eye pain – Ask Eye Doc

Recurrent Corneal ErosionAcute angle-closure glaucomaOcular inflammation IritisUveitisOptic neuritisEndophthalmitisDry Eye SyndromePink eyeAllergic ConjunctivitisCavernous sinus thrombosisSinusitisComputer-related eye strainOcular injuryCorneal abrasionCorneal ulcerShinglesCorneal burnForeign body in the eyePost 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 wakingExtreme eye painExcessive tearingLight sensitivity (photophobia)Red-eye Risk Factors for Recurrent Corneal Erosion History of Refractive surgery (LASIK, PRK, RK)History of corneal abrasion or corneal traumaDry eye SyndromeContact lens wearHistory 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, your 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. https://youtu.be/5etTujt9aOs Symptoms of Angle Closure Glaucoma Red EyePainful EyeNausea (some cases)Vomiting (some cases)Blurred visionLoss of visionColored 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 pressureEye drops to lower eye pressure Eye drops to decrease inflammation Laser 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). 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 eyeStressLack of sleepAllergiesInflammatory conditions such as arthritis, Inflammatory bowel disease, Bachets, Crohn's Disease, sarcoidosis, ankylosing spondylitis, and Sjogren’sChemical burnSunburnTraumaInfections: bacterial or viralEye rubbingGrave’s diseaseMedication 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 painRednessLight-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 movementsDecreased visionChange in color visionFlashes 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. InfectionsMedication side effectsAuto-immune diseasesNeuromyelitis OpticaSjogren’sMyelin 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 eyeRed-eyeNauseaVomitingLight sensitivityBlurred visionEyeball hard to the touchWhite inside of the eye (hypopyon, see photo) Causes of Endophthalmitis Cataract surgeryGlaucoma surgeryRetinal surgeryVitreous 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 eyeballSteroid (anti-inflammatory) injection into the eyeballIV antibioticsOccasionally oral antibioticsMay 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 IrritationForeign body sensationBurningIntermittent fluctuations in visionPhotophobia/light sensitivityTired/Heavy eyesRed eyesTearingOccasionally eyes crusted shut in the morningOccasionally severe pain upon waking (Recurrent corneal erosion)Sandy/gritty sensation Common Causes of Dry Eye Syndrome Meibomian Gland DysfunctionBlepharitisRosaceaAcneOmega-3 deficienciesDehydrationAdvanced ageHormone changes/MenopauseDry windy environmentMedicationsAir conditioning and heaterComputer useEye surgeryVitamin A deficiencySjogren’s SyndromeAutoimmune diseasesAllergiesSmokeContact LensesLagophthalmosDiabetes Common Dry Eye Treatments: Hot compresses 10-20 minutesEyelid cleaners such as OcuSoft, Systane lid wipes, or baby shampooArtificial tears lubricate the eyes. Make sure it does not say to get the red out.XiidraRestasisPunctal plugsStay hydratedOmega 3 supplementationAvoid smoke and windReview medication side effectsAdjust your seat to be higher than your computer monitorUse daily contact lenses instead of extended wear contact lensesUse a humidifierSleep with an eye mask if you have lagophthalmosTreat rosaceaTreat blepharitisEat a balanced diet high in omega 3 fatty acids and antioxidantsDry 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-eyeItching eyes (typically allergic conjunctivitis)Thick discharge (typically bacterial conjunctivitis)Watery eyes (typically viral conjunctivitis) Causes of Pink Eye AllergyVirusBacteria Pink Eye Treatments Depend on the cause: Discontinue contact lens useAllergic Conjunctivitis: Allergy eye drops or cold Artificial tearsViral Conjunctivitis: Artificial tearsBacterial 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 SepsisSinus infectionTooth infectionEar infectionNose infection Common Symptoms of Cavernous Sinus Thrombosis Eye PainDouble visionBlurred vision or loss of visionBulging eyes (this could be a symptom of other conditions, click here to learn about 14 conditions that cause bulging eyes)Droopy eyelidRed-eye Cavernous Sinus Thrombosis Treatment Treat the source of the infectionAntibioticsSteroids in some casesBlood-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 PainTeeth painEnd of the day fatigueHeadacheNasal congestionPostnasal dripFacial pain Common Causes AllergyInfectionDeviated septumNasal polyps Treatments Hot compressesDecongestantsNasal sprays: Try xylitol before a decongestantSinus rinse: Netti potStay hydratedGinger, 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 fatigueEye Strain or fatigueRed EyesWatery eyesBlurred visionHeadache Treatment for Computer-Related Eye Strain 20-20-20 Rule: look at something 20 feet away, every 20 minutes for 20 secondsSit higher than your monitorUse 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 painRed-eyeBlurred visionWatery 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-eyePainful eyeWatery eye Treatment of a Corneal Abrasion Antibiotic eye dropsSometimes a Bandage Contact lens for pain reliefSteroid eye drops (in some cases) https://youtu.be/faiyzVkmFBY 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 lensesWeakened immune systemAuto-immune diseasesDiabetesPoor hygieneHIVDry eye SyndromeOcular Trauma Treatment of Corneal Ulcer Antibiotic eye dropsSteroid eye dropsRegular follow-up with an eye doctorDiscontinue contact lens wear Shingles (Herpes Zoster Virus) The original uploader was Mariegriffiths at English Wikipedia..The original uploader was Mariegriffiths at English Wikipedia., CC BY-SA 3.0 http://creativecommons.org/licenses/by-sa/3.0/, via Wikimedia Commons 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 symptomsItchy rash on one side of the face, arm, or bodyBurning skinMuscle ache on one side of the bodySensitive skin on one side of the bodySevere 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 BathsCorn starch bathCorn 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’sAvoid saunas or steam rooms Corneal Burn A corneal burn can occur if a chemical gets into the eye. Symptoms of a Corneal Burn Painful EyeRed EyeWatery eyeBlurred visionLight sensitivity Treatment of a Corneal Burn Remove Contact lenses immediatelyRinse the eye with Saline or cool water for 15 minutesSee an eye doctor as soon as possibleAntibiotic eye dropsSteroid 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 eyeRed-eyeWatery eyeHard 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.