Eye pain/discomfort

Eye pain can result from surface irritation, infections, or deeper ocular and systemic conditions. Some causes are mild and self-limiting, while others are emergencies that threaten vision. Understanding the differentials and when to refer 🚨 is vital in clinical practice.

🔹 Conjunctivitis (Viral / Bacterial / Allergic)

• Tests: 👓 Clinical exam, slit-lamp; conjunctival swab if infection suspected.
• Presentation: Red, watery or sticky eyes, mild irritation, crusting in bacterial cases, itching in allergic cases.
• Management:
  • 👾 Viral → Supportive (cold compresses, lubricants).
  • 🦠 Bacterial → Topical antibiotics (erythromycin, chloramphenicol, tobramycin).
  • 🌼 Allergic → Antihistamine drops, lubricants, allergen avoidance.

🔹 Corneal Abrasion

• Tests: 🔦 Fluorescein staining under cobalt blue light, check for FB under eyelid.
• Presentation: Sharp pain, photophobia 🌞, foreign body sensation, tearing.
• Management: Antibiotic ointment 💊, pain relief, avoid contact lenses 👓 until healed.

🔹 Dry Eye Syndrome

• Tests: 💧 Schirmer’s test (tear production), slit-lamp (tear film stability).
• Presentation: Gritty eyes, fluctuating blurred vision, worse on screen use 📱 or in dry environments.
• Management: Artificial tears, warm compresses, lid hygiene; punctal plugs or cyclosporine in severe cases.

🔹 Glaucoma (Acute Angle Closure)

• Tests: 📈 Tonometry (↑ IOP), gonioscopy, fundus exam for optic nerve cupping.
• Presentation: Sudden severe pain 🚨, headache, nausea 🤢, halos around lights, blurred vision.
• Management: Emergency → IV acetazolamide 💉, topical beta-blockers, pilocarpine, definitive laser iridotomy.

🔹 Uveitis / Iritis

• Tests: 🔍 Slit-lamp (cells and flare), IOP measurement, autoimmune screen (HLA-B27, ANA, syphilis serology).
• Presentation: Aching pain, photophobia, blurred vision, small irregular pupil.
• Management: Corticosteroid eye drops 👁️, cycloplegics (atropine), treat systemic disease if present.

🔹 Optic Neuritis

• Tests: Ophthalmoscopy (± swollen disc), visual field loss, MRI brain/orbits (check for MS).
• Presentation: Subacute painful vision loss, worse on eye movement, colour desaturation (red looks washed out).
• Management: IV corticosteroids 💉, neurologist input, MS screening.

🔹 Foreign Body in Eye

• Tests: Lid eversion 👁️, fluorescein staining, slit-lamp exam.
• Presentation: Sharp pain, FB sensation, tearing, photophobia.
• Management: Irrigation 💦, sterile swab removal, topical antibiotics, pain relief.

🔹 Sinusitis (Referred Eye Pain)

• Tests: 👃 Clinical exam (sinus tenderness), CT sinuses if chronic.
• Presentation: Dull periocular ache, nasal congestion, fever 🤒, worse on bending forward.
• Management: Antibiotics (if bacterial), saline irrigation, NSAIDs, decongestants.

🔹 Scleritis

• Tests: 🔬 Slit-lamp, autoimmune blood tests (RA, GPA, SLE).
• Presentation: Severe boring pain (worse at night), violet hue sclera, reduced vision.
• Management: Systemic NSAIDs, corticosteroids, immunosuppressants; urgent rheumatology referral.

🚨 Red Flag Symptoms (Urgent Ophthalmology Referral)

• Sudden vision loss 👁️❌
• Severe pain not relieved by simple measures
• Halos around lights 🌈 or acute blurred vision
• Photophobia + small irregular pupil (iritis)
• Foreign body suspected but not visible / penetrating injury ⚔️
• Systemic associations (autoimmune disease, MS suspicion)

📌 Summary

Most causes of eye pain are benign (like conjunctivitis 🌼), but conditions such as acute glaucoma, uveitis, or optic neuritis require urgent action 🚨. Always check vision, pupillary responses, and red flag signs. When in doubt → refer early to ophthalmology.