Recurrent Corneal Erosion
Acute angle-closure glaucoma
Ocular inflammation
Iritis
Uveitis
Optic neuritis
Endophthalmitis
Dry Eye Syndrome
Pink eye
Allergic Conjunctivitis
Cavernous sinus thrombosis
Sinusitis
Computer-related eye strain
Ocular injury
Corneal abrasion
Corneal ulcer
Shingles
Corneal burn
Foreign body in the eye
Post eye surgery

Waking up with eye pain can be really scary and even debilitating.

Sometimes when we sleep the eye gets so dry that the eyelid attaches to the cornea like a tongue on a frozen pole. When this happens to the eye and we open our eyelids this can be extremely painful.

The cornea can be very sensitive to pain due to its many nerve endings. As you know the smallest piece of debris in the eye feels like a boulder.

So when the cornea becomes scratched or abraded it can cause severe pain.

There is an eye condition called Recurrent corneal erosion (RCE), which is characterized by a repeated breakdown of the outermost layer of the cornea (corneal epithelium), which causes pain, light sensitivity, excessive tearing, and foreign body sensation upon waking.

Many cases of Recurrent Corneal Erosion occur after an injury or surgery to prior weakening of the corneal structure making it more susceptible to corneal breakdown (erosion).

Symptoms of Recurrent Corneal Erosion

Foreign body sensation upon waking
Extreme eye pain
Excessive tearing
Light sensitivity (photophobia)
Red-eye

Risk Factors for Recurrent Corneal Erosion

History of Refractive surgery (LASIK, PRK, RK)
History of corneal abrasion or corneal trauma
Dry eye Syndrome
Contact lens wear
History of Cataract surgery

Treatment of Recurrent Corneal Erosion

Healing of the corneal erosion can take a few hours to a few days depending on the severity.

Usually, the eye doctor will prescribe antibiotic ointment and/or drops.

Depending on the severity and pain intensity a bandage contact lens may be necessary to help with the pain.

In severe cases, an amniotic membrane (Prokera) can be placed on the eye for 3 days to aid in the healing process.

It is important to keep the eye well lubricated using artificial tears at least 4 times per day and nighttime ointment. This helps the cornea to heal and to prevent future corneal erosion.

Acute Angle Closure Glaucoma

Think of your eyes like a sink with a faucet and a drain. The angle of the eyes is where the drain is located and if it closes, pressure can build up inside of the eye due to the fluid being produced but not draining. Angle-closure glaucoma not only causes eye pain but can also cause nausea and vomiting and if left untreated can cause blindness.

Patients who experience severe eye pain should see an eye doctor immediately.

Symptoms of Angle Closure Glaucoma

Red Eye
Painful Eye
Nausea (some cases)
Vomiting (some cases)
Blurred vision
Loss of vision
Colored lights

(In contrast to open-angle glaucoma, which shows little to no symptoms). Click here for more information about open-angle glaucoma.

Treatment of Angle Closure Glaucoma

The main treatment of Angle Closure Glaucoma is to lower the eye pressure and decrease inflammation with the use of eye drops, oral medications, and lasers.

Oral medication to lower eye pressure: Acetazolamide (Diamox)
- This can be administered to the patient in the office
- May cause nausea or vomiting

Eye drops to lower eye pressure (click here for detailed information on glaucoma eye drops)
- Administer any glaucoma drop that is available in the office
  - Preferably a combination eye drop that contains two glaucoma medications in one such as:
    - Combigan
    - Cosopt

Eye drops to decrease inflammation
- A steroid drop: such as prednisolone may be necessary
  - Do not assume a steroid is needed, make sure the Doctor has recommended a steroid drop
  - Steroids can increase IOP (intraocular pressure)

Laser (LPI: Laser peripheral iridotomy): to open the angle of the eye to reduce eye pressure (this type of laser can be used preventable to avoid angle-closure on patients with narrow-angle).
- This can be done in the office immediately
- The laser is used to open create a hole in the iris to prevent angle closure or to aid in the situation of a closed-angle attack

Ocular Inflammation

Inflammation of the eye can cause pain, redness, and blurred vision. Ocular inflammation has numerous and sometimes unknown causes.

Common Causes of Ocular Inflammation

A red eye is usually an inflamed eye, the following are some of the common causes of ocular inflammation:

Dry eye
Stress
Lack of sleep
Allergies
Inflammatory conditions such as arthritis, Inflammatory bowel disease, Bachets, Crohn’s Disease, sarcoidosis, ankylosing spondylitis, and Sjogren’s
Chemical burn
Sunburn
Trauma
Infections: bacterial or viral
Eye rubbing
Grave’s disease
Medication side effects (click here for a list of medications that can affect the eyes)

Treatment of Ocular Inflammation

The treatment of ocular inflammation will depend on the cause. Typically a mild steroid drop can be used to reduce inflammation. In the case of bacterial infection, an antibiotic drop is used. Allergies can be treated with anti-allergy medications or eye drops. Keep in mind that medications that treat allergies can cause dry eyes (for dry eye treatments click here).

Iritis and Uveitis

Uveitis is an inflammation inside the eye.

Uveitis can affect 3 parts of the eye: (anterior, middle, and posterior)

Anterior Uveitis: swelling or inflammation of the iris (also known as iritis)
Intermediate Uveitis: inflammation of the middle part of the eye called the ciliary body
Posterior Uveitis: inflammation of the back of the eye (choroiditis or retinitis)
Diffuse Uveitis (Panuveitis) can affect all three parts of the eye.

According to uveitis.org, uveitis is the third leading cause of blindness in the U.S.

Uveitis treatment

Seek treatment if you are experiencing:

Eye pain
Redness
Light-sensitivity

Uveitis is treated with steroid eye drops with a slow taper, starting with a higher dose and slowly decreasing the dose to avoid rebound inflammation.

Optic Neuritis

Optic Neuritis is inflammation of the optic nerve. The optic nerve is a bundle of neurons that transmit the visual signal from the eye to the brain.

Symptoms of Optic Neuritis

Eye Pain that worsens with eye movements
Decreased vision
Change in color vision
Flashes of light that worsens with eye movements (in rare cases)

Causes of Optic Neuritis

The cause of Optic Neuritis is unknown but the following conditions can have an association:

Multiple Sclerosis: the risk for MS (multiple sclerosis) is greater in someone who has had optic neuritis.
Infections
Medication side effects
Auto-immune diseases
Neuromyelitis OpticaSjogren’s
Myelin oligodendrocyte glycoprotein (MOG) antibody disorder

Endophthalmitis

Endophthalmitis is a serious eye infection that can quickly lead to loss of vision if not treated promptly. Endophthalmitis is an infection inside the eye. Bacteria can enter the eyeball after eye surgery or an injury that has created a wound into the eyeball.

Common Symptoms of Endophthalmitis

Painful eye
Red-eye
Nausea
Vomiting
Light sensitivity
Blurred vision
Eyeball hard to the touch
White inside of the eye (hypopyon, see photo)

Causes of Endophthalmitis

Cataract surgery
Glaucoma surgery
Retinal surgery
Vitreous surgery (vitrectomy)
Penetrating eye injury

Endophthalmitis Treatment

A patient with endophthalmitis will be sent to a retinal specialist immediately.

Endophthalmitis treatment may include:

Antibiotic injection into the eyeball
Steroid (anti-inflammatory) injection into the eyeball
IV antibiotics
Occasionally oral antibiotics
May require vitrectomy (surgical removal of the vitreous gel inside of the eye).
May require intraocular pressure-lowering medications (oral or eye drops)
Daily monitoring

The goal of treatment is to treat the infection and calm the inflammation. Once the infection is gone the visual outcome is variable.

Dry Eye Syndrome

Dry Eye Syndrome can be extremely painful and there are many causes, so many in fact that I wrote an article on 21 causes of Dry Eye Syndrome (click here to view).

Common Dry Eye Symptoms

Irritation
Foreign body sensation
Burning
Intermittent fluctuations in vision
Photophobia/light sensitivity
Tired/Heavy eyes
Red eyes
Tearing
Occasionally eyes crusted shut in the morning
Occasionally severe pain upon waking (Recurrent corneal erosion)
Sandy/gritty sensation

Common Causes of Dry Eye Syndrome

Meibomian Gland Dysfunction
Blepharitis
Rosacea
Acne
Omega-3 deficiencies
Dehydration
Advanced age
Hormone changes/Menopause
Dry windy environment
Medications
Air conditioning and heater
Computer use
Eye surgery
Vitamin A deficiency
Sjogren’s Syndrome
Autoimmune diseases
Allergies
Smoke
Contact Lenses
Lagophthalmos
Diabetes

Common Dry Eye Treatments:

Hot compresses 10-20 minutes
Eyelid cleaners such as OcuSoft, Systane lid wipes, or baby shampoo
Artificial tears lubricate the eyes. Make sure it does not say to get the red out.
Xiidra
Restasis
Punctal plugs
Stay hydrated
Omega 3 supplementation
Avoid smoke and wind
Review medication side effects
Adjust your seat to be higher than your computer monitor
Use daily contact lenses instead of extended wear contact lenses
Use a humidifier
Sleep with an eye mask if you have lagophthalmos
Treat rosacea
Treat blepharitis
Eat a balanced diet high in omega 3 fatty acids and antioxidants
Dry Eye Device: ILUX, Lipiflow, IPL

Pink Eye (Conjunctivitis)

Pink eye is not a technical diagnosis, but a term that most people say when someone has an eye infection. Pink eye could be due to bacteria, viruses, or allergies.

For more detailed information on Pink Eye please click on this link to my post on pink eye.

Common Symptoms of Pink Eye

Red-eye
Itching eyes (typically allergic conjunctivitis)
Thick discharge (typically bacterial conjunctivitis)
Watery eyes (typically viral conjunctivitis)

Causes of Pink Eye

Allergy
Virus
Bacteria

Pink Eye Treatments Depend on the cause:

Discontinue contact lens use
Allergic Conjunctivitis: Allergy eye drops or cold Artificial tears
Viral Conjunctivitis: Artificial tears
Bacterial Conjunctivitis: antibiotic eye drops or sometimes oral antibiotics

Cavernous Sinus Thrombosis

Cavernous Sinus Thrombosis is extremely rare, affecting approximately two to four per million people per year, with a higher incidence in children.

A cavernous sinus thrombosis is a blood clot that occurs in the cavity at the base of the brain.

Common Causes of Cavernous Sinus Thrombosis

Sepsis
Sinus infection
Tooth infection
Ear infection
Nose infection

Common Symptoms of Cavernous Sinus Thrombosis

Eye Pain
Double vision
Blurred vision or loss of vision
Bulging eyes (this could be a symptom of other conditions, click here to learn about 14 conditions that cause bulging eyes)
Droopy eyelid
Red-eye

Cavernous Sinus Thrombosis Treatment

Treat the source of the infection
Antibiotics
Steroids in some cases
Blood-thinner such as Heparin

Sinusitis

Sinusitis is an infection of the sinuses. The sinuses surrounding the eyes can become inflamed and cause pressure on the eyes.

Common Symptoms

Eye Pain
Teeth pain
End of the day fatigue
Headache
Nasal congestion
Postnasal drip
Facial pain

Common Causes

Allergy
Infection
Deviated septum
Nasal polyps

Treatments

Hot compresses
Decongestants
Nasal sprays: Try xylitol before a decongestant
Sinus rinse: Netti pot
Stay hydrated
Ginger, lemon, honey tea

Computer-Related Eye Strain

For more details on computer vision syndrome including a video and chart please click here.

Common Symptoms of Computer-Related Eye Strain

End of the day fatigue
Eye Strain or fatigue
Red Eyes
Watery eyes
Blurred vision
Headache

Treatment for Computer-Related Eye Strain

20-20-20 Rule: look at something 20 feet away, every 20 minutes for 20 seconds
Sit higher than your monitor
Use a blue light filter (click here to learn about blue light and how to activate the filter on your mobile device).
Take breaks
Treat Dry Eyes: Use Artificial tears and stay well-hydrated (click here for more dry eye treatments)

Ocular Injury

An injury to the eye may result from severe blunt trauma to the eye. Any penetrating wound into the eye is considered a medical emergency. If you have had an injury to your eye go to the ER or preferably the nearest Ophthalmologist immediately.

A globe rupture will require immediate surgical intervention, usually under general anesthesia, meaning you will be asleep for the procedure.

Depending on the severity of the injury, your vision will most likely be impaired. The sooner the rupture is repaired the better the outcome will be.

Symptoms of an Ocular injury

Eye pain
Red-eye
Blurred vision
Watery eye

Corneal Abrasion

A corneal abrasion is just what it sounds like an abrasion or scratch to the cornea. This will be very painful as the cornea has many nerve endings.

Common symptoms of a Corneal Abrasion

Red-eye
Painful eye
Watery eye

Treatment of a Corneal Abrasion

Antibiotic eye drops
Sometimes a Bandage Contact lens for pain relief
Steroid eye drops (in some cases)

Corneal Ulcers

The cornea, like our skin, has a protective layer called the epithelium. When the corneal epithelium becomes damaged it can become sore, inflamed, and infected resulting in a corneal ulcer.

Corneal ulcers are most common in patients who wear contact lenses. Especially patients who wear contact incorrectly. Wearing Contact lenses incorrectly means: sleeping in your lenses, wearing them past the recommended use, and not cleaning them properly.

Common Risk Factors of Corneal Ulcers:

Over-wearing contact lenses
Weakened immune system
Auto-immune diseases
Diabetes
Poor hygiene
HIV
Dry eye Syndrome
Ocular Trauma

Treatment of Corneal Ulcer

Antibiotic eye drops
Steroid eye drops
Regular follow-up with an eye doctor
Discontinue contact lens wear

Shingles (Herpes Zoster Virus)

Shingles and the Eye

Unfortunately, there is a risk of shingles affecting the eye. If the shingles blister is near your eye, then see your eye doctor immediately. Using an eye ointment at bedtime can be helpful as a barrier while sleeping to protect the eye.

If the Shingles have affected your eye then anti-viral eye drops should be started to prevent scarring of the cornea, which can lead to decreased vision.

Again, the sooner you have treatment the better the outcome.

Symptoms of Shingles:

Flu-like symptoms
Itchy rash on one side of the face, arm, or body
Burning skin
Muscle ache on one side of the body
Sensitive skin on one side of the body
Severe pain on one side of the body

The symptoms can vary from mild to severe. Shingles are typically unilateral, meaning that it usually affects one side of the body or face.

Risk Factors for Shingles

Increased age: about half of the cases of shingles are people age 60 or over.
Decreased immune response: a weakened immune system can make you more susceptible to developing shingles.
Stress: has been shown to weaken the immune system.
Steroid usage

Treatment of Shingles

Shingles are typically treated with oral prescription medications called anti-virals. If you have a rash then do not hesitate to see your doctor. The quicker you are treated the faster the symptoms will dissipate.

How to relieve symptoms of Shingles

Cool Baths
Corn starch bath
Corn starch applied to the rash in the form of a paste (I applied cornstarch will in the bath and found it very soothing)
Avoid sun (since the rash burns, sun exposure can intensify this symptom)
Over the counter pain reliever (Advil was very helpful at relieving most of my symptoms)
Stay hydrated (drink a lot of water throughout the day)
Avoid swimming or jacuzzi’s
Avoid saunas or steam rooms

Corneal Burn

A corneal burn can occur if a chemical gets into the eye.

Symptoms of a Corneal Burn

Painful Eye
Red Eye
Watery eye
Blurred vision
Light sensitivity

Treatment of a Corneal Burn

Remove Contact lenses immediately
Rinse the eye with Saline or cool water for 15 minutes
See an eye doctor as soon as possible
Antibiotic eye drops
Steroid eye drops (in some cases)

Foreign Body in the Eye

A foreign body can be anything from metal to dust and anything in between. Just the other day I had a patient with a thin string that had penetrated his cornea, when I pulled on it, the string was about an inch long inside of his cornea.

When anything gets into the eye it can be very painful.

Symptoms of a Foreign Body in the Eye

Painful eye
Red-eye
Watery eye
Hard to open the eye

Treatment of a Foreign Body in the Eye

Sometimes just rinsing the eye is enough to remove an object in the eye; however, sometimes it requires a visit to the eye doctor to remove the object.

In cases where the object penetrates the eye then antibiotic eye drops may be necessary.

Pain after Eye Surgery

Any eye surgery is bound to cause a little pain. If the pain becomes severe, causing blurred vision, nausea, or severe light sensitivity see your eye doctor immediately.

Conclusion:

Eye pain can cause be debilitating. It is important to seek proper treatment by an Optometrist or Ophthalmologist to help with fast recovery.