This discussion is adapted from an article in the October 2008 issue of EyeNet magazine.
In approaching eye pain, one can must evaluate for an intraocular pathology. “Inside the eye” causes of eye pain may include:
2. narrow angle glaucoma
3. shingles affecting the eye
4. trauma or a foreign body inside the eye
Extraocular or “outside the eye” causes must also be considered:
1. orbital inflammation
2. orbital tumor
3. giant cell arteritis or “temporal arteritis.”
To evaluate the orbit, a CT or MRI of the orbit may be recommended.
Headache disorders should also be considered:
1. Migraine. Migraine is often accompanied by light sensitivity and nausea or vomiting.
2. Cluster headache
4. Trigeminal neuralgia. This entity may occur after shingles.
In general these headache disorders should be evaluated by a neurologist or neuro-ophthalmologist.
Retinal conditions such as diabetic eye disease, macular degeneration, vitreous separation, and retinal detachment generally do not cause eye pain. Neovascular glaucoma with elevated pressure may cause an achy eye. Endophthalmitis or infection deep inside the eye may cause an achy eye. If a patient has an into-the-eye injection or eye surgery and develops an achy eye days later the doctor should be called immediately to rule out infection.