Eye pain can arise from various ophthalmological and systemic conditions, each presenting with distinctive characteristics. In a clinical setting, it is pivotal to assess the specific features of the eye pain to accurately differentiate between these conditions and guide appropriate management. Here is a comprehensive breakdown of common causes of eye pain:

1. Surface Disorders (Anterior Segment Issues):
– Conjunctivitis: Often presents with gritty discomfort rather than severe pain. Infective forms manifest with mucopurulent discharge, while allergic types are associated with intense itching and watery discharge.
– Corneal Abrasions and Erosions: These typically cause significant pain and photophobia. Patients often describe a sensation of a foreign body in the eye.
– Keratitis: This includes infectious causes such as bacterial, viral (e.g., herpes simplex), and fungal infections. Pain is typically severe, with associated redness, photophobia, and tearing.
– Photokeratitis: Caused by UV light exposure, presenting with symptoms such as severe pain, redness, and photophobia, usually appearing 6 to 12 hours post-exposure.

2. Deeper Ocular Issues:
– Scleritis: Characterized by severe, boring pain that can radiate to surrounding areas. It is often associated with systemic inflammatory conditions.
– Uveitis (Anterior): Presents with a deep ache and photophobia. It’s often accompanied by redness predominantly around the limbus and visual disturbances.
– Acute Angle-Closure Glaucoma: Severe ocular pain, blurry vision, headache, nausea and vomiting are classic symptoms. Examination reveals a hard eye with significantly elevated intraocular pressure.

3. Orbital and Systemic Causes:
– Orbital Cellulitis: Often presents with pain on eye movement, redness, swelling, and potential visual disturbances. Prompt treatment is essential to prevent complications.
– Trauma: May result in various types of eye pain depending on the structure affected, from superficial injuries to deeper ones involving the orbit or optic nerve.

4. Neuropathic or Referred Pain:
– Conditions such as trigeminal neuralgia or cluster headaches can also manifest as severe eye pain.

Approach to Evaluation:
– History: Detailed assessment of onset, duration, nature (sharp, dull, constant, intermittent), and associated symptoms (e.g., visual changes, discharge, photophobia) are crucial.
– Examination: Evaluate for visual acuity, pupil reaction, slit-lamp examination for anterior chamber activity, fluorescein staining for corneal defects, and intraocular pressure measurement.
– Referral and Imaging: In cases where initial evaluation suggests serious pathology, or there is rapid deterioration, prompt referral to an ophthalmologist is advisable. Imaging might be indicated if orbital or neurological causes are suspected.

Management:
– Treatment is dictated by the underlying cause, ranging from topical antibiotics for bacterial conjunctivitis to systemic treatment for scleritis or uveitis. Pain management might include oral NSAIDs or topical anesthetics, although the latter is used cautiously.

It’s pertinent to recognize when eye pain may be indicative of a sight-threatening condition, warranting urgent intervention. In systemic association, a collaborative approach with specialists in rheumatology or infectious disease may be necessary.