What is neuropathic corneal pain. How does it differ from dry eye disease. What are the common symptoms of neuropathic corneal pain. What causes this condition. How is neuropathic corneal pain diagnosed. What treatment options are available for managing neuropathic corneal pain. Can neuropathic corneal pain be prevented.

Understanding Neuropathic Corneal Pain: A Complex Eye Condition

Neuropathic corneal pain, also known as corneal neuralgia, is a challenging eye condition characterized by heightened sensitivity and pain in the eyes, face, or head. This disorder often results from nerve damage to the cornea combined with inflammation, leading to a malfunction in the nervous system. Despite its significant impact on patients’ quality of life, neuropathic corneal pain is frequently misdiagnosed as dry eye disease, potentially delaying proper treatment and exacerbating symptoms.

Key Characteristics of Neuropathic Corneal Pain

• Hypersensitivity in the eye area
• Persistent pain not alleviated by conventional dry eye treatments
• Potential involvement of surrounding facial areas
• Often mistaken for dry eye disease

Does neuropathic corneal pain only affect the eyes? No, the condition can extend beyond the ocular region. Due to shared nerve supplies, patients may experience discomfort in the face, ears, or head, making diagnosis and treatment more complex.

Recognizing the Symptoms of Neuropathic Corneal Pain

Identifying neuropathic corneal pain can be challenging due to its overlap with other eye conditions. However, understanding the distinct symptoms is crucial for early diagnosis and effective management.

Common Symptoms

• Ocular pain
• Photosensitivity
• Foreign body sensation
• Burning sensation
• Severe eye dryness

Are the symptoms of neuropathic corneal pain always confined to the eyes? Not necessarily. The condition can manifest as pain or aching in the face, ears, or head due to shared nerve pathways with the cornea.

It’s important to note that while symptoms may resemble dry eye disease, patients with neuropathic corneal pain often do not show signs of dryness during eye examinations and typically do not respond well to standard dry eye treatments.

Exploring the Causes of Neuropathic Corneal Pain

Neuropathic corneal pain can arise from various factors, all of which result in damage to the corneal nerves. Understanding these causes is essential for both prevention and targeted treatment approaches.

Common Causes and Risk Factors

• Complications from eye surgeries (e.g., LASIK, cataract surgery)
• Chronic dry eye disease
• Radiation therapy
• Extended contact lens wear
• Toxicity from eye drop preservatives
• Shingles
• Diabetes
• Trigeminal neuralgia
• Systemic conditions leading to nerve damage

Can neuropathic corneal pain develop spontaneously? While it’s rare, some cases of neuropathic corneal pain may occur without a clear triggering event. However, most cases are associated with identifiable causes or risk factors.

It’s worth noting that damaged nerves typically regenerate on their own. However, untreated inflammation can heighten nerve sensitivity, potentially leading to inappropriate signal transmission between the eye and the brain. This mechanism is similar to phantom pain experienced by amputees.

The Connection Between Neuropathic Corneal Pain and Other Health Conditions

Research suggests that neuropathic corneal pain may have a higher prevalence among individuals with certain neurological or psychiatric conditions. This potential link underscores the complex nature of the disorder and the need for a comprehensive approach to diagnosis and treatment.

Associated Conditions

• Anxiety
• Depression
• Chronic migraines
• Recurrent headaches
• Fibromyalgia
• Autoimmune diseases

Does having one of these conditions guarantee the development of neuropathic corneal pain? No, the presence of these conditions does not necessarily lead to neuropathic corneal pain. However, they may increase the risk or complicate the management of the eye condition.

It’s important to note that more research is needed to fully understand and confirm these associations. Patients with neuropathic corneal pain and coexisting health conditions may benefit from a multidisciplinary approach to treatment.

Diagnosing Neuropathic Corneal Pain: Challenges and Techniques

Accurate diagnosis of neuropathic corneal pain can be challenging due to its similarity to other eye conditions, particularly dry eye disease. However, specialized diagnostic techniques can help differentiate this condition from others.

Diagnostic Process

1. Clinical suspicion based on symptoms and lack of response to conventional dry eye treatments
2. Confocal microscopy to identify nerve abnormalities
3. Evaluation by an ophthalmologist or neurologist specializing in corneal disorders

Is confocal microscopy widely available for diagnosing neuropathic corneal pain? Unfortunately, the specialized microscopes required for confocal microscopy are not available in all medical practices. Patients may need to seek care at academic centers or large multi-specialty private practices to access this diagnostic tool.

Dr. Pedram Hamrah, an ophthalmologist and corneal specialist at Tufts Medical Center, emphasizes the importance of persistence in seeking a proper diagnosis: “Often, people with neuropathic corneal pain are told that what they are feeling is ‘in their head.’ It is important that these individuals do not give up, but instead seek another opinion.”

Treatment Approaches for Neuropathic Corneal Pain

Managing neuropathic corneal pain requires a multifaceted approach aimed at addressing both nerve regeneration and inflammation reduction. Treatment strategies may vary depending on the severity of the condition and individual patient factors.

Common Treatment Options

• Autologous serum tears (eye drops made from the patient’s own blood)
• Low-dose anti-inflammatory steroids
• Amniotic membrane lenses
• Neurostimulation techniques
• Blue filter glasses
• Systemic neuro-modulatory therapies
• Topical recombinant corneal nerve growth factor

Are all treatments for neuropathic corneal pain equally effective? No, the efficacy of treatments can vary among patients. A personalized treatment plan, often combining multiple approaches, is typically necessary for optimal management of the condition.

Dr. Hamrah advises that early diagnosis and treatment are crucial for the best outcomes. The sooner a patient receives appropriate care, the higher the chances of achieving complete relief from neuropathic corneal pain.

Living with Neuropathic Corneal Pain: Coping Strategies and Support

Dealing with neuropathic corneal pain can be challenging, both physically and emotionally. Developing effective coping strategies and seeking appropriate support can significantly improve quality of life for individuals affected by this condition.

Coping Strategies

• Educating oneself about the condition
• Adhering to prescribed treatment plans
• Practicing good eye hygiene
• Managing stress through relaxation techniques
• Maintaining a healthy lifestyle
• Seeking support from friends, family, or support groups

Can lifestyle modifications help manage neuropathic corneal pain? Yes, certain lifestyle changes can complement medical treatments and help alleviate symptoms. These may include adjusting screen time, using proper lighting, and avoiding triggers that exacerbate discomfort.

It’s important for patients to communicate openly with their healthcare providers about their symptoms, concerns, and the effectiveness of their current treatment regimen. Regular follow-ups and adjustments to the treatment plan may be necessary to achieve optimal symptom control.

Future Directions in Neuropathic Corneal Pain Research and Treatment

As our understanding of neuropathic corneal pain continues to evolve, researchers and clinicians are exploring new avenues for diagnosis, treatment, and prevention of this challenging condition.

Emerging Areas of Research

• Advanced imaging techniques for earlier and more accurate diagnosis
• Novel pharmacological interventions targeting nerve regeneration and pain modulation
• Personalized medicine approaches based on genetic and molecular profiles
• Non-invasive therapies utilizing cutting-edge technologies
• Integration of artificial intelligence in diagnosis and treatment planning

What role might artificial intelligence play in managing neuropathic corneal pain? AI could potentially assist in early detection of the condition, predict treatment outcomes, and help tailor personalized treatment plans based on vast amounts of patient data and research findings.

As research progresses, it is hoped that new treatments will emerge, offering more effective and targeted options for patients suffering from neuropathic corneal pain. Continued collaboration between researchers, clinicians, and patients will be crucial in advancing our understanding and management of this complex condition.

In conclusion, neuropathic corneal pain represents a significant challenge in the field of ophthalmology, requiring a nuanced approach to diagnosis and treatment. As awareness of this condition grows and research advances, patients and healthcare providers can look forward to improved outcomes and quality of life for those affected by this debilitating disorder.

What Is Neuropathic Corneal Pain?

Neuropathic corneal pain is a condition that causes your eyes, face or head to be over sensitive. It also causes them pain. This condition is also called corneal neuralgia. Doctors don’t know the exact cause of neuropathic corneal pain. They think it results from nerve damage to the cornea combined with inflammation. This combination makes your nervous system not work correctly.

The condition is often misdiagnosed as dry eye disease. Left untreated, it can lead to severe and debilitating pain.

What Is Somatic Symptom Disorder?

Somatic symptom disorder causes extreme distress over pain and other physical conditions. In rare cases, somatic symptom disorder can lead to suicide. If you have somatic symptom disorder, the pain from neuropathic corneal pain can make your disorder worse.

Early diagnosis and treatment of neuropathic corneal pain can improve your outcome.

Neuropathic Corneal Pain Symptoms

Symptoms of neuropathic corneal pain that affect the eyes include:

• pain
• sensitivity to light and air
• foreign body sensation
• burning
• severe dryness in the eyes

Symptoms are not always restricted to the eyes. Areas around the eye share a nerve supply with the cornea. Some patients with this condition can feel pain or aching in the face, ears or head.

Symptoms of neuropathic corneal pain can sometimes overlap with dry eye disease. But patients with neuropathic corneal pain may not show dryness in an eye exam. People with neuropathic corneal pain usually do not respond to conventional dry eye therapies.

Causes of Neuropathic Corneal Pain

Any condition that results in corneal nerve damage can cause neuropathic corneal pain.

A small number of patients can develop the condition as a complication of:

• LASIK
• cataract surgery
• other eye surgeries

Neuropathic corneal pain can also result from:

• chronic dry eye disease
• radiation therapy
• extended contact lens wear
• toxicity from preservatives
• shingles
• diabetes
• trigeminal neuralgia, a chronic condition that causes facial pain
• any systemic condition that can lead to nerve damage

Damaged nerves usually regenerate on their own. But untreated inflammation can make damaged nerves more sensitive. You and your ophthalmologist must address the injury and inflammation. If not, over time they can trigger inappropriate signals transmitted to and from the brain. The resulting pain resembles the phantom pain experienced by amputees.

Neuropathic corneal pain seems more common in patients with existing neurological or psychiatric problems. These conditions include:

• anxiety
• depression
• chronic migraines
• headaches
• fibromyalgia
• autoimmune disease

More research is needed to confirm this connection.

Neuropathic Corneal Pain Diagnosis

Doctors suspect neuropathic corneal pain when dry eye therapies and drops for pain don’t improve symptoms. They use a specific high-powered microscope to perform confocal microscopy to diagnose it. This microscope allows an ophthalmologist or neurologist to see nerve abnormalities. These are special microscopes that many practices don’t have. The technology is available in some academic centers and large multi-specialty private practices. You may need to travel to get this test.

“Often, people with neuropathic corneal pain are told that what they are feeling is ‘in their head.’ It is important that these individuals do not give up, but instead seek another opinion,” says Pedram Hamrah, an ophthalmologist and corneal specialist at Tufts Medical Center.

Neuropathic Corneal Pain Treatment

Treatment for neuropathic corneal pain has two aims:

• to regenerate nerves
• to reduce inflammation that makes nerves more sensitive

Treatments can include:

• eye drops made with the patient’s own blood (autologous serum tears)
• low-dose anti-inflammatory steroids
• amniotic membrane lenses
• neurostimulation
• blue filter glasses
• systemic neuro-modulatory therapies
• topical recombinant corneal nerve growth factor

Other treatments are in development.

Dr. Hamrah advises that the less time from diagnosis to treatment, the more chance a patient has of getting complete relief from neuropathic corneal pain.

Eye discomfort and redness in adults

About this Symptom Checker

Eye discomfort and redness in adults

Find possible causes of eye discomfort and redness based on specific factors. Check one or more factors on this page that apply to your symptoms.

Eye discomfort best described as

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  Achy




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  Dry or itchy




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  Gritty sensation




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  Redness without actual discomfort

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  Sensitivity to light




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  Severe pain




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  Stinging or burning sensation

Appearance of eye includes

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  Bleeding on the surface of the white of the eye




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  Crusted eyelashes after sleeping




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  Excessive tearing




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  Red, painful lump on the eyelid

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  Redness




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  Stringy mucus in or around the eye




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  Swelling around the eye

Vision problem includes

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  Blurred vision




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  Dark, floating spots in vision

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  Vision loss

Triggered by

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  Allergens or other irritants




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  Injury or trauma

Worsened by

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  Dry, warm air




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  Eye movement

Accompanied by

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  Runny or stuffy nose

1. Walls RM, et al. , eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 30, 2017.
2. Palmer J, et al. Abdominal pain mimics. Emergency Medicine Clinics of North America. 2016;34:409.
3. UpToDate. https://www.uptodate.com/contents/search. Accessed Oct. 30, 2017.
4. Zeiter D. Abdominal pain in children. Pediatric Clinics of North America. 2017;64:525.
5. Palmer J, et al. Abdominal pain mimics. Emergency Medicine Clinics of North America. 2016;34:409.
6. Feldman M, et al. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed Oct. 30, 2017.
7. Merck Manual Professional Version. https://www.merckmanuals.com/professional. Accessed Oct. 30, 2017.
8. AskMayoExpert. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
9. Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Nov. 2, 2017.
10. Zitelli BJ, et al., eds. Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Nov. 11, 2017.
11. Ferri FF. Ferri’s Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Nov. 11, 2017.
12. Muncie HL, et al. Dizziness: Approach to evaluation and management. American Family Physician. 2017;95:154.
13. American College of Emergency Physicians. https://www.acep.org. Accessed Nov. 11, 2017.
14. U.S. Food and Drug Administration. http://www.fda.gov. Accessed Nov. 11, 2017.
15. Schmitt BD. Fever. In: Pediatric Telephone Protocols: Office Version 15th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2015.
16. Mannenbach MS (expert opinion). Mayo Clinic, Rochester, Minn. June 14, 2017.
17. Goyal DG (expert opinion). Mayo Clinic, Rochester, Minn. June 14, 2017.
18. Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 28, 2017.
19. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org. Accessed Nov. 20, 2017.
20. Petty RE, et al., eds. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Nov. 20, 2017.
21. Elsevier Point of Care. https://www.clinicalkey.com.  Accessed Nov. 20, 2017.
22. Kasper DL, et al., eds. Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed Nov. 20, 2017.
23. Wein AJ, et al., eds. Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com.. Accessed Dec. 2, 2017.
24. National Eye Institute. https://nei.nih.gov. Accessed Dec. 5, 2017.
25. Wilkinson JM (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 8, 2017.

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Pain in the eye area

Causes of pain in the eye area can be different, common to such pain is their localization. Soreness can be felt both directly in the eyeball – for example, when pressed – and other tissues (eye muscles, eyelids, etc.).

Below we describe what causes pain in the eye area and what should be done to treat it.

Muscle pain

If the problem is in the eye muscles, then pain is felt mainly when the eyeball is moved. However, in some cases, the pain is a response to a stimulus, such as a bright flash of light. According to experts, pain in the oculomotor muscles usually has a pulling character and is similar to fatigue (often fatigue leads to discomfort in the muscles).

Muscle pain and weakness occur, as a rule, after significant visual exertion – this is a long work at the computer or a long stay behind the wheel (pain in the eye muscles is often noted in truck drivers who have to concentrate on the road).

Coping with muscle pain is quite easy. For example, you can relieve fatigue with the help of certain exercises. The essence of such exercises is the alternation of strong muscle tension and their relaxation. Eye drops will also help to relieve inflammation and pain – although such drops can be freely bought at a pharmacy, we strongly advise you to consult an ophthalmologist first.

Pain with infection

Infectious inflammation is considered to be the second most common cause of eye pain. The introduction of various pathogens can lead to an infectious disease of the organs of vision, and all inflammations are divided both according to the type of pathogen and according to the localization of the inflammatory process in certain structures: conjunctivitis (inflammation of the mucous membrane), iritis (inflammation of the iris), keratitis (inflammation of the cornea) and etc.

Often, herpesvirus infection, chronic sinusitis and tonsillitis lead to pain in the eye area. Also, the eyes can be affected in systemic diseases – for example, in rheumatism. In this case, eye pain can be eliminated by curing the underlying disease. If the pathology is caused by a bacterial infection, antibiotics are used.

Increased intraocular pressure

High pressure in the cavity of the eyeball is called glaucoma. This pathology often manifests itself in the form of attacks of severe pain in the eye area. In addition, glaucoma is indicated by:

• blurred vision, blurred vision;
• paroxysmal headache, which is concentrated in the dorsal and temporal regions;
• general weakness, nausea and vomiting;
• dilated pupil, non-responsive to light;
• induration, hardening of the eyeball, even with light pressure there is a sharp sharp pain.

For more information about glaucoma and how to treat it, see the article “Treatment of glaucoma”.

Pain and discomfort in dry eye syndrome

This condition, also called xerophthalmia, affects not only the mucous membrane of the organs of vision, but also other structures of the eyeball. For whatever reason the patient develops xerophthalmia, the symptoms are always the same – discomfort and pain in the eyes, a feeling of dryness. In most cases, dry eye syndrome occurs in people who spend a long time at a computer monitor or perform small work under artificial lighting. Often office workers complain of dry eyes, who sit at a computer for a long time in rooms with artificial lighting and dry air-conditioned air.

In case of xerophthalmia, eye drops are used to relieve unpleasant symptoms, similar in composition to normal tear fluid, they envelop the mucous membrane and moisturize it. These are over-the-counter products, but your ophthalmologist will make recommendations about these drops.

Eye vascular problems

The eyeball has a dense network of blood vessels that nourish the retina and other tissues of the eye with oxygen and remove metabolic products from them. Vascular eye pain can be caused by diabetes mellitus and other vascular diseases. They can be noted for a long time, have a aching character.

In case of such pains, a comprehensive examination will help to get rid of the disease, during which the doctor will establish the cause of the problem.

Pain and injury of the eye

Pain in the eye area is often caused by mechanical damage to the eyeball or surrounding tissues. Our eyes are easily damaged, because they have a thin and complex structure, moreover, they are poorly protected from negative external influences. If you get an eye injury or foreign objects get into the eye tissue, you should immediately seek medical help.

Quite often, the eye is injured as a result of chemical burns (for example, when safety rules are violated during the use of household chemicals). If a caustic chemical gets into the eye, the first aid is to flush the affected eye with plenty of cool running water, then go to an ophthalmologist. But chemical eye burns in most cases can be prevented if you remember to use safety glasses.

Remember: only a qualified ophthalmologist who has the results of diagnostic tests in his hands can correctly determine the cause of eye pain. Self-treatment of pain in the eye area is completely unacceptable and can end sadly, up to blindness.

In order to preserve vision, the patient must receive correct and timely treatment: antibiotic solutions for bacterial infections or for the prevention of such complications, antiglaucoma drugs (sympathomimetics, miotics, prostaglandins, etc.) for increased intraocular pressure, anti-inflammatory drugs. Folk remedies (herbal decoctions, tinctures) can also be used to a limited extent, but only in agreement with the attending physician.

Once again – if you experience pain in the eye or tissues surrounding the eye, contact an ophthalmologist (for example, the Moscow ophthalmological clinic “OKOMED”). The specialist will examine you, prescribe additional studies and make a diagnosis, after which he will determine an individual course of treatment.

Pressing pain in the eyes: causes and consequences

Medical advice

Why do my eyes hurt at the end of the day or after sleep as if they were being pressed? Pain is a symptom of what diseases? Is it dangerous for the eyes?

1579

04/26/2023

Pressing pain in the eyes may be due to normal fatigue or to a serious illness.

Contents

1. Why there is a feeling that something is pressing on the eyes: causes
2. Eye diseases which may cause pain in the eyes
3. When to see an ophthalmologist
4. Eye hurts: what to do so that the situation does not happen again?

Why there is a feeling that something is pressing on the eyes: causes

• Headache, migraine. The most common reason why the eyes hurt as if they were being pressed from the inside. Additionally, there is a pulsation in the temples and the back of the head, nausea, dizziness, and a painful reaction to bright light appear. Usually migraines, in which there is pressure on the eyes, are not one-time phenomena, but regular and prolonged.

• Increased blood pressure. If your head and eyes hurt, measure your blood pressure with a blood pressure monitor. Additional symptoms, such as dizziness, will not help to find the source of pain.

• Sinusitis, sinusitis and other sinus infections. In such cases, the eyes hurt even after sleep. Infectious diseases are characterized by nasal congestion, loss of smell, fever, bad breath, etc.
• Optic neuritis. This is an inflammatory disease of the peripheral nerves, in which the pathology can affect the optic nerve and cause severe discomfort. With neuritis, unpleasant sensations are permanent, but intensify when a person looks from one object to another.
• Visual fatigue and strain. If you regularly strain your eyesight, such as sitting at a computer for a long time, reading small text, working with small details, or driving a car, your eyes will get tired and start to hurt. The same situation will arise if you work in a dark room. Therefore, first of all, analyze the situation, give yourself a break, for example, do gymnastics or take a walk. But if your eyes hurt after sleeping, it’s most likely something else.

With these pathologies, blood circulation may be disturbed, intraocular pressure may increase, which causes an unpleasant symptom. It is also important to consider that there are many blood vessels and nerve endings in the eyeball. When the body fights infection, the blood flow increases, which affects the condition of the person.

Eye diseases which may cause eye pain

Despite the fact that discomfort can be caused by pathologies in different organs, most often we are talking about ophthalmic diseases. Among them:

• Glaucoma. The disease is characterized by a sharp increase in intraocular pressure, so discomfort is common.
• Inflammation of the optic nerve. When a person becomes ill, blind spots may occur, that is, part of the image will be as if hidden behind a partition.
• Dry eye syndrome. If the tear fluid is not produced in the right amount, the person experiences discomfort.

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• Scleritis. This is an inflammation of the sclera, that is, the white outer protective shell. The blood vessels dilate, the eyes turn red.
• Infectious lesions. Conjunctivitis, blepharitis or keratitis affects the optic nerves and eye muscles, so these diseases can be the reasons that something presses on the eyes from the inside.
• Trauma. Usually people know about it even without diagnostics.
• Intraocular hypertension. This is a pathology in which a person has increased intraocular pressure. Only a doctor can diagnose the disease.

An unpleasant state is temporary and can occur with overexertion, after smoking or drinking alcohol.

• Incorrect vision correction. For example, if a person does not correct myopia or presbyopia, or if glasses and contact lenses are not correctly fitted.

When to see an ophthalmologist

Pain in the eyes can be a signal of serious diseases that are easier to deal with at an early stage. You should not guess what to do and how to be treated, it is better to immediately contact a specialist.

Of course, not all people are ready to make an appointment with an ophthalmologist if they feel discomfort. But there are situations when this must be done:

• pressing pain does not go away for several days;
• decreased visual acuity, blind spots appeared;
• eyes reddened;
• there was a sensation of a foreign body or sand in the eyes;
• appeared photophobia, lacrimation;
• the pain is so severe that pain medication has to be taken;
• there are additional symptoms, such as pain and dizziness, nausea, etc.

The ophthalmologist will first determine the cause of the pathology. If it is not ophthalmic, he will refer you to another specialist, such as a neurologist or a general practitioner. If necessary, the doctor will diagnose: determine visual acuity, the condition of the retina, cornea, examine the fundus, measure intraocular pressure, assess the risk of developing glaucoma.