Why Does My Eye Hurt When I Blink?

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Overview

Many things can cause your eye to hurt when you blink. Most will clear up quickly on their own or with some treatment. A few, however, may be serious and require emergency medical attention.

Learn more about why your eye hurts when you blink and what you can do to ease the pain.

Common causes for eye pain when you blink include dry eyes, a stye, or pink eye (conjunctivitis). More serious conditions that can cause your eye to hurt when you blink include glaucoma or optic neuritis.

You should see your doctor if symptoms don’t ease within 48 hours or at-home remedies aren’t effective and the pain gets worse. If the condition is more serious than a simple infection or irritation of your eye, you will need medical attention quickly.

Pain when blinking is often only one symptom of a problem. Others may appear, too. If your eye pain isn’t caused by an obvious injury or condition, other symptoms can help you and your doctor understand what is causing the pain.

These symptoms include:

• pain when moving your eyes
• pressure in your eyes
• inflammation of your eyelid or eyelash follicles
• pain or sensitivity when exposed to light
• tenderness around your eyes (the sinuses)

When it’s a medical emergency

If you experience the following symptoms when you blink, you should seek emergency medical treatment:

• unbearable pain
• impaired vision
• severe pain when touching your eye
• vomiting or abdominal pain
• appearance of halos around lights
• difficulty closing your eyelids entirely because your eye is bulging outward

If you’re experiencing any of these symptoms, or if the pain and symptoms remain after you gently flush your eyes with water or saline, call 911 or visit an emergency room right away.

Learn more: First aid for eye injuries »

Eye pain when you blink isn’t always a sign of a bigger problem. It can be irritating but isn’t always dangerous. However, that doesn’t mean you shouldn’t take treatment seriously.

If you don’t get treatment for any underlying infections, injuries, or inflammation, your symptoms could last longer than necessary. The symptoms may grow more severe, too. This can lead to additional complications.

Complications of not treating an eye issue properly include:

• permanent damage to your cornea or eyelids
• permanent vision changes, including partial or entire loss of vision
• a more widespread infection

If the cause of your eye pain isn’t obvious, your doctor may need to run tests or conduct an exam. A general family doctor can prescribe medications for many of the most common causes of eye pain. These include pink eye, styes, and dry eyes.

Your general practitioner may recommend you see an ophthalmologist, an eye doctor, if they believe the issue is more serious and may require special tests and treatments. Ophthalmologists have specialized equipment that can help them detect the pressure inside your eyeballs. If the pressure is building dangerously fast, an ophthalmologist will be helpful in reaching a diagnosis and beginning treatment quickly.

Eye pain is often temporary. But if common treatments, including painkillers, eye drops, or a warm compress, don’t reduce your symptoms, you should call your doctor. If symptoms significantly worsen or the number of symptoms grows in a brief window of time, you should seek emergency medical treatment.

Once your doctor diagnoses an underlying cause, treatment can begin immediately. Treatments for eye pain are very effective.

You can help prevent future eye health problems by taking these steps:

Ocular Neuropathic Pain – StatPearls

Continuing Education Activity

Ocular neuropathic pain is a diagnosis of exclusion which refers to the heightened perception of pain in response to normally non-painful stimuli. It usually presents without any visible objective exam findings, making it extremely difficult to identify. For this reason, it is often misdiagnosed as dry eye disease. This activity describes the etiology, epidemiology, evaluation, treatment, and management of ocular neuropathic pain. This activity also highlights the role of the interprofessional team in the recognition and management of this condition.

Objectives:

• Explain the etiology of ocular neuropathic pain.

• Review the presentation of a patient with ocular neuropathic pain.

• Describe the current treatment options available for ocular neuropathic pain.

• Summarize interprofessional team strategies for improving the outcomes of patients suffering from ocular neuropathic pain.

Access free multiple choice questions on this topic.

Introduction

Ocular neuropathic pain is a diagnosis of exclusion which refers to the heightened perception of pain in response to normally non-painful stimuli. It usually presents without any visible objective exam findings, making it extremely difficult to identify. [1] For this reason, it often gets misdiagnosed as dry eye disease.

Ocular neuropathic pain may present with accompanying visible damage to tissue; however, it can also occur as a result of a physiological dysfunction of the nervous system.[1] With other corneal pathologies, the intensity of corneal pain often correlates with vital dye staining. However, in patients with ocular neuropathic pain, symptoms are severe and unaccompanied by equivalent signs, which is why ocular neuropathic pain is sometimes referred to as “corneal pain without stain” or “phantom cornea.”[2] This is the ocular analog of complex regional pain syndrome, systemic neuropathic pain, or reflex sympathetic dystrophy.

Other names for this condition include, but are not limited to corneal neuropathic pain, corneal neuralgia, ocular pain syndrome, keratoneuralgia, corneal neuropathic disease, and corneal allodynia.

Ocular neuropathic pain is an important differential to consider because many patients get misdiagnosed due to its significant overlap with dry eye disease. The disparity between signs and symptoms often results in patients being dismissed or considered malingering, hysterical, or psychosomatic.[3] As demonstrated by case reports, patients with extreme cases of this condition have even committed to suicide due to the severity of chronic pain.[4] An important first step in treating ocular neuropathic pain is to communicate the belief that the condition and the symptoms are real.[2]

The objective of this article is to provide a summary of the condition and review approaches for its treatment and management, as well as increase awareness of this underrecognized disease.

Etiology

Ocular neuropathic pain can result from injury to or disease of peripheral corneal nerves.[1] The healing process results in aberrant regeneration and upregulation of nociceptors in the corneal nerves, which leads to hyper-responsivity and an increased perception of pain to ordinarily non-painful stimuli.[5] Ocular neuropathic pain may also result from a variety of systemic conditions which alter the somatosensory pathway. [1]

A comprehensive list of potential underlying causes that can lead to or have been associated with ocular neuropathic pain and trigger the heightened pain response to non-noxious stimuli are listed below in Table 1 (adapted from Dieckmann et al.).[1][2][6]

Epidemiology

As stated in the above table, ocular neuropathic pain has many systemic associations. The four most common are depression, anxiety, fibromyalgia, and headache.[1] Following these are diabetes, celiac disease, HIV, and idiopathic small fiber neuropathies.[1]

The proportion of females with ocular neuropathic pain is higher than men.[7] Females also tend to have a higher incidence of associated conditions such as fibromyalgia and autoimmune diseases. While autoimmune diseases affect between 5 to 8% of the population, 78% of the affected are women.[7] This association may be contributory to the higher incidence of ocular neuropathic pain in women.

Pathophysiology

The human cornea is often referred to as one of the most potent pain generators in the human body. [6] Unsurprisingly, it is also among the most densely innervated tissues with approximately 7000 nerve terminals per square millimeter, making the cornea about 300 to 600 times more sensitive than skin.[6] Corneal nerves carry the sensation of touch, pain, and temperature.[8] Most of the nerves of corneal subbasal plexus are unmyelinated (C fibers) and some are myelinated (Ad fibers).

Corneal nerves detect mechanical, thermal, and chemical stimuli. Input is perceivable as pain or a range of dysesthesias (unpleasant abnormal sensations)[6]:

• Photoallodynia (pain sensation in response to a non-painful stimulus, light)

• Burning

• Irritation

• Dryness

• Grittiness 

Pain protects tissue from injury. Detection of painful stimuli by nociceptors transmits via action potentials to higher order centers where the pain is perceived.[1] Iatrogenic damage, trauma, and inflammation of the ocular surface can result in damage to this system, which may increase the sensitivity of peripheral nerves. [1][3] This increased sensitivity, or peripheral sensitization, intensifies pain signaling. Chronic stimulation can cause sensitization of the central nervous system and thus increased awareness of pain and photoallodynia.[1]

History and Physical

Due to the complexity of mechanisms involved in ocular neuropathic pain, the subjective symptoms of corneal dysesthesia can vary significantly. Patients may describe feelings of burning, aching, boring, hot poker-like fire, foreign body, and photophobia. The symptoms may substantially affect the quality of life of the patients and may cause impaired functioning relative to activities of daily living.

The Ocular Pain Assessment Survey (OPAS) may help evaluate corneal and ocular surface pain as well as its impact on the quality of life.[6] Surveys are useful not only in diagnosing but also in monitoring the efficacy of therapeutic approaches.[3]

Patients may also present with blepharospasm that developed due to chronic corneal nociceptor hyperactivity. [2][9] 

Evaluation

To verify a diagnosis of ocular neuropathic pain, viewing the cornea in vivo using a confocal microscope allows for detection of abnormalities of the corneal nerves.[6] Specific characteristics of the instrument also enable it to be a tool to differentiate among various causes of perceived ocular pain, gauge the relative contributions of central versus peripheral mechanisms, and monitor the success or failure of treatment.[10]

The use of esthesiometers can be used for the detection of mechanical nociceptor responses and allow quantification of nerve fiber functionality.[6] Findings of morphological changes and hypersensitivity of corneal nerves in patients with chronic symptoms suggest the presence of ocular neuropathic pain.[5] 

Since the above diagnostic methods are not readily available to a majority of practitioners, ocular neuropathic pain is often considered a diagnosis of exclusion.

Patients may demonstrate an exaggerated pain response to touch, air, and drops. A thorough case history is paramount to revealing the causation—whether that be the history of refractive or cataract surgery, ocular surface disease, infection, systemic disorders, systemic pain syndromes, etc. Clinicians often dismiss these patients due to the lack of clinical findings.[2]

Initial examination of an ocular neuropathic pain patient resembles a dry eye workup. The ocular surface should be assessed with vital stains, tear production measured via Schirmer test, and tear quality evaluated with tear break up time, tear osmolarity, and/or tear proteomics.[6]

The ocular surface will appear healthy, unlike cases of dry eye which may present with surface staining, abnormal tear osmolarity, etc.[1] When the patient has subjective complaints of corneal pain without objective findings, it should raise suspicion of ocular neuropathic pain. Examiners must keep in mind that it is also possible for dry eye to be comorbid with ocular neuropathic pain and it can be difficult to differentiate these two diagnoses when they present together.  

Distinguishing between central or peripheral pain origins for ocular neuropathic pain can be helpful when determining treatments. A proparacaine challenge test can be used to make this determination.[1][6] If patients experience either complete or partial relief with topical 0.5% proparacaine hydrochloride they likely have peripheral or mixed combined forms, respectively. If no relief or there is a worsening of symptoms, then the patient has central sensitization of pain, which can be very challenging to treat.[1][6]

Treatment / Management

Severe pain sensation and light sensitivity prevent those afflicted with ocular neuropathic pain from performing activities of daily living and is associated with symptoms of anxiety and depression—even suicidal thoughts in extreme cases.[6]  

Treatment strategies encompass several approaches[1][6][3]:

Ocular surface treatment:

• Copious lubrication with artificial tears decreases the hyperosmolarity of tears and halts over-stimulation of corneal nociceptors. Preservative-free tear supplements are preferred if frequent instillation is needed.

• Topical and/or systemic antibiotics along with dietary supplements (omega3 fatty acids) to treat evaporative dry eye and blepharitis

• Bandage contact lenses

• Scleral lenses provide a cushion of fluid over the entire cornea, while some patients experience immediate relief, for some patients, the lenses can trigger pain due to severe hyperalgesia[1] PROSE contact lens (prosthetic replacement of the ocular surface ecosystem) is custom made rigid gas permeable lens with liquid reservoir and may be helpful in post-LASIK neuralgia.

• Compounded lacosamide 0.1% may combine with preservative-free saline inside the bowl of a scleral lens

Anti-inflammatory[6][11][1]:

• Soft steroids such as fluorometholone or loteprednol to dampen surface inflammation

• Topical or oral NSAID agents

• Topical immunomodulators such as cyclosporine 0. 5% or lifitegrast 5% is also an option, but their therapeutic effects are not immediate

• Tacrolimus 0.03% eye drops have been shown to improve tear stability and have an anti-inflammatory effect

• Topical or oral antibiotics such as doxycycline or azithromycin are useful adjunct therapy when meibomian gland dysfunction is present

• Amniotic membranes provide anti-inflammatory, anti-fibrotic, and neurotrophic effects; since not all patients can tolerate the polycarbonate ring of self-retained tissues such as PROKERA, the corneal amniotic membranes can be placed underneath a bandage contact lens

Neuroregeneration:

• Autologous serum tears (20%)- Serum contains various growth factors which play a crucial role in neuroregeneration and healing – these factors include nerve growth factor, transforming growth factor beta, insulin-like growth factor 1, epidermal growth factor, fibronectin, and substance P

Others[12][13][14]:

• Systemic analgesics, tricyclic antidepressants (10 to 15 mg  at bedtime), and antipsychotics to treat associated non-ocular pain

• Anticonvulsants such as carbamazepine (200 mg/day), gabapentin (300 to 900 mg/day) or pregabalin (150 mg/day), which are also used to treat trigeminal neuralgia 

• Low dose naltrexone (1. 5 mg at bedtime), an opioid antagonist used off-label

• Opioid agonists such as tramadol  (50 mg/day) may provide acute relief but require caution due to the potential for dependence

• Vitamin B has proven effective in herpes, diabetic neuropathy, and neuropathic pain

  • Also assists with re-innervation and re-epithelization of the corneal surface – specifically, B12 increases serotonin levels and inhibits nociceptive neuronal activity

Alternative therapies[1][6][1]:

• Acupuncture treatment semi-weekly

• Electrical neurostimulation to treat chronic intractable pain with central sensitization

• Invasive neuromodulation therapies such as deep brain stimulation and Intrathecal analgesic infusions may provide relief for severe, intractable cases of neuropathic pain

Differential Diagnosis

As previously noted, ocular neuropathic pain is a diagnosis of exclusion. The following are essential to rule out[1]:

• Trigeminal neuralgia

• Oculofacial pain

• Referred pain

• Ocular surface disease

• Sinus dysfunction

• Ocular medication toxicity

• Contact lens-related problems

• Corneal disorder (abrasion, erosion, infiltrate, ulcer, etc. )

• Chemical injury

• Trauma

• Uveitis

• Post-herpetic neuralgia

Take, for example, ocular surface disease. The mechanism is as follows: reduced tear secretion leads to inflammation. Inflammation causes sensitization of nociceptive nerve endings, which leads to feelings of dryness and pain. In the long term, inflammation and nerve injury alter gene expression within the trigeminal ganglion, propagating ocular dysesthesias and neuropathic pain.[10] It is easy to see how this particular differential diagnosis is often a misdiagnosis of ocular neuropathic pain.

Prognosis

The prognosis of patients with ocular neuropathic pain dramatically varies. Patients often have chronic symptoms requiring a multimodal treatment approach.[2][6] Early interventions yield better outcomes.

Complications

For reasons other than the obvious, treatment and management of chronic pain is an arduous task. Patients with chronic pain become increasingly anxious about it, and anxiety correlates with increased susceptibility to pain–a vicious cycle. [3] Chronic pain is not only psychologically taxing but physically as well. Studies have found comorbidity with many other conditions such as chronic fatigue, joint pain, and depression.[15] 

Deterrence and Patient Education

Preventative screenings for certain risk factors, including autoimmune diseases and systemic pain conditions, should be considered before planning refractive surgeries such as LASIK. This approach may reduce the risk of subsequent development of ocular neuropathic pain.[3] Additionally, since patients suffering from more severe cases of ocular neuropathic pain also more frequently report overlapping psychiatric disease, screening for pre-existing personality disorders which could predispose a patient to depression and suicidal thoughts are equally important.[16] Healthy-minded individuals are more equipped to cope with chronic pain for longer while they seek treatment and are less likely to resort to self-harm.

Patients with ocular surface disease indicated higher pain responses at non-ocular sites such as the forearm compared to those without the condition, which would indicate that patients with the ocular surface disease have a lower systemic pain threshold, as is consistent with central sensitization in dry eye patients. [5] 

To reiterate, an important first step in treating ocular neuropathic pain is to communicate the belief that the condition is real.[2] The second is to actively screen for it.

Pearls and Other Issues

• Dry eye patients who fail to respond to dry eye treatments and have persistent symptoms without objective findings warrant further investigation

• An important first step in treating ocular neuropathic pain is to communicate the belief that the disease is real, as there is often a psychological component associated with this chronic pain

• Ocular neuropathic pain is a diagnosis of exclusion; a thorough case history is important along with an examination of ocular health

Enhancing Healthcare Team Outcomes

Given the challenges in both diagnosis and treatment of ocular neuropathic pain, the best approach to this condition is with an interprofessional team consisting of physicians, specialists (including neurology, psychiatry, rheumatology, ophthalmology and optometry), specialty-trained nursing, and when appropriate, pharmacists and psychological personnel, all communicating across disciplines to direct the case towards optimal clinical results. [Level V]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Causes of ocular neuropathic pain. Image courtesy S Bhimji MD

References

1.

Dieckmann G, Goyal S, Hamrah P. Neuropathic Corneal Pain: Approaches for Management. Ophthalmology. 2017 Nov;124(11S):S34-S47. [PMC free article: PMC5743225] [PubMed: 29055360]

2.

Rosenthal P, Baran I, Jacobs DS. Corneal pain without stain: is it real? Ocul Surf. 2009 Jan;7(1):28-40. [PubMed: 19214350]

3.

Jacobs DS. Diagnosis and Treatment of Ocular Pain: the Ophthalmologist’s Perspective. Curr Ophthalmol Rep. 2017;5(4):271-275. [PMC free article: PMC5711963] [PubMed: 29226029]

4.

Theophanous C, Jacobs DS, Hamrah P. Corneal Neuralgia after LASIK. Optom Vis Sci. 2015 Sep;92(9):e233-40. [PubMed: 26154691]

5.

Galor A, Levitt RC, Felix ER, Martin ER, Sarantopoulos CD. Neuropathic ocular pain: an important yet underevaluated feature of dry eye. Eye (Lond). 2015 Mar;29(3):301-12. [PMC free article: PMC4366454] [PubMed: 25376119]

6.

Goyal S, Hamrah P. Understanding Neuropathic Corneal Pain–Gaps and Current Therapeutic Approaches. Semin Ophthalmol. 2016;31(1-2):59-70. [PMC free article: PMC5607443] [PubMed: 26959131]

7.

Fairweather D, Frisancho-Kiss S, Rose NR. Sex differences in autoimmune disease from a pathological perspective. Am J Pathol. 2008 Sep;173(3):600-9. [PMC free article: PMC2527069] [PubMed: 18688037]

8.

Shaheen BS, Bakir M, Jain S. Corneal nerves in health and disease. Surv Ophthalmol. 2014 May-Jun;59(3):263-85. [PMC free article: PMC4004679] [PubMed: 24461367]

9.

Belmonte C, Acosta MC, Merayo-Lloves J, Gallar J. What Causes Eye Pain? Curr Ophthalmol Rep. 2015;3(2):111-121. [PMC free article: PMC4432221] [PubMed: 26000205]

10.

Belmonte C, Nichols JJ, Cox SM, Brock JA, Begley CG, Bereiter DA, Dartt DA, Galor A, Hamrah P, Ivanusic JJ, Jacobs DS, McNamara NA, Rosenblatt MI, Stapleton F, Wolffsohn JS. TFOS DEWS II pain and sensation report. Ocul Surf. 2017 Jul;15(3):404-437. [PMC free article: PMC5706540] [PubMed: 28736339]

11.

Moscovici BK, Holzchuh R, Chiacchio BB, Santo RM, Shimazaki J, Hida RY. Clinical treatment of dry eye using 0.03% tacrolimus eye drops. Cornea. 2012 Aug;31(8):945-9. [PubMed: 22511024]

12.

Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015 Jul 06;2015(7):CD008242. [PMC free article: PMC6447238] [PubMed: 26146793]

13.

Derry S, Wiffen PJ, Aldington D, Moore RA. Nortriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015 Jan 08;1(1):CD011209. [PMC free article: PMC6485407] [PubMed: 25569864]

14.

Pakravan M, Roshani M, Yazdani S, Faramazi A, Yaseri M. Pregabalin and gabapentin for post-photorefractive keratectomy pain: a randomized controlled trial. Eur J Ophthalmol. 2012;22 Suppl 7:S106-13. [PubMed: 22577038]

15.

Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 Mar;152(3 Suppl):S2-S15. [PMC free article: PMC3268359] [PubMed: 20961685]

16.

Crane AM, Levitt RC, Felix ER, Sarantopoulos KD, McClellan AL, Galor A. Patients with more severe symptoms of neuropathic ocular pain report more frequent and severe chronic overlapping pain conditions and psychiatric disease. Br J Ophthalmol. 2017 Feb;101(2):227-231. [PMC free article: PMC5575758] [PubMed: 27130915]

Disclosure: Majid Moshirfar declares no relevant financial relationships with ineligible companies.

Disclosure: Erin Benstead declares no relevant financial relationships with ineligible companies.

Disclosure: Paige Sorrentino declares no relevant financial relationships with ineligible companies.

Disclosure: Koushik Tripathy declares no relevant financial relationships with ineligible companies.

Eye diseases in dogs, causes, symptoms, treatment

For many diseases, early diagnosis and treatment are key to maintaining and restoring vision.

Causes of eye diseases

The dog’s eyes perform an important function – they convert reflected light into nerve impulses that the brain uses to form images of the world. For this, all parts of the eye must be healthy.

However, there are some reasons why vision may suffer:

● Heredity.

● Age.

● Disorders of the immune system.

● Metabolic abnormalities.

● Infections, parasites.

● Injuries.

Diseases of the structures of the eye, eyelids, and surrounding tissue can be accompanied by discomfort and/or loss of vision, which subsequently interferes with your dog’s normal life and impairs its quality.

Eye symptoms

The best way to protect your dog’s vision is to catch eye conditions early, when they are most easily treated. Signs of vision problems:

● The dog scratches the eyelids or eyes;

● squints;

● Bumps into objects;

● Afraid of the dark or frightened in situations that did not frighten her before;

● Discharge may appear from the dog’s eyes. They can be transparent, cloudy, different shades;

● Eyelids may be swollen;

● The eyeball may appear red;

● Obvious damage to the structures of the eye: scratches, ulcers;

● Clouding of the lens or cornea;

● Loss of vision;

● The third eyelid may partially cover the eye.

Most common eye diseases

Diseases of the structures of the visual apparatus cannot be treated lightly. The consequences can be deplorable – chronic pain and blindness.

Let’s take a look at some of the most common vision problems that dogs face and how to deal with them.

Horner’s syndrome

Horner’s syndrome is a collection of clinical signs that are often seen together, arising from damage to the sympathetic nerve leading to the eye:

● Constricted pupil that does not dilate (miosis)

● Drooping of the upper eyelid (ptosis)

● Sunken eye (enophthalmos)

● Rise of the third century

These symptoms are painless, although they may interfere with vision due to a raised third eyelid. Treatment consists in eliminating the causes of the syndrome.

Proptosis

The eyeball and its supporting muscles and ligaments are located in the orbit (orbit). Eye proptosis in dogs is when the eyeball partially or completely protrudes from the orbit.

Dog breeds with protruding eyes, a short muzzle and nose are more prone to this eye disease. Common brachycephalic dogs that are prone to eye proptosis are:

● Pekingese

● Pug

● Boston Terrier

● Chihuahua

● Lhasa Apso

● French Bulldog

● Shih Tzu

If your dog’s eye is misaligned, it should be examined by a veterinarian as soon as possible. It is important to remain calm. The eye dries quickly, so it is recommended to cover it with sterile gauze with saline or contact lens solution.

Be aware that your dog is in a lot of pain and may not behave as usual. Pain, stress and fear can make any animal behave unpredictably. It is recommended to use a carrier for transporting a small dog. Thus, the pet will be in a safe and enclosed space. When transporting an immobile, injured larger dog, a blanket, beach towel, blanket, or board can be used as a stretcher. Try to keep movement to a minimum to prevent further damage to the eye.

Lachrymation (epiphora)

Lachrymation leading to coat staining and skin infection can be the result of many conditions, including abnormally positioned eyelashes, inflammation of eye structures, allergies, corneal ulcers, nasolacrimal duct obstruction, and so on.

Treatment for excessive tearing depends on what is causing it and may include:

● Local antibiotics or steroids for inflammation of the tear ducts;

● Antibiotics and other topical medications for corneal damage;

● Surgery for blocked ducts, ulcers, or abnormal eyelashes.

Conjunctivitis

Mucus, yellow-green pus, or watery discharge from the eyes can be signs of conjunctivitis, an inflammation of the lining of your dog’s eye. There is a wide range of causes for this condition, from allergies, trauma, birth defects, and tear duct problems to foreign bodies, plague, or even tumors. Other signs of conjunctivitis include red eyes, frequent blinking, strabismus, pawing at the eyelids, or closing the eyes.

To treat conjunctivitis, it’s important to know what’s causing it. Depending on the cause, therapy may include:

● Removing the irritant and soothing the area with painkillers; antibiotics and saline solutions to fight infection;

● Surgery to treat duct diseases or birth defects;

● Antihistamines for allergies.

Keratoconjunctivitis sicca

Dry keratoconjunctivitis occurs when your dog’s body doesn’t produce enough tears to lubricate the eyeball and other eye structures. When tear fluid is not released, the surface of the eye becomes irritated. Ulcers can form, and in severe cases, the disease leads to perforation of the eyeball itself. In chronic cases of dry keratoconjunctivitis, scarring can form on the surface of the cornea, which becomes cloudy and dull, and the dog’s vision deteriorates.

Some breeds are more susceptible to dry eyes than others, such as Yorkshire Terriers and Pugs.

In addition to cloudy eyes, there are other symptoms of dry keratoconjunctivitis. These include mucous discharge, redness around the whites, swelling of eyelid tissue, and strabismus or excessive blinking. This disease is often associated with autoimmune inflammation of the lacrimal glands and can be chronic, troubling the dog throughout its life. Diagnosis includes an examination and a test to measure lacrimation.

Fortunately, keratoconjunctivitis sicca can usually be treated with tear replacement drugs and topical antibiotics, and in severe cases, surgical options are available to increase tear production.

Blepharitis

Blepharitis is inflammation of the eyelids of one or both eyes. It occurs as a result of trauma, infection, disruption of the meibomian glands, allergies, parasitic diseases.

Symptoms:

● Severe swelling and redness of the lower and upper eyelids

● Hair loss around the eyes

● Ulcers and wounds on the surface of the eyelid

● Itching

● Soreness

● Squinting eyes

● Photophobia

Treatment consists in eliminating the root cause, local administration of antimicrobial, anti-inflammatory drugs. Sometimes systemic therapy is required.

Eyelid volvulus

Inversion of the eyelid (entropion) is a disorder in which the eyelashes or the edge of the eyelid permanently injure the cornea of ​​the eye. This happens due to deformation of the eyelid in the central or in the corner. The cause of entropion can be a breed predisposition, heredity or injury.

Most often, inversion of the eyelids occurs in spaniels, English bulldogs, poodles, sharpei.

Treatment is surgical only.

Eyelid eversion

Eyelid eversion is the turning of the edge of the eyelids outwards. The causes of the pathology are the same as with volvulus, it can also occur due to senile muscle weakness.

The main symptoms include:

● Sagging of the ciliary edge of the eyelids;

● Chronic conjunctivitis;

● Lachrymation.

Surgical treatment.

Corneal ulcer

A corneal ulcer is a slowly healing ulcer on or in a dog’s cornea that is accompanied by inflammation. Most of these injuries result from trauma, and antibiotics are often used to treat them. Small dog breeds with very short noses and large eyeballs are more prone to injury. In severe cases, surgical removal of the problem is required.

Uveitis

Anterior uveitis is an inflammation of the choroid of the eye. This is a serious disease that can lead to permanent loss of vision.

Symptoms of anterior uveitis include redness, discharge, strabismus, an unusually shaped pupil, swelling of the eyeball, excessive tearing, and cloudiness or dullness.

This painful condition can have a number of causes, including autoimmune disease, cancer, trauma, metabolic disorders, parasites, and fungal, viral, and bacterial infections. To narrow down the causes, a veterinary ophthalmologist performs a series of diagnostic tests. Treatment will depend on may include eye drops, ointments, and oral medications.

Ulcerative keratitis

Ulcerative keratitis results from keratoconjunctivitis sicca, injury from rubbing or scratching of the eye, bacterial or viral infections, or other ophthalmic problems such as drooping eyelids or dystichia (problematically located fur).

As it develops, corneal ulcers may appear bluish, reddish, or just a haze on the surface of your dog’s eye. Like other serious problems, keratitis can be painful and is often accompanied by discharge and strabismus.

To diagnose a corneal ulcer, a veterinarian will use a fluorescein stain test and sometimes samples will be taken for culture. Ulcers are usually treated with medicated drops to prevent infection and relieve pain, and in severe cases, surgery may be required to save your dog’s eye, so it’s best to take your pet to the vet as soon as you notice signs of eye discomfort, such as squinting or rubbing your eye with your paw. .

Glaucoma

Glaucoma is an increase in intraocular pressure with loss of vision. The disease in most cases is painful. Signs of glaucoma include:

● Redness

● Turbidity

● Lachrymation

● Loss of vision

● Enlargement of the eyeball

● Unusual aggressiveness

● Lethargy

● Loss of appetite

Normal physiology requires aqueous humor to form in one structure behind the pupil (the ciliary body), pass through the pupil, and exit the space between the cornea and the iris. When the fluid cannot flow out properly, the pressure in the eye increases. Some patients have primary glaucoma when there is no comorbidity, secondary causes of glaucoma include: inflammation, trauma, and tumors. All of these factors can prevent fluid from draining from the eye. Treatment of glaucoma consists in the appointment of drops to reduce pressure.

Cataract

A cataract in dogs is a clouding of the lens of the eye. Many people mistakenly think that the lesion is on the surface (considered to be a “film” on the eye), but the clouding is actually deep inside the eyeball. The lens of a dog is located behind the iris and pupil. As your pet approaches 8-10 years of age, the lens naturally becomes cloudier (blue-gray) due to the aging process. This is not the same as a cataract, which is usually white. The change associated with aging is called nuclear sclerosis and makes it difficult to focus on close-up objects. Cataracts associated with diabetes mellitus also occur in dogs.

To eliminate this disease, a surgical operation is used – phacoemulsion.

If your dog is injured or if you notice any of the symptoms of eye disease, we recommend that you take immediate action. At Dobrye Ruki Veterinary Clinic, we provide high-level ophthalmological care around the clock. Instant diagnostic tests are available for your pets. The specialists of the clinic select an individual treatment for each animal: therapy, surgery and eye microsurgery.

EYES AND THYROID – Article I Clinic for Evidence-Based Medicine NEPLACEBO

Author –
Shvedova Anna Evgenievna

08/30/2018

“Doctor, won’t my eyes pop out?” – such a question is often heard at the reception by endocrinologists from patients with various diseases of the thyroid gland.

😕 Many have heard something about eye damage in diseases of the thyroid gland. Someone saw how the neighbor’s eyes changed due to illness, someone remembers the photo of N.K. Krupskaya . . Of course, people are worried about a possible change in appearance, and not for the better. How are the eyes and thyroid connected?

✏ Thyroid diseases are many and varied. One of the most common diseases is called diffuse toxic goiter, or Graves’ disease. This is an autoimmune disease – for some, not fully understood, reason, the body begins to attack its own thyroid gland. In this disease, the immune system produces antibodies that stimulate the thyroid gland (antibodies to the TSH receptor), and it begins to produce too many hormones. These same antibodies, especially if their level is significantly elevated, can “attack” the tissues of the eye and orbit (fatty tissue around the eyeball and the muscles that move the eye), and lead to an autoimmune disease of the eye and orbit tissues (this is called endocrine ophthalmopathy). Eye damage can occur simultaneously with thyroid dysfunction, may precede it, and may develop after the diagnosis of Graves’ disease, and sometimes after radical treatment (surgery or radioiodine therapy).

✏ Inflammation and swelling occurs, the volume of fatty tissue and muscles increases, and the space in the eye socket is limited, because its walls are made of bones and cannot move apart. Therefore, with swelling and thickening of the tissues behind the eye, a protrusion of the eyeball can occur – the so-called exophthalmos. In mild cases, the patient feels discomfort, “sand” in the eyes, the whites of the eyes may turn red, the eyelids may swell. With a more severe lesion, these symptoms are accompanied by pain in the eyeballs and protrusion of the eyes (less often – one eye), the upper eyelids rise, and there is a so-called “angry look” – the eyes are excessively open, as in anger or fear. Sometimes a person cannot close their eyelids completely; in severe cases, compression of the optic nerve occurs, which leads to decreased vision. Severe eye damage, of course, requires treatment.

😲 That was the scary part.

🙂 Now, the good news.

🙂 If you have nodules in the thyroid gland, or postpartum thyroiditis has occurred, or there is a diffuse non-toxic goiter (enlargement of the thyroid gland without dysfunction) – the eyes will not “pop out”. These are not the diseases in which endocrine ophthalmopathy should be feared. Eye involvement is VERY rare in people with autoimmune thyroiditis. So hypothyroidism and autoimmune thyroiditis are also no reason to worry about the eyes.

🙂 Another good news. If you have DTG (diffuse toxic goiter, Graves’ disease), then this does not mean that there will definitely be something wrong with your eyes. Ophthalmopathy occurs in only 20-50% of patients with Graves’ disease, and most cases are mild and do not require serious treatment.

📌 If the diagnosis of DTG has already been established, then the main thing that you can do to prevent eye damage is to stop smoking, including passive smoking. No one knows exactly why, but smoking is a powerful risk factor for the development and progression of ophthalmopathy. Another way to prevent is to maintain the level of thyroid hormones within normal limits (for this you need to find a competent doctor and make joint efforts). Both excess and lack of hormones provoke the development of endocrine ophthalmopathy in patients with DTG.