Practical approaches to eye pain

A guide to red flags and points to consider when assessing local eye pain and neuro-ophthalmologic causes of headache
  • It is important to determine if eye pain originates from the eye or if symptoms are part of a serious systemic disease.
  • Common presenting local eye pain symptoms include ocular pain described as ‘eye discomfort’, ‘eye strain’, ‘eye dryness’, ‘watery eyes’, ‘hot-burning’, ‘pressure’.1
  • Local causes can be benign, due to ocular surface disease, refractive error or heterotropia. These are usually settled with correct local treatment or spectacle correction. However, serious ocular causes include angle-closure glaucoma and herpetic eye disease and require urgent referral.2
  • Common presenting neuro-ophthalmologic symptoms include orbital pain, visual disturbance, aura, photophobia, lacrimation, conjunctival injection, ptosis.3,4
  • Primary headaches which may involve ophthalmic manifestations include migraines, giant cell arteritis, idiopathic intracranial hypertension and painful Horner’s syndrome.2