defect (Swinging Flashlight Test)
    2. Anterior Uveitis
      1. Aniscoria (Unequal Pupils)
    3. Acute Angle-Closure Glaucoma (Narrow Angle Glaucoma)
      1. Fixed, dilated pupil

IV. Causes: Eye Pain with Visible lesions

  1. See Red Eye
  2. Ocular foreign body
  3. Entropion Conjunctivitis
  4. Hordeolum
  5. Chalazion
  6. Corneal Ulcer
  7. Interstitial Keratitis
  8. Iritis
  9. Iridocyclitis
  10. Glaucoma
  11. Ocular Herpetic infection
  12. Conjunctiva calcification
  13. Band keratopathy

V. Causes: Eye Pain without lesions (quiet non-Red Eye)

  1. See Eye Pain without Redness
  2. Visual Loss or Visual Field Deficit
    1. Narrow Angle Glaucoma
    2. Intraocular tumor
    3. Uveitis
    4. Posterior Scleritis
    5. Optic Neuropathy, Optic Neuritis or retrobulbar neuritis
  3. Associated neurologic deficits
    1. Tolosa-Hunt Syndrome
    2. Cavernous Sinus Thrombosis
    3. Transient Ischemic Attack or Cerebrovascular Accident
    4. Cluster Headache
    5. Trigeminal Neuralgia
  4. Associated Headache
    1. Migraine Headache
    2. Temporal Arteritis
    3. Acute Sinusitis (Ethmoid, Sphenoid, or Frontal Sinus involvement)
    4. Cluster Headache
    5. Increased Intracranial Pressure
  5. Consider other diagnoses
    1. Corneal Abrasion
    2. Graves Disease
    3. Eye strain

VI. References

  1. Fiore (2011) Am Fam Physician 82(1): 69-73 [PubMed]
  2. Dargin (2008) Med Clin North Am 26(1): 119-216 [PubMed]
  3. Lee (2004) Neurol Clin 22(1): 75-97 [PubMed]
  4. Pflipsen (2016) Am Fam Physician 93(12): 991-8 [PubMed]

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