Eye pain
Eye pain, or ophthalmalgia, 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.
Emergency Actions
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 decrease intraocular pressure (IOP). If drug treatment doesn’t reduce IOP, the patient needs laser iridotomy or surgical peripheral iridectomy to save vision.
History
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 he have headaches? If so, find out how often and at what time of day they occur.
Physical assessment
During the physical examination, don’t manipulate the eye if you suspect trauma. Carefully assess the lids and conjunctivae 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, page 272.)
Medical causes
Blepharitis
With blepharitis, burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include 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 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 pain, tenderness, redness, and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.
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, foreign-body sensation, visible conjunctival follicles, and eyelid edema.
Corneal abrasions
With corneal abrasions, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common. The patient commonly reports feeling that “something is in” the eye.
Corneal erosion (recurrent)
With recurrent corneal erosion, severe pain occurs on waking and continues throughout the day. Conjunctival injection and photophobia also occur.
Corneal ulcers
Both 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.
Foreign body in the cornea or 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.
Glaucoma
Open-angle glaucoma may cause mild aching in the eyes as well as loss of peripheral vision, halo vision, and reduced visual acuity that isn’t corrected by glasses. Angle-closure glaucoma is characterized by blurred vision and sudden, excruciating pain in and around the eye. 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.
Herpes zoster ophthalmicus
With herpes zoster ophthalmicus, eye pain occurs with severe unilateral facial pain, usually days before vesicles erupt. Other signs include red, swollen eyelids; excessive tearing; a serous eye discharge; conjunctival injection; and a white, cloudy cornea.
Hordeolum
A hordeolum (stye) usually produces localized eye pain, burning, and discomfort that increases as the stye grows. Eyelid erythema and edema are also common.
Hyphema
Occurring after eye injury or surgery, hyphema accompanies sudden pain in and around the eye. Orbital and lid edema, conjunctival injection, and visual impairment may occur. The patient may report nausea.
Keratoconjunctivitis sicca
Keratoconjunctivitis sicca, also known as dry eye syndrome, causes chronic burning pain in both eyes, itching, a foreign-body sensation, photophobia, dramatic conjunctival injection, and difficulty moving the eyelids. Excessive mucoid discharge and inadequate tearing are typical.
Lacrimal gland tumor
Lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos. The patient may also have ptosis and eye deviation.
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 cellulitis
Optic cellulitis causes dull, aching pain in the affected eye, some degree of exophthalmos, eyelid edema and erythema, purulent discharge, impaired extraocular movement and, occasionally, decreased visual acuity and fever.
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.
Orbital floor fracture
Sometimes called a blowout fracture, orbital floor fracture causes eye pain, dramatic eyelid edema and, possibly, enophthalmos and diplopia. The patient may report recent eye trauma and reduced vision. Ecchymosis and ptosis may be visible.
Orbital pseudotumor
An orbital pseudotumor causes deep, boring eye pain and diplopia in about 50% of patients. However, prominent exophthalmos and lateral ocular deviation are more characteristic. Eyelid edema and restricted extraocular movement may also occur.
Uveitis
Anterior uveitis causes sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil. Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape. Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity (the patient usually can perceive only light).
Other causes
Treatments
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.
Special considerations
To help ease eye pain, have the patient lie down in a darkened, quiet environment and close his eyes. Prepare him for diagnostic studies, including tonometry and orbital X-rays.
Pediatric pointers
Trauma and infection are the most common causes of eye pain in children. Be alert for nonverbal clues to pain, such as tightly shutting or frequently rubbing the eyes.
Geriatric pointers
Glaucoma, which can cause eye pain, is a disease most commonly found in older patients; it becomes clinically significant after age 40. Usually occurring bilaterally, glaucoma can lead to slowly progressive vision loss, especially in peripheral visual fields.
Patient counseling
Tell the patient that seeking medical help for eye pain is important. Stress the importance of meticulous compliance with drug therapy to prevent an increase in IOP. Also stress the importance of protecting the eyes when involved in activities that could result in eye injuries.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Eye discharge
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