Red Flag Symptoms - Eye pain

A clinical history and examination will usually elicit the diagnosis, says Dr Mehul Mathukia.

Be sure to exclude a foreign body as a cause of eye pain
Be sure to exclude a foreign body as a cause of eye pain

There are many causes for eye pain, (see box). Often eye pain is also associated with a red eye. The commonest causes are foreign body or corneal abrasion. Most diagnoses can be made by history or examination.

Possible causes
  • Acute angle glaucoma
  • Anterior uveitis
  • Orbital cellulitis
  • Corneal abrasion or foreign body
  • Corneal ulcer
  • Keratoconjunctivitis
  • Scleritis
  • Acute sinusitis
  • Cluster headache or migraine

In taking a history, one should explore the onset of the pain, the quality and severity of the pain, and also any previous similar episodes. Eye pain can be described as sharp, aching or throbbing.

There may be associated photophobia, reduced visual acuity, pain when blinking or pain on movement of the eye. Also relevant may be the presence of an aura (migraine), fever (infection), pain when moving head or purulent rhinorrhea (acute sinusitis).

Scratchiness or a 'foreign body sensation' may suggest disorders of the eyelids, conjunctiva or cornea. Deeper pain, often aching or throbbing, may suggest a serious disorder, such as glaucoma, uveitis or scleritis. A red eye suggests that the disorder may be ocular rather than referred.

A past medical history of autoimmune conditions, MS, migraine or previous sinus infections may be relevant. It is also wise to see if the patient wears contact lenses, or works in an environment where a foreign body might result.

Acute uveitis may be associated with aching or throbbing pain

On examination, check for fever and also signs of sinusitis. Then a comprehensive eye examination should be completed. Ensure your hands are clean before examining the eye to minimise the potential risk of infection.

The eye exam would include a check of visual acuity and visual fields. In addition, papillary reflexes and and extraocular movements should be checked.

The orbital and periorbital structures should be examined. If there is a suspicion of a foreign body, the patient may need to be sent to casualty for further slit lamp examination or fluoroscein staining using a Wood's lamp.

Further investigations in hospital may include CT/MRI imaging if there is concern about orbital cellulitis or a tumour.

  • Dr Mathukia is a GP principal in Ilford, Essex

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Item Code: MINT/PPR-12008

Date of Preparation: May 2012

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