Diagnosis | Eye Pain


In order to find out the causes of the eye pain, the doctor interviews the person concerned. The eye is inspected from the outside. Then the eye is systematically examined according to the accompanying symptoms.

If a foreign body is suspected in the eye, the doctor looks under the lower and upper eyelid of the eye. The visual acuity, the visual field and the eye muscle and pupil motor functions are tested according to the suspected diagnosis. Furthermore, an ophthalmoscopy of the back of the eye can provide information.

When using the slit lamp, the eye is literally put under the “magnifying glass” or viewed. If an acute glaucoma attack is suspected, palpation of the eyeballs is strongly recommended. This means that the intraocular pressure is increased and the eyeball is hardened. If certain pathogens are suspected in eye inflammations, these can be examined by smear test. Depending on the suspected diagnosis, further examinations such as an ultrasound examination, computer tomography or magnetic resonance imaging are recommended.

What to do / alleviate

Eye pain can often be relieved by simple exercises and by switching off the source of the pain. If the eyes are overtired, the warmth of your own hands often helps: after rubbing both clean hands together, place them on the eyes for about a minute. Eye drops containing salt water, artificial tears or medical eye drops can also reduce the symptoms.

In this case you should pay attention to the ingredients. If possible, eye drops should not be taken permanently. In addition, regularly taken breaks during close-up work (PC, reading) can minimize eye pain.

For some people the 20-20-20 rule is helpful: look into the distance for 20 seconds every 20 minutes. Relaxation exercises such as PMR are also helpful for some people: close your eyes as tight as possible, hold them for 10 seconds, then relax again. Raise your eyebrows and open your eyes as much as possible and hold them for 10 seconds, then relax.

Eye pain can also often be reduced by keeping them moist. This can be achieved by winking and drinking a sufficient amount of water and using a humidifier. Irritants, such as cigarette smoke, but also animal hair or substances to which the person concerned is allergic should be avoided if possible. In addition, the wearing of adapted glasses often provides relief in cases of defective vision.

Home remedies

For overstrained eyes that cause eye pain, warm dry or moist compresses often have a soothing effect. For dry compresses, for example, rapeseed or uncooked rice is filled in a cloth bag or sock, which is knotted at the end and warmed in the microwave under supervision. Before applying the compress, visual aids such as glasses or contact lenses should be removed.

For moist compresses, cloths or washcloths can be moistened with warm water and warmed. The compresses should be very warm to hot, but should not exceed the burn and individual comfort limits. Some patients with eye pain find compresses in the form of tea bags with a complementary fragrance soothing.

Black and green tea should be avoided because of the possibly irritating ingredients. Herbal teas containing, for example, chamomile, eyebright or marigold are recommended. Dried herbs can also be used.

Some sufferers with burning eyes report a relaxing and pain-relieving effect of dry, cool lavender compresses on the eyes. People with defective vision, incorrectly adjusted visual aids, as well as those with normal vision, may blink less while working at the computer or computer screen, which causes their eyes to dry out more quickly. This can cause painful eyes.

Also, an incorrectly adjusted height of the screen can lead to a posture that can cause neck pain and therefore eye pain. In addition, flickering of the screen can cause eye strain, which can lead to eye pain. In addition, a light source coming from the side and the reflected light from the computer screen can dazzle the eyes.

This can cause eye pain. The light source should preferably be behind you and at best be equipped with a lampshade. The computer should at best be placed 50-65 cm away and at eye level.

A filter for blue light as well as an anti-flicker filter can reduce flickering on the screen. Anti-reflective or anti-flicker lenses can also prevent eye pain when working with the computer. You should also make sure that the screen is clean, as dust and smudges will increase the flicker and cause the eyes to strain more.

A feeling of pressure in or behind the eye can be caused by dry eyes or uncorrected visual defects, both long, short and presbyopia. This feeling of pressure can result from overexertion in the context of an accommodation spasm. An inflammation of the eye, often conjunctivitis, can also cause a feeling of pressure.

If the feeling of pressure increases when bending down, the cause may be a sinus disease. Foreign bodies under the eyelid or on the surface of the eye, as well as injuries to the eye usually do not express themselves as a feeling of pressure, but as a stabbing pain. Some affected persons fear a tumour if they feel pressure in or behind the eye.

But an eye tumour often does not initially cause eye pain. Only when the tumour grows and the ultrasound examination shows clear protrusions do various symptoms appear. Also an increased intraocular pressure does not make itself noticeable by a feeling of pressure.

Unfortunately, the affected person often does not even notice the increased intraocular pressure for a long time. The damage to the optic nerve is usually not noticeable to the affected person. If a clear problem is detected during the examination of the visual field, more than half of the nerve fibres of the optic nerve have usually already died.

Eye pain is often difficult to differentiate from headaches. In general, a distinction is made between eye problems that cause headaches and headaches that cause eye complaints. A headache originating in the eye is usually accompanied by other complaints, such as vision problems.

Eye problems that can cause headaches include a glaucoma attack, defective vision or inflammatory eye diseases. On the other hand, headaches that trigger eye complaints can be caused by migraines, butterfly lichen or Wegener’s ́scher granulomatosis. Eye pain can occur in the context of various forms of migraine.

If the eyes are also involved, the affected person complains of visual field loss with flickering vision. Some people notice bright, jagged lines. Cluster headache, a special form of migraine, is accompanied by a real “eye migraine”.

In this case, changes can be seen on the outside of the eye and in the temporal region. A dilation of the conjunctival vessels becomes visible. The eyelid and the surrounding temporal region are often reddened and swollen.

Affected persons often complain about pain and irritation in the area. In addition, the pupil narrows on the affected side and some people also complain of photophobia. Eye mobility and neck mobility are interdependent.

If the neck is poorly mobile, this causes poor eye mobility and vice versa. In the context of this, neck pain, eye pain can be caused. The eyes, as so-called telereceptors, ensure that our head involuntarily aligns itself in the direction in which we look at something.

For example, when we look at something further down (e.g. if the computer screen or television is set too low), we place our head with tense neck muscles in the neck. In addition, an incorrectly adjusted car seat can lead to a hunched back and consequently cause tense neck muscles and finally neck and eye pain. Dizziness and eye pain can have different causes and various accompanying symptoms.

If this combination occurs as a result of migraine, it also often leads to temporary loss of visual field. Neck tensions can also cause dizziness and eye pain. However, visual disturbances do not usually occur in this case.

In addition, visual defects or incorrectly adjusted glasses can cause dizziness and eye pain. The mucous membranes of the nose swell up when you have a cold. Mostly the main and the paranasal sinuses are affected.

Because of the proximity to the orbit, this can cause eye pain. If the sphenoid sinus is affected, this can cause pressure on the optic nerve and thus also lead to blurred vision. If the sphenoid bone or frontal sinus is affected, this can cause pressure on the outer eye muscles and, in addition to eye pain, double vision.

If lymph congestion or pus develops in the ethmoid or frontal sinus, this can cause swollen, painful eyelids. In all affected paranasal sinuses, bending can increase a feeling of pressure in the eye. If a cold leads to visual disturbances such as blurred vision, double vision or swollen eyelids, it is recommended to consult a doctor immediately.

Bacteria and viruses can enter the brain through the paper-thin partition wall of the facial skull and cause meningitis. If there are no visual disturbances, the eye pain caused by a cold is usually harmless. As soon as the cold has subsided, the eye pain disappears.

A real flu is a viral infection caused by the flu viruses. The upper respiratory tract cells are often affected by influenza. These lead to an inflammation of the nasopharynx.

Since the nose is connected to the eye by the nasolacrimal duct, the flu viruses can enter the eye. This can lead to a viral conjunctivitis of the eyes in the course of a flu. This is particularly contagious, as the symptoms appear only after about 2 days, but the person affected is already contagious before that.

The viruses can be spread by shaking hands, speaking or coughing. Since the risk of infection is high, the viruses usually pass from the affected eye to the other eye. In the case of viral conjunctivitis, the eyes hurt and water.

Usually the eyes are red, swollen and there is severe itching. The eyelids can be so swollen that they cannot be closed completely. When bacteria enter the orbit as part of a sinusitis, the periosteum in the orbit can become inflamed.

This usually causes high fever, as well as eye pain in the inner corner of the eye and enormous headaches in the forehead area. In addition, the eyelid may be swollen. However, this happens rarely.

The formation of a purulent abscess between the frontal sinus and the eye capsule is also possible, but rare. In this case, extreme eyelid swelling and eye pain may occur. The eyeball bulges out and is often difficult to move.

As a result, those affected often complain of double vision. In case of eye pain in combination with fever and visual disturbances, a doctor should be consulted. Eye pain can occur in the context of an allergy.

Conjunctivitis can develop. This usually manifests itself as a burning, itching pain on both sides. In addition, the eyes often water and are reddened.

Sometimes the eyelids are also swollen. Furthermore, those affected often complain about being afraid of light. The barleycorn is an acute inflammation of the eyelid glands.

It leads to an accumulation of pus under the skin of the eyelids. There is severe eye pain, swelling and redness of the eyelid. A barleycorn is perceived as very unpleasant and sometimes very painful, but is usually harmless.

It usually disappears after a few days. However, since it is a contagious pathogen on the skin, it is essential to ensure adequate hygiene, otherwise the pathogens can enter the inside of the eye. The eye should therefore never be touched by hand or squeezed!

If the symptoms persist for longer than a few days or if additional symptoms occur, a doctor should be consulted. If a barleycorn occurs more frequently, a doctor should also be consulted, as the suspicion of diabetes mellitus must be ruled out. Intense light in the form of UV radiation can cause eye pain.

Strong sunlight, snow or welding without protective goggles can cause so-called blinding in the eye. Mostly these flashes cause very strong eye pain, as well as reddened eyes. The intense light on the cornea of the eye can cause small injuries and a kind of sunburn on the eye.

If one avoids the cause, these injuries subside quickly. But they can also be the entry point for bacteria and cause inflammation and ulcers in the eye. It is therefore advisable to always wear protection/sunglasses when exposed to strong light.

Eye pain can be triggered by psychological stress. Mostly it is accompanied by other complaints, such as dry eyes and eyelid cramps. In some cases, psychological stress can also cause chronic eye complaints.

Both benign, malignant tumours and pseudotumours of the eye can cause eye pain. The word “eye tumour” means “swelling of the eye”. Therefore, swelling of inflammatory eye tissue is called a pseudotumour.

These swellings compress the nerves of the eye and this can cause eye pain. In principle, a tumour can develop anywhere in the eye. Malignant tumours include eye melanoma in adults and retinoblastoma in children.

Unilateral eye pain often occurs and is usually harmless. They can be caused by the eye itself or by the environment, such as headaches, like migraines. Acute sinusitis can also cause unilateral eye pain.

It is also possible, although less frequently, that polyps or tumours of the paranasal sinuses cause unilateral eye pain. In addition, unilateral injuries to the eye or foreign bodies under an eyelid or on the surface of the eye can cause stabbing unilateral eye pain. Viral and bacterial conjunctivitis usually begins unilaterally.

Accordingly, the eye pain is also unilateral. Especially the viral eye pain passes to the other side. Conjunctivitis triggered by an allergy, on the other hand, is characterized by mostly direct bilateral eye pain.

Moreover, eye muscle inflammations are often unilateral, with unilateral eye pain. Tumours can also lead to unilateral eye pain. Triggering eye pain caused by migraine is also usually unilateral.

But a stroke can also cause unilateral eye pain. With an eye muscle inflammation, the outer eye muscles are affected. For example, if the right eye is affected, eye movements on the right side can be restricted and painful.

Depending on which external eye muscle is affected, eye movements to the left or right (or up and down) are restricted and painful. For example, if the right rectus medialis muscle is affected, the right eye may hurt when moving the eye to the left. If the right rectus lateralis muscle is affected, the right eye may hurt when moving the eye to the right.

If the optic nerve responsible for the respective eye muscle is inflamed, the same complaints occur accordingly during eye movements. Visual disturbances and eye pain can also be warning signs of a stroke. This can be caused by a blockage, bursting or tearing of a blood vessel, for example the carotid artery.

A tear in the wall causes bruising of the vessel wall. This blocks the blood flow and can lead to a stroke. For example, a tear in the wall of the left carotid artery causes eye problems on the left side.

Head, neck and eye pain occurs suddenly, usually in connection with limited eye mobility of the affected eye. The eye is also often not completely open. The eyelid hangs down compared to the other eyelid.

The pupil of the affected eye is usually reduced in size. If there is a circulatory disturbance, for example in the left visual centre of the brain, the right side of the body is affected and accordingly, eye pain occurs on the right side. Mostly, however, visual field failures or double vision and the like are in the foreground.

In both cases an emergency doctor should be consulted immediately! eye pain behind the eye usually manifests itself as permanent pain in the eye socket. The cause is often inflammation of the orbit, bleeding behind the eyeball or a tumour of the lacrimal gland. With this type of eye pain a doctor should always be consulted.