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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Related Studies

Ontology: Eye pain (C0151827)

Definition (MSH) A dull or sharp painful sensation associated with the outer or inner structures of the eyeball, having different causes.
Definition (MSHCZE) Tupá či ostrá bolest vnějších nebo vnitřních struktur očního bulbu, způsobená různými příčinami.
Definition (NCI) Painful sensation in the eye.
Definition (NCI_CTCAE) A disorder characterized by a sensation of marked discomfort in the eye.
Concepts Sign or Symptom (T184)
MSH D058447
ICD10 H57.1 , H57.10
SnomedCT 162286001, 139556001, 194185002, 41652007
English EYE PAIN, Eye pain NOS, eye pain (symptom), eye pain, ocular pain, Eye ache, Pain eye, Pain in eyes, Ocular pain, unspecified eye, Eye Pains, Pains, Eye, Eye Pain, Pain, Eye, eye ache, Pain;eye, pain in eye, pain in eyes, eye pains, Eye Pain [Disease/Finding], Eye pain NOS (finding), Eye painful, Pain in eye, Ocular pain, Pain in eye (finding), eye; pain, ocular; pain, ophthalmic; pain, pain; eye, pain; ocular, pain; ophthalmic, Eye pain
Dutch pijn oog, pijn in ogen, oculaire pijn, Pijn oog, oculair; pijn, oftalmisch; pijn, oog; pijn, pijn; oculair, pijn; oftalmisch, pijn; oog, Oogpijn, oogpijn
French Yeux endoloris, Douleur dans les yeux, DOULEUR OCULAIRE, Douleur oculaire, Douleur de l'oeil, Douleur des yeux, Algie oculaire
German Schmerz Auge, Schmerz in den Augen, okulaere Schmerzen, AUGENSCHMERZEN, Augenschmerz, Augenschmerzen
Italian Dolore agli occhi, Dolore oculare
Portuguese Dor nos olhos, Olho dorido, DOR OCULAR, Dor Ocular, Dor ocular
Spanish Dolor de ojo, Dolor en los ojos, OJOS, DOLOR, Dolor Ocular, dolor ocular, SAI (hallazgo), dolor ocular, SAI, dolor en el ojo (hallazgo), dolor en el ojo, dolor ocular, Dolor ocular
Japanese 眼痛, ｶﾞﾝﾂｳ
Czech Bolest v očích, Bolest oka, Bolestivé oko, oko - bolest, oči - bolest, bolest oka, bolest očí
Korean 눈통증
Russian ГЛАЗ, БОЛИ, GLAZ, BOLI
Hungarian Ocularis fájdalom, Szemfájdalom, Fájdalom a szemekben, Szem fájdalom
Polish Ból oka
Norwegian Øyesmerte, Øyesmerter
Derived from the NIH UMLS (Unified Medical Language System)

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