Eye pain [Ophthalmalgia]

Eye pain may be described as a burning, throbbing, aching, or stabbing sensation in or around the eye. It may also be characterized as a foreign-body sensation. This sign varies from mild to severe; its duration and exact location provide clues to the causative disorder.

Eye pain usually results from corneal abrasion, but it may also be due to glaucoma or other eye disorders, trauma, and neurologic or systemic disorders. Any of these may stimulate nerve endings in the cornea or external eye, producing pain.

Action stat!

If the patient's eye pain results from a chemical burn, remove contact lenses, if present, and irrigate the eye with at least 1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to reduce intraocular pressure (IOP). If drug treatment doesn't reduce IOP, the patient will need laser iridotomy or surgical peripheral iridectomy to save his vision.

History and physical examination

If the patient's eye pain doesn't result from a chemical burn, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of sudden, severe pain. Does the patient wear contact lenses? How often are they removed or replaced if they're disposable? Does he have headaches? If so, find out how often and at what time of day they occur.

During the physical examination, don'tmanipulate the eye if you suspect trauma. Carefully assess the lids and conjunctiva for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye.)

Medical causes

Acute angle-closure glaucoma.Blurred vision and sudden, excruciating pain in and around the eye characterize acute angle-closure glaucoma; the pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.

Blepharitis.Burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include a foreign-body sensation, lid ulcerations, and loss of eyelashes.

Burns.With chemical burns, sudden and severe eye pain may occur with erythema and blistering of the face and lids, photophobia, miosis, conjunctival injection, blurring, and an inability to keep the eyelids open. With ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.

Chalazion.A chalazion causes localized tenderness and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.

Conjunctivitis.Some degree of eye pain and excessive tearing occurs with four types of conjunctivitis. Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge. Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.

If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.

Viral conjunctivitis produces itching, red eyes, a foreign-body sensation, visible conjunctival follicles, and eyelid edema.

Corneal abrasions.With this type of injury, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common.

Corneal ulcers.Bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea; unilateral pupil constriction; and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.

Dacryocystitis.Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling in the lacrimal punctum area.

Episcleritis.Deep eye pain occurs as tissues over the sclera become inflamed. Related effects include photophobia, excessive tearing, conjunctival edema, and a red or purplish sclera.

Erythema multiforme major.Erythema multiforme major commonly produces severe eye pain, entropion, trichiasis, purulent conjunctivitis, photophobia, and decreased tear formation.

Foreign bodies in the cornea and conjunctiva.Sudden severe pain is common, but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.

Hordeolum (stye).Hordeolum usually produces localized eye pain that increases as the stye grows. Eyelid erythema and edema are also common.

Iritis (acute).Moderate to severe eye pain occurs with severe photophobia, dramatic conjunctival injection, and blurred vision. The constricted pupil may respond poorly to light.

Lacrimal gland tumor.A lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos.

Migraine headache.Migraines can produce pain so severe that the eyes also ache. Additionally, nausea, vomiting, blurred vision, and light and noise sensitivity may occur.

Ocular laceration and intraocular foreign bodies.Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.

Optic neuritis.With optic neuritis, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.

Scleritis.Scleritis produces severe eye pain and tenderness, along with conjunctival injection, a bluish purple sclera and, possibly, photophobia and excessive tearing.

Sclerokeratitis.Inflammation of the sclera and cornea causes pain, burning, irritation, and photophobia.

Subdural hematoma.Following head trauma, a subdural hematoma commonly causes severe eye ache and headache. Related neurologic signs depend on the hematoma's location and size.

Trachoma.Along with pain in the affected eye, trachoma causes excessive tearing, photophobia, eye discharge, eyelid edema and redness, and visible conjunctival follicles.

Uveitis.Anterior uveitis causes the sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil.

Posterior uveitis causes an insidious onset of similar features as well as gradual blurring of vision and distorted pupil shape.

Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.

Other causes

Treatments and surgery.Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.

Nursing considerations

▪ To help ease eye pain, have the patient lie down in a darkened, quiet environment and close his eyes.

▪ Prepare the patient for diagnostic studies, including tonometry and orbital X-rays.

Patient teaching

▪ Stress the importance of following instructions for drug therapy.

▪ Teach the patient about ways to protect the eyes.

▪ Tell that the patient that he should seek medical attention for any eye pain.

▪ Explain the underlying cause of the patient's eye pain and its treatment.

Pictures

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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