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  • Writer's pictureAtanas Bogoev M.D. and Maria Cholakova

What Causes Pain Behind the Eyes?

Pain behind the eyes can be a discomforting experience affecting individuals from various walks of life. It can range from mild to severe and come with other symptoms. We will shed light on possible triggers and offer insights for those seeking a better understanding of their condition.


Understanding Pain Behind Eye


Patients with persistent or severe eye pain should seek medical evaluation to determine the root cause and receive the necessary care. The data in this article is only informational and does not equal a doctor's diagnosis.


Pain Intensity


Before we delve into why there's pain behind your eyes, let's talk about the intensity of the sensation. We can classify eye pain into various types. That's depending on the characteristics of the discomfort: sharp, stabbing, aching, or throbbing.


Sharp pain is a sudden, intense, and stabbing sensation. It can feel like a brief, shooting discomfort within, behind, or around the eye. Similarly, stabbing pain causes fast, acute, and piercing sensations. It can be severe and short-lived.


Aching pain is a dull, persistent discomfort or soreness around or behind the eyes. There is often a connection with underlying conditions that may cause a constant, nagging ache. A throbbing pain is rhythmic, pulsating, and often due to vascular changes like migraines or increased intraocular pressure.


Locations of Eye Pain


Eye pain can occur in various locations around the eye, indicating different potential causes:

  • Behind the eyes (Retrobulbar)

  • Around the eyes (Periorbital)

  • In the eye socket (Orbital)

Eye sensations may be hard to read sometimes. So here is more information on how to identify discomforts.


Retrobulbar pain (behind the eyes) often indicates eye conditions that affect structures at the back of the eye. Those are the optic nerve, retina, or posterior segment. Causes may include optic neuritis, retinal disorders, posterior scleritis or increased intraocular pressure, as in glaucoma. In some cases, patients may feel eye pain and headache at the same time, or confuse the first with the second.


Periorbital pain (around the eyes) refers to discomfort in the area surrounding the eye. For example, the eyelids and the skin. This type of pain may be triggered by conditions such as sinusitis, allergies, or local infections of the eyelids. If the sensation is intense, people may think they have a headache behind the eyeball.


Orbital pain (in the eye socket) is pain deep within the eye socket. Some associations are orbital cellulitis (a severe eye infection), orbital inflammation, or in very rare cases - tumors. It's important not to panic if you think you might be experiencing this constant pain and go for an eye exam if you have any concerns.



Common Causes of Retrobulbar Pain


The bothersome pain behind the eyeball is a specific type of eye ache that may indicate several underlying conditions. Patients should differentiate this type of pain from periorbital or orbital pain. The causes and implications differ significantly.


Let's discuss what causes pain behind the eyes, categorized into ocular and non-ocular triggers.


Ocular Causes of Pain Behind the Eyes


Eyestrain

Pain type: dull pain, mild discomfort

eye strain pain in head and behind eye

Eyestrain occurs when the eye muscles fatigue due to continuous or intense use of digital devices, reading, or other visually demanding tasks requiring close-up focus. It can lead to aching or mild discomfort behind the eyes. Adjusting lighting, taking breaks, and using proper ergonomics can alleviate eyestrain. Eyestrain is often accompanied by headaches above the eyes.


Dry Eye Syndrome

Pain type: stabbing surface pain, mild to moderate discomfort

dry eye facts

Dry eye results from insufficient tear production or when tears evaporate too quickly. It can lead to irritation, burning, gritty sensation, and aching pain behind the eyes. Lubricating eye drops (or artificial tears) and lifestyle changes can manage dry eye symptoms. The pain from dry eye is usually in the front part of the eye and is mailed, predominantly accompanied by a foreign body sensation and a sensation of dryness.


Scleritis

Pain type: deep aching pain, severe discomfort


Scleritis is a severe inflammatory condition affecting the sclera (the eye's white part). The common causes are autoimmune diseases like rheumatoid arthritis or systemic conditions such as lupus. It can also be idiopathic (without a known cause). Scleritis pain is typically deep, severe, constant, and aching, it radiates to the forehead and brow area. The eye pain is often worse at night and can be severe enough to disrupt sleep.


Uveitis

Pain type: deep aching pain, moderate discomfort

uveitis inforgraphic

Uveitis is inflammation of the uvea. Patients with the condition may feel aching sensations behind their eyes, along with redness, blurry vision, and light sensitivity. People should address uveitis promptly to avoid complications.


Glaucoma

Pain type: deep aching pain, moderate discomfort

glaucoma pressure

Glaucoma is a group of eye diseases with increased intraocular pressure (IOP), leading to optic nerve damage and vision loss. Pain behind the eyes in glaucoma is often due to elevated eye pressure and may be associated with symptoms like blurry vision, halos around lights, and nausea.


Corneal Disorders

Pain type: sharp, stabbing pain, moderate discomfort

corneal abrasion

Corneal abrasions and corneal infections can cause stabbing or sharp pain behind the eyes. The gritty, foreign body sensations often intensify by blinking or with eye movement. Prompt treatment when the symptoms occur is crucial to prevent complications.


Preseptal Cellulitis

Pain type: surface, throbbing pain, mild to moderate discomfort


Preseptal cellulitis, or periorbital cellulitis, is an infection and inflammation of the tissues in front of the orbital septum (outside the eye socket). Common pathogens are Staphylococcus aureus or Streptococcus species after a minor eye injury, insect bites, or an infected eyelash follicle. Patients feel the pain on the surface of the eyelids. They may experience tenderness, or a burning sensation, along with eyelid swelling, redness, and warmth.


Orbital Cellulitis

Pain type: deep, throbbing pain, severe discomfort


Orbital cellulitis shares the same pathogens but is a far more serious condition than preseptal cellulitis. It is an inflammation within the eye socket (orbit), often resulting from sinusitis complications or a spread of infection from the adjacent sinuses. The pain behind eye in orbital cellulitis is throbbing and relentless, felt deep within the eye socket. Eye movement tends to excavate the pain. Patients also report redness, swelling, and protrusion.


Optic Neuritis

Pain type: acute sharp, throbbing pain, severe discomfort

eye parts

This condition involves inflammation of the optic nerve. One of its prevalent associations is with multiple sclerosis. It is also common with vascular disorders, hereditary optic neuropathies, radiation exposure, and autoimmune disorders. Optic Neuritis often causes sharp, throbbing pain behind the eye, which worsens with eye movement or eye compression. Vision loss and visual field defects, as well as reduced contrast sensitivity and color sensitivity, can accompany this pain.



Non-Ocular Causes of Pain Behind the Eyes


When we discuss the types of pain in and behind eye, we can't always assume the cause is related to ocular problems. In fact, the eye pain behind eyeball is very often not an eye pain at all. It may be an intense headache or nerve issue that you feel in your ocular area as well.


Sinusitis

Pain type: dull aching pain, mild discomfort


The proximity of the sinuses to the eye sockets is a common reason why sinusitis may feel like pain behind the eyeballs. Inflammation, allergic reaction, or infection of the paranasal sinuses, especially the ethmoid or sphenoid, can lead to minor discomfort with aching or pressure-like sensations, commonly felt behind the eyes. Patients may experience tenderness over the sinuses and have additional symptoms such as nasal congestion or facial tension.


Tension Headaches

Pain type: dull aching pain, mild discomfort


Headaches commonly occur as a result of stress and muscle tension. We refer to them as tension headaches. In some cases, the tension can cause a dull aching feeling. And the truth is eye pain and headache often go hand in hand. So people often (mistakingly) confuse their head pain behind eye with eye problems. The unpleasant experience can be constant or episodic and essentially does not pose a serious vision threat.


Temporomandibular Joint Disorders (TMJ)

Pain type: dull aching pain, mild to moderate discomfort


Temporomandibular joint disorders affect the jaw joint, as well as its surrounding muscles. Pain from TMJ issues can radiate to the temples and behind the eyes. Patients tend to describe the discomfort behind eye as a constant dull sensation. Clicking or popping noises when moving the jaw may also be present.


Dental Problems

Pain type: deep aching pain, mild to moderate discomfort


Dental issues are also common non-ocular health problems liable to trigger eye pain. Tooth infections, jaw pain, or protruding wisdom teeth (especially to the upper row of teeth) may contribute to pain to in the region behind the eyes. That's due to the close proximity of the jaw to the eye sockets and the facial nerve connections.


Migraines

Pain type: throbbing pain, moderate to severe discomfort


Migraine headaches can be very persistent. They may lead to intense head pain behind eye. Often on only one side of the head, but not always. The sensation can be throbbing and accompany other symptoms like nausea and light sensitivity. Some migraines have a so-called visual aura with typical visual sensations before the pain onset.


Cluster Headaches

Pain type: stabbing pain, moderate to severe discomfort


Cluster headaches are severe head pains occurring in clusters. They typically manifest on one side of the head and may cause stabbing pain in the head. Due to the intensity of the sensation, patients report feeling the pain behind the eyeball. Some of the common accompanying symptoms of this pain in the head and behind eye are eye redness and tearing on the affected side.


Neuralgias and Cranial Nerve Disorders

Pain type: sharp, stabbing pain, severe discomfort


Disorders affecting cranial nerves, especially the trigeminal nerve (cranial nerve V), trigger excruciating pain behind the eyes. These nerves play a significant role in facial sensation, so cranial nerve disorders feel like lighting strikes across the face. Conditions like trigeminal neuralgia can cause severe, shooting pain along the trigeminal nerve branches, which include areas around the eyes.



Diagnosis of Pain Behind Eye


The diagnosis process typically follows these steps:

  1. Discussing medical history

  2. Eye examination

  3. Ophthalmic tests and evaluations

  4. Imaging studies (MRI/CT), if needed

  5. Consultations with other specialists, if needed


Medical History


Obtaining a thorough medical history is a crucial first step in diagnosing the underlying cause of any pain behind eye. The patient's history can provide valuable information about the onset, duration, and progression of the pain. Information about any recent trauma, infections, or systemic conditions is also important.


Eye Examination


An examination of the eye and its structures allows the eye doctor to assess indicators of the pain. Examination of the eyes, including visual acuity, pupillary responses, and extraocular movements, can reveal important clues. Palpation of the eye sockets, sinuses, and the head and neck region can identify sources of pain.


Ophthalmic Tests and Evaluations


Certain eye tests help eye doctors make an assessment and determine the correct diagnosis.


Tonometry measures intraocular pressure and is crucial in diagnosing conditions like glaucoma and other eye diseases linked to high pressure in the eye.


A slit-lamp examination allows the ophthalmologist to assess the anterior eye structures, such as the cornea and iris, and detect any abnormalities.


Visual field tests can reveal defects in the patient's peripheral and central vision, which may be indicative of various eye conditions.


slit lamp exam for pain behind eye

Imaging Studies


Imaging is not an integral part of finding the source of ocular pain behind the eyes. It's only a diagnosis option when the ophthalmologist indicates irregularities in the eye during the exam or if they have suspicions of a serious underlying condition.


The two primary imaging methods are CT scan and MRI.


CT Scan is a computed tomography (CT) scan. It provides detailed images of the eye structures and the surrounding sinuses and skull. It is valuable in evaluating fractures, tumors, and bony abnormalities.


MRI (Magnetic Resonance Imaging) is particularly useful for soft tissue evaluation. It can reveal information about the optic nerve, the brain, and other soft tissues in and around the eyes. It is essential in diagnosing conditions like optic neuritis or intracranial causes of eye pain.


Consultations with other specialists


After the eye exam, your eye doctor may refer you to another specialty specialist. Those may be dentists, neurologists, or other medical specialties, depending on where the root of the problem is (or where they suspect it is). With this collaborative approach to eye health and general health, patients get a comprehensive diagnosis and treatment plan. This often leads to better outcomes and a better quality of life.


Treatment and Management


Treatment Approaches and Medications


Treatment of pain behind the eyes depends on the underlying cause. Specific treatments are often necessary, such as:

  • Antibiotics for infections (e.g., sinusitis or corneal infections)

  • Steroids to reduce inflammation (e.g., for optic neuritis)

  • Medications to manage high intraocular pressure in glaucoma

  • Surgical interventions for conditions like retinal detachment or tumors


Pain management medication may consist of analgesics, anti-inflammatory drugs, eye drops, or antibiotics.


Over-the-counter or prescription pain relievers (analgesics) can manage pain behind the eyes in cases of tension headaches or migraines. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce inflammation and alleviate discomfort. Conditions like glaucoma may require the use of eye drops to lower intraocular pressure. While infections may necessitate antibiotics or antiviral medications.

Only take medication that a doctor recommends for your specific case! Do NOT self-medicate.

Non-Pharmacological Management


In some cases, your doctor may ask you to make adjustments and changes to your way of life. That's a way to alleviate long-term pain by eliminating certain trigger factors.


Lifestyle changes can be beneficial in managing eye discomfort from eyestrain or headaches. Reducing screen time, improving ergonomics, managing stress, and maintaining proper eye hygiene may help. Lubricating eye drops or artificial tears are effective in relieving dry eye irritation by maintaining ocular moisture.



Surgical Interventions


Surgical interventions are quite rare when it comes to pain behind the eyes. It is only appropriate for certain serious and acute conditions.


Orbital surgery may be required in cases of orbital cellulitis or bleeding in the orbita. Retinal surgery (retinal reattachment or laser treatment) is a viable option for some severe retinal disorders, such as retinal detachment or diabetic retinopathy. Optic nerve decompression surgery may be helpful in certain cases of intracranial pressure or optic nerve compression. In extreme cases of chronic sinusitis, surgical interventions may address sinus blockages and inflammation.


There's no need to worry. Your attending doctor will guide you through all the non-surgical options first. Surgery is always a last resort and is typically reserved for medical emergencies.


Prognosis and Complications


The prognosis for people with pain behind the eyes depends on the cause, and the promptness of diagnosis and treatment. Some general considerations include:


  • Prompt diagnosis and appropriate treatment are essential in managing the condition and preventing complications

  • Vision impairment occur in cases where eye conditions, such as glaucoma or retinal disorders, are not treated on time

  • Some conditions, like migraines and tension headaches, often have good long-term outcomes with proper management

  • The prognosis for conditions like optic neuritis may depend on the associated disease (e.g., multiple sclerosis or neuromyelitis optical)


Overall, early diagnosis and management are critical in achieving better outcomes. As well as in reducing the risk of complications related to the pain behind the eye.


Now that you know what causes pain behind your eyes, it's time to get off the internet and go to the doctor for a reliable diagnosis and treatment plan.


Learn more about your eye health in the Ophthalmology24 blog!


Resources:


Checked by Atanas Bogoev, MD.

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