Eye pain from the most obvious - eyelid pain

Two conditions cause eye pain here, and the same two treatments are used for both – they are stye and chalazion - also called an internal hordeolum or meibomian cyst.

A stye is an abscess starting at one eyelash, which will be one of those in the middle of the red swelling, which is centered just away from the edge of the lid.

A home remedy for stye is to rub a gold ring on the eyelid. Let me know if you think this helps you.

A chalazion is initially on the inside of the lid, best seen by pulling the lid away from your eye.

When a chalazion is visible from the front, it is a bit further away from the edge of the lid than a stye, and not red.

Both are treated by applying heat, and sometimes releasing the contents...

Pull the eyelash out for a stye.

Opening is seldom needed for chalazion, but then is best done by cutting on the inside of the eyelid, under local anaesthetic and using a small curette to scrape out the cyst at the same time.

Application of heat to your eye.

Do you have a vacuum flask at home? This is also called a Dewar flask after its inventor, or a Thermos flask after the first brand name.

This is a very convenient device with which to apply heat to your eye.

Fill it with boiling water and bend over it with your eyes closed. Position the eye as close as you can bear to the steam from the flask.

Stay there for a good 10 minutes, so your face is bright red from the heat.

The other more traditional method is to have a wooden spoon with cloth wrapped around it, dipped in water as hot as you can bear, then applied to your closed eye until the heat goes out of it. It is then redipped and reapplied.

Another way is to press a hot flannel onto your eyes.

Blepharospasm - a rare cause of eye pain

Irritation and discomfort of eyelids here leads to increased blinking rate, persistent twitching then involuntary screwing up of the eyes sometimes lasting minutes or even hours.

This is one of the facial dystonias, usually treated with Botox these days. I've only seen one person with it, years ago. These days I would be looking at magnesium deficiency as a likely cause .

Ocular pain from eye infection - also obvious - red eyes

Conjunctivitis is the most likely reason you've eye pain with a uniformly red eye. If you have thick yellow pus in your eye, the infection is bacterial.

If you've had unprotected sex, and it is very quickly severe, gonococcal conjunctivitis is a serious possibility. This needs urgent medical treatment.

If the discharge is watery, it is most likely a virus.

Virus conjunctivitis is much more common, and can similarly follow a recent head cold. It can start in one eye and spread to the other in a few days.

Feel around just in front of your ear, for a tender lump about one quarter inch across. This may be a pre-auricular lymph gland, supporting the virus infection idea.

Virus conjunctivitis is highly contagious. It is easily spread on towels and face washers.. If you know who you have to thank for your conjunctivitis, and they had no pus either, it is also reassuring as to the cause.

Antibiotic ointment or drops are very helpful for bacterial infection, useless for viruses. Making the distinction is therefore well worthwhile.

The only medical treatment for virus conjunctivitis is cortisone eye drops such as FML drops, and they certainly don't speed up recovery. Artificial tear drops and cool compresses on your eyelids, may give comfort.

The common adenovirus infection can cause keratitis as well as conjunctivitis, and need cortisone eye drops for months even. This is a deeper infection of the cornea, damaging vision.

One treatment you could ask about is eye washouts with a pinch of sodium ascorbate (vitamin C) powder in a glass of water.

There is one virus infection which is treatable, caused by the cold sore virus, Herpes simplex or HSV. This is a cause of recurrent eye pain, but you may be having your first attack.

If the redness is confined to or worse in one part of the white of only one eye, this is a very real possibility.

Another is that you've got something in your eye. Have you been using a grinding wheel or angle grinder, or working with dust blowing around?

Either way, it is important to get someone professional to look in your eye. They will have much better magnification and be able to use fluorescein stain to show up a dendritic ulcer from HSV.

The ulcer caused by HSV may need cleaning up by an eye doctor, and acyclovir drops may be prescribed. If this is believed to be the first time you've had the condition, acyclovir tablets will also be prescribed. It takes a full week of treatment to get better.

Marginal keratitis is also a possibility if only part of the white of your eye is red. Here there is an little, rounded, white area on the clear part of the eye. It is close to the edge, next to the red area on the white of the eye.

It causes irritation rather than pain, watering and photophobia.

This is also a recurrent condition. If you had a similar episode before, it would have lasted about 1-2 weeks without treatment.

It is caused by allergy to the golden Staphylococcus germ. It is not infection on the eye and is not an ulcer.

It is very important to have it checked out, to ensure it is not an infection on the front of your eye. Especially if you wear contact lenses, a very serious possibility is infection here by Pseudomonas germs. The white area is likely to be closer to the pupil, and there is more eye pain.

The other good reason to diagnose marginal keratitis, is that it will be better in 2 days, with prescription eye drops. Treating eyelid disease or face rashes may help prevent recurrences.

Eye pain from eye injury - eye protection

Squash players are very aware of this risk and wear appropriate eye protection. Ordinary glasses are not adequate protection when using grinding wheels and hammering metal.

Protective goggles need to have a plastic return at the sides.

Even with the best of protection, please have a check if something hits your eye. Tiny bits of flying metal can easily penetrate your eyeball. Blunt injury as from falling on one's face can cause retinal haemorrhage.

If you get a bit of grit or dry plant material in your eye, it will often be picked up under your upper lid as you blink. The upper lid will then drag it up and down over the eye, scratching each time.

The first thing to do is to grasp your upper eyelashes, and pull your upper lid away from the eye then down over the front of your lower lid, then let it go.
This will often wipe the foreign body off the inside of your upper lid, giving immediate relief.

Scleritis as a cause of eye pain (and red eye)

If you already have rheumatoid arthritis or another connective tissue disease, boring pain in your eye plus a violaceous to red lump on the white of your eye may be scleritis.

This needs attention from your doctor.

It may just be episcleritis, which is not much of a problem.

The common condition of pterygium is not painful, causing slight discomfort outdoors especially in the wind. The lump and slight reddening in this condition, is immediately alongside the iris and sometimes spreading onto it.

Eye pain from recurrent corneal erosions

Recurrent corneal erosions are loss of surface cells from the front of your eye, due to epithelial basement membrane dystrophy.

The surface epithelial cells attachment complexes consist of hemidesmosomes of the basal epithelial cells, the underlying basement membrane, and the anchoring fibrils of the Bowman layer.

The surface cells sit on the basement membrane, and that sits on the Bowman layer.

The hemidesmosomes are essentially anchors that protrude through the under surface of the basal cells. This attachment system is faulty here.

Typical symptoms of RCE include...

Mild to severe eye pain
Slightly blurred vision (when the epithelial and basement changes are in the visual axis)
Feeling as if something is in your eye (with recurrent erosion, when the epithelium loosens)

There may be abnormal adherence between your eyelid and cornea contributing to this happening - your lid and eye stick together overnight.

Sudden sharp eye pain often is felt in the early morning during sleep or on awakening, when a frank epithelial defect occurs because of the eyelid movement across the loosened epithelium - the lid and eye are torn apart when one opens one's eye in the morning.

The eye pain is fleeting in most cases, lasting only for a few seconds, but it may last from minutes to 1-2 hours.

People's first response is to rub the affected eye, which unfortunately doesn't help the condition.

It commonly follows a recent eye injury such as a poke in the eye by something in the garden, or a baby's fingernail poked in a mother's eye.

This is diagnosed by your eye doctor, using fluorescein stain and a slit lamp which gives good magnification.

It is very important to continue the treatment for some time to allow full healing. This will be 3 to 5 months.

Eye pain from dry eyes

Scratchiness, burning, photophobia or a foreign body sensation can be caused by lack of adequate tears, worse when reading or out in the wind.

Your eyes may actually be watering due to this condition, as well!

This seemingly nonsensical statement is because of lack of the lipid Meibomian gland secretions, evaporation of the tear film and the eye compensating by temporary pouring out of the watery part of your tears.

The lipid (fat), floating on the surface, normally prevents this evaporation.

There are many diseases which can lead to this problem, but so can a number of medications. If your symptoms have come on when a new drug was started, ask your doctor about this. This can include eye drops (due to the preservatives used.)

This is a problem also when you can't properly close the eye, as after Bell's palsy. Poorly acting thyroid gland and Parkinsons disease can also cause it because of reduced blink rate.

Symptoms are brought on by reading, because our normal 15-20 blinks per minute may now be reduced to 3 per minute even.

Nearly 8% of women get dry eyes after their menopause. Treatment may be nothing more than watery eye drops such as Genteel, before reading.

If eye drops are needed frequently, the preservatives may be toxic to the epithelial cells. Preservative free preparations are needed then.

Antioxidant nutrient supplementation has been shown¹ to significantly improve tear stability and ocular surface. The supplement used was either Visionaceᵀᴹ or visonace plusᵀᴹ.

An exercise from an old book was 25 quick blinks followed by 3 firm squeezes (of your eyelids together.) This has an immediate effect on my vision when I remember to do it, and I suspect would help dry eyes too.

The author of the book wanted people to do it every two hours, and claimed it often helped people's vision.

In men, dry eyes are likely to be secondary to another problem, such as eyelid inflammation (blepharitis) with poor Meibomian gland function reducing the lipid part of the tears.

Treatments include pressing a hot flannel on your eyes, a course of tetracyline by mouth for 6 weeks, cortisone eye drops at night and a thicker artificial tear drop such as Optive.

Tetracycline is an antibiotic, but here is being used to increase the lipid part of your tears.

Diagnosis needs a test by the eye doctor, and treatment is best using prescription drops and ointment.

Trichiasis - eye pain from corneal abrasion due to inturned eyelashes

This is not at all obvious, either to yourself or to your doctor often. It feels as if something is irritating your eye, but the cause isn't to be seen.

The eyelashes concerned are often tiny, thin and virtually colorless.

It needs a good magnification and a good light, which can be angled around as the eyelid is moved and pulled out. The light is best coming in from one side.

Then you need a really good pair of pincers, as they are hard to get a hold of as well.

This "trichiasis" condition is likely to recur as lashes grow again.
"Blepharoplasty" operations can be used to prevent this eye pain - a sort of upper eyelid tuck, where skin and muscle are removed to stop the eyelid turning in.

Temporary relief can be obtained by splinting the upper eyelid² with a 5mm wide strip of hypoallergic adhesive tape. The skin is pulled up tight as this is applied across the upper eyelid.

Eyelid skin conditions causing eye irritation

Some are obvious - such as warts.

Early skin cancer may not be obvious at all, just a slight unevenness on the margin of the lid. Eyelashes may be missing or misdirected towards your eye.

Your eyelids act as windscreen wipers over the front of your eyes, and need a sharp, smooth edge to work properly.

You may be able to feel thickening of the skin or see a patch of dry scaly skin here, in skin cancer.

Blepharitis is reddening or dandruff-like scaling of the edge of the eyelids, where your Meibomian glands deliver their fatty secretions.

Meibomian gland dysfunction in blepharitis, produces secretions deficient in polyunsaturated fatty acids and polar lipids like phosphatidylethanolamine.

These are important for the function of the fatty surface layer of your protective tear film, which slows down evaporation between blinks.

Here, evaporation is increased and the tear film on your eye may break up, leading to gritty eye pain.

One teaspoon of bicarbonate in 250ml of water can be used on a cotton wool ball, to rub along the lid edges. Baby shampoo can be used on a cotton bud, to remove crusting.

Angle closure glaucoma - very serious cause of eye pain

This genuine eyeball pain, and is fortunately uncommon.

Red eye usually coexists with pain, headache, or nausea and vomiting when caused by acute closed-angle glaucoma.

Diminished visual acuity - blurred vision, is a red light symptom, indicating need for urgent medical assessment.

If you use two fingers, gently pressing one after the other into your eyeball to assess the tension, the affected eye will be hard and tender in this condition.

If you have any glycerin (glycerol) in your kitchen cupboard, and your aren't vomiting, have some (50:50 with iced water) while your are leaving for the hospital. The proper dose is at least 1gm per kgm body weight, but this is hard to keep down.

Pain from your eye, felt in your forehead.

Subacute angle closure glaucoma can cause pain episodes lasting a couple of hours, which are not recognized as eye pain, but thought to be due to migraine.

Astigmatism pain can be felt in your head. Tired eyes, blurred vision and frontal headache when doing a long precise task at a fixed distance, is typical. The blurred vision can be relieved by rubbing your eyes. Squinting can improve your vision in this condition. You can find a self test clock chart on the net, but you will need to see an optometrist for a proper evaluation.

You can identify the darkest, most distinct line on the spokes of the astigmatic clock chart, if you have astigmatism. Otherwise they all look the same.

In astigmatism, the front of the eye is not quite spherical, a little barrel shaped.

While we are on the subject of doing a self eye test, age related macular degeneration (AMD or ARMD) is a very common problem which causes no eye pain at all, but can rob you of sight.

The Amsler grid eye self test for this condition, is also available on line at this other site. Early diagnosis of this condition is really important, so that you can slow it down or better, with antioxidants. Vitamins A, C, E zinc, copper, selenium and lutein are good starters.

Pain from your forehead, felt in your eye.

The muscle under the skin around one's eye is quite thin and quite strong. I stretch it by grasping the skin just below the hairline in the temples, between my fingers on the left side and my thumb on the right.

To prevent my fingers slipping on the person's skin, a piece of paper tissue (just one layer) helps the grip. Once I have gripped firmly enough to pull the skin across the scalp, I pull it down towards the tip of the person's nose. It is quite hard on the hand and it often takes about 5 minutes, but one can feel the orbicularis oculi muscle giving way bit by bit and finally it relaxes altogether and my fingers and thumb move steadily over the edge of the bony orbit, carrying the skin with them over the  bone.

This can have a dramatic benefit. People who need this are usually chronically stressed.

Frontal sinusitis as cause of eye pain

Dark circles under eyes and puffy eyes, can indicate this condition, when the pain is felt in your eye.

See the sinus pain page on this site.

Eye pain all the way from your neck, or even lower.

One sided headache stretching from the back of your head to your eye, commonly comes from neck structures.

I've seen people with tenderness of the floor of the frontal sinus or of the eye itself, where an obvious cause has been found in the neck, and the pain has quickly gone after neck treatment.

The lower end of levator scapulae superiorus , can be responsible too.

Need help or have a helpful tip to share, or an experience others can learn from?

You can have your own page on this site, be anonymous if you prefer, and help other people or get useful opinions.

It's very quick and easy

From eye pain page back to home page

References for eye pain page

1. Blades KJ, Patel S, Aidoo KE.
Eur J Clin Nutr. 2001 Jul; 55(7):589-97.

2. http://archopht.jamanetwork.com/article.aspx?articleid=1157410#tab1


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