What’s Causing That Pain Behind Your Eyes?

Your ability to see relies on complex structures that work behind the scenes. Chief among them are the optic nerves, which transmit visual information to the brain, and the extraocular muscles, which control eye movement.

According to data from the Journal of Neuro-Ophthalmology, the most common eye pain-related neurologist visits include headaches or migraine pain behind the eye, trigeminal neuralgia, and cranial nerve disorders. All these are primarily nerve-related conditions which happen behind the eye. 

Experiencing pain in any part of the eye is most discomforting and can affect the overall quality of our lives. According to this paper, surface eye pain is more common and affects about 6.8% (about 20 million) of the adult population in the U.S.

But what is causing the pain behind your eyes?

In this post, we will look at the causes of eye pain and vision changes and how they may contribute to this pain and diagnosis, treatment, and management options.

What Pain Behind The Eye May Indicate 

The key differences between surface eye pain and pain behind the eyes lie in the structures involved. Surface pain typically affects the cornea and the conjunctiva, which are part of the outermost layers of the eye.

The cornea is densely packed with nerve endings, making it one of the most pain-sensitive structures in the body, which explains why even minor irritation can trigger significant discomfort. However, when pain emerges from deeper structures, the underlying cause is often more complex.

The pain behind your eyes may indicate:

• Glaucoma: involving increased pressure on the optic nerve;
• Optic neuritis: inflammation of the optic nerve;
• Strabismus: misalignment due to issues with the extraocular muscles;
• Migraines: often triggering pain via the optic nerve Pathway;
• Cranial nerve palsy: affecting the function of ocular muscles.

Understanding where the source of the eye pain is coming from, whether from the surface or deeper structures, is the first step in determining the cause of the eye pain.

While surface discomfort is often linked to irritation or minor injury, pain behind the eyes can signal more serious neurological or structural issues.

Common Symptoms Related to Pain Behind the Eye

Pain behind the eye often presents with more intense symptoms than surface eye pain because it involves deeper structures such as the nerves, muscles, and sinuses.

Common nonspecific symptoms of eye pain include:

• Deep, aching pain;
• Pain that worsens with eye movements;
• Chronic headaches;
• Pressure sensation;
• Eye bulging;
• Redness around eyes or swelling;
• Double vision;
• Decreased or blurry vision;
• Stabbing pain.

If you are experiencing any of these symptoms, especially if they persist or worsen, it’s important not to ignore them. Pain behind the eye can range from mild and harmless to a sign of something more serious involving the nerves, sinuses or even the brain.

Paying attention to these warning signs and seeking medical advice when needed can help you get the right diagnosis and early treatment.

Eye Strain and Digital Fatigue: Leading Causes of Discomfort

Digital fatigue is a condition that arises from prolonged screen time as a result of excessive use of digital devices. These conditions include visual strain, mental exhaustion, and physical strain. Our attention in this article is focused on the visual disturbances related to digital fatigue.

Computer vision syndrome (CVS) is a component of digital fatigue, and it refers to conditions that affect the eyes due to excessive screen use. These may include eyestrain headache, blurry vision, headaches, or dry eye syndrome, which causes discomfort to the eye.

A study involving 160 participants found that over 78% of them experienced such symptoms with prolonged screen exposure.

To help in preventing eye strain, experts recommend following the 20-20-20 rule (looking 20 feet away every 20 minutes for 20 seconds), using blue-light filters, and adjusting screen brightness.

Although there is no evidence of permanent damage, the associated strain can significantly affect productivity and quality of life.

Sinus Infections and Pressure: Effects on The Eyes

Sinusitis (sinus infection) is the inflammation of the sinus and can be caused by bacteria, fungi, or viruses. The sinus or paranasal sinuses, as they are commonly called, are hollow cavities within the skull that produce mucus and lighten the weight of the skull, among other functions.

There are four sinuses, namely:

• The frontal sinuses;
• The sphenoid sinuses;
• The ethmoid sinuses;
• The maxillary.

Anatomically, the eye and paranasal sinuses are located close to each other. The sphenoid sinuses lie near critical structures such as the optic nerve, carotid artery (the artery that supplies blood to the eye), and several cranial nerves involved with vision and eye movement.

As a result, when the sinuses become infected, particularly in chronic sinusitis, the infection can spread to adjacent eye structures, potentially leading to rare serious orbital complications such as cavernous sinus thrombosis. These complications often involve swelling, fluid buildup, and compression of the extraocular muscles and optic nerves.

They can lead to the following symptoms:

• Aching or throbbing pain during eye movement;
• Pressure behind the eye;
• Tightness, difficulty opening or closing the eye;
• Retro-Orbital pain.

Eye pain linked to sinus infections often worsens when bending over or lying down. It may also come with symptoms like sinus infection eye pain, nasal congestion, facial tenderness and headaches.

While most sinus-related eye pain is resolved with proper treatment of the infection, persistent or severe symptoms should be evaluated to rule out complications like orbital cellulitis or vision-threatening inflammation.

Migraines and Cluster Headaches: Links to Retro-Orbital Pain

Retro, meaning behind, and orbital, meaning eye – retro-orbital pain, refers to pain that is felt behind or deep within the eye, often described as a pulling or aching sensation. The orbit is the bony socket that houses the eye and its supporting structures, including muscles. When they become strained or inflamed, they can create a pulling sensation or pain behind the eye.

According to the insights shared with the American Academy of Ophthalmology by Sean Gratton, MD, of the University of Missouri, the trigeminal nerve, which innervates the eye, plays a central role in the development of migraines. When a migraine is triggered, it can stimulate this nerve, leading to pain (retro-orbital pain).

While migraine pain behind the eye is often the common cause of retro-orbital pain, other causes, such as the rare condition, Tolosa-Hunt Syndrome, and pain from muscles of the neck, head, or jaw area, can also contribute.

Cluster headache pain is a form of chronic headache with both neurological and vascular components contributing to its cause. It is usually characterised by a severe one-sided retro-orbital pain that could be accompanied by restlessness, agitation, and autonomic symptoms.

The pain is commonly described as burning, boring, stabbing, or squeezing. While rare, tension headache symptoms may also include a mild, dull ache behind the eye.

Optic Neuritis: Symptoms of Optic Nerve Inflammation

Optic neuritis is an inflammation of the optic nerve that impairs your ability to see sharply or distinguish fine details (visual acuity). In severe cases, it can lead to optical nerve pain accompanied by vision loss. 

Optic neuritis may affect one eye (unilateral) or the two eyes (bilateral). The inflammation can involve either the visible front part of the optic nerve (the optic disc or optic papilla) or the deeper, hidden portion known as the retrobulbar optic nerve.

This can lead to a range of symptoms, including:

• Pain with eye movement;
• Vision loss;
• Loss of colour vision;
• Photopsia;
• Decreased visual acuity;
• Uthoff’s phenomenon;
• Central Scotoma.

Optic neuritis can cause pain behind the eye since the optic nerve runs from the back of the eye (optic disc) through to the retrobulbar space into the brain.

Glaucoma: High Intraocular Pressure Causes Deep Eye Pain

Research shows that glaucoma is the leading cause of irreversible blindness worldwide, affecting nearly 70 million globally. Of these, about 10% experience complete blindness in both eyes.

The condition is broadly classified into two main types: open-angle glaucoma and angle-closure glaucoma. In the United States, the majority of cases are open-angle glaucoma, which progresses slowly and often without early symptoms. In contrast, angle-closure glaucoma develops rapidly and is considered a medical emergency.

The development of high intraocular pressure (IOP) stems from the imbalance between the production of aqueous humour (the clear fluid in the eye) and its drainage through the trabecular meshwork and uveoscleral outflow pathways. When this fluid is not adequately drained or the drainage system becomes overwhelmed, pressure builds up inside the eye.

This elevated pressure exerts stress on the optic nerve, potentially causing compression, structural deformation, and remodelling of the nerve fibres. Over time, this can result in a sustained increase in pressure, often accompanied by deep, aching pain behind the eye.

Eye Injuries and Trauma: External Factors Causing Pain

Pain to the eye cannot always be internal or as a result of an increase in ocular pressure, which is often more subtle. Sometimes, the pain in your eye could be a result of injuries and subsequent trauma sustained from such injuries.

Common external factors that cause eye pain

• Corneal abrasion: This can occur as a result of a scratch to the cornea and is the most common cause of eye injuries. Symptoms include severe pain, foreign body sensation, sensitivity to light, redness of the eye and trauma history.
• Thermal burns: Thermal or flash burns from heat can damage the cornea. Symptoms include redness of the eyes, severe pain and blurry vision.
• Chemical burns: This could arise from acid or alkali splash from industrial chemicals. Symptoms include severe pain, tearing and photophobia.
• Direct assault: Blunt force from accidents, injuries, or sports. Symptoms include eye pain, swelling and internal bleeding.

Wearing protective covering helps reduce some of these injuries. In some cases, home-made remedies like cold compresses may relieve mild discomfort, but trauma-related pain requires medical attention.

Refractive Errors and Uncorrected Vision Strain Eye Muscles

Refraction is the bending of light as it passes through the eye. In optics and vision, refraction determines how light rays are focused on the retina to produce clear vision. Therefore, refractive errors occur when distant objects cannot be properly focused on the retina with a relaxed eye.

The eye doesn’t bend light properly, causing blurry vision which is often due to the shape of the cornea or length of the eyeball. To make up, the eye muscles strain to refocus the objects, hence causing eye strain and headache in the process.

It is the most common type of vision problem, andover 150 million Americans are affected.

There are different types of refracting errors, and they include:

• Myopia;
• Hyperopia;
• Presbyopia;
• Astigmatism.

No one should go blind because of refractive errors. Wearing corrective lenses can provide significant eye pain relief. In cases of accompanying discomfort, over-the-counter pain relief can help manage symptoms while addressing the root causes.

Infections and Inflammatory Eye Conditions (e.g Uveitis) 

Although the eye has protective coverings that shield it from infections, injuries, and environmental damage, coverings can sometimes fail in their duties. This leaves your eye vulnerable to infections and inflammatory triggers.

Some of the conditions that expose your eye to infections and inflammation include conjunctivitis, keratitis, blepharitis, uveitis, scleritis, optic neuritis, giant cell arteritis, etc.

Infections and inflammatory eye conditions can range from mild irritations to serious threats to vision if left untreated. Whether caused by bacteria, viruses, autoimmune responses, or allergic reactions, these conditions often present with overlapping symptoms like redness, pain, swelling and blurred vision.

Your eyes are sensitive, and timely care can make all the difference in protecting both your comfort and your sight.

When Pain Behind The Eye Signals Medical Emergency

We often feel pain in our eyes from time to time. In some cases, they resolve on their own without any medical intervention, but when pain becomes persistent, sudden, and feels different in terms of its severity and intensity, then it could signal a medical emergency.

Seek immediate care if eye pain is accompanied by flashing lights, floaters, sudden vision loss, pain with eye movement, nausea, or recent traumatic experiences like accidents.

Consult your doctor if you experience any of these symptoms.

Diagnosis and Testing: Expectations at The Doctors’ Office

An ophthalmologist would check your medical history and carry out some physical examinations during your diagnosis.

An eye test would generally include these:

• Direct observation;
• Palpation;
• Refraction;
• Visual field testing;
• Ophthalmoscopy;
• A slit-lamp examination;
• Tonometry.

During the examination, the ophthalmologist may gently press around your eyes, collect any discharge for laboratory testing, or apply eye drops to dilate your pupils for a more thorough internal eye examination. These tests would help with eye pain diagnosis and rule out more serious conditions.

Treatment Options: From Eye Drops to Neurological Therapies

Treatment for eye pain depends on the root cause.

Some conditions may require:

• Home remedies for eye pain, like warm compresses;
• Pain management for headaches;
• Eye drops (lubricants, steroids, antibiotics, or anti-glaucoma agents);
• Anti-allergy for itching;
• Prescription medications for migraine;
• Neurologist-recommended treatments for trigeminal-related eye pain;
• Lifestyle adjustments or stress management for pain management of headache.

Always check with your ophthalmologist to know what treatment suits your condition.

Pain behind the eye can stem from a range of causes, some minor, others serious. While symptoms may overlap, addressing the root cause is key to effective relief and preventing long-term damage. Always seek a professional diagnosis to ensure the right treatment path for your specific condition.

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Frequently Asked Questions

What is synechiae in the eye?

Synechiae in the eye refer to abnormal adhesions between parts of the eye, most commonly between the iris and either the lens or the cornea. The lens is the posterior synechiae, and the cornea is the anterior synechiae. This adhesion usually occurs as a result of inflammation, trauma or infection and interferes with fluid drainage in the eye.

What is rubeosis in the eye?

Rubeosis in the eye is the abnormal growth of new, fragile blood vessels on the surface of the iris. This condition has been linked to severe retinal conditions like diabetic neuropathy, or central retinal occlusion.

What is endophthalmitis in the eye?

This is a serious and potentially vision-threatening inflammation or infection inside the eye. It usually involves vitreous or aqueous humour and can occur after eye surgery, trauma or as a complication of an eye infection.

References

1. Editorial: Eye Pain: Etiology And Therapeutic approaches
2. Anatomy, Head And Neck: Eye Lateral Rectus Muscles
3. The Most Common Causes of Eye Pain at 2 Tertiary Opthalmology And Neurolpgy Clinics 
4. Eye Pain-Eye Disorders
5. Digital Fatigue in The Age of Screens: Eye And Postural Strain Among 18-35-Year-Old Screen Users
6. Sinus Infection
7. Increased Risk of Open-angle Glaucoma Following Chronic Rhinosinusitis: A Population- Based Match-Cohort Study
8. Digital Devices And Your Eyes
9. Clinical Features of Visual Disturbances Secondary To Isolated Sphenoid Sinus Inflammatory Disease
10. Pain Behind The Eye: Re-orbital Pain
11. American Academy of Ophthalmology
12. Tolosa-Hunt Syndrome
13. Pathophysiology of Cluster Headache: A Trigeminal Autonomic Cephalgia 
14. Optic Neuritis
15. The Pathophysiology And Treatment of Glaucoma
16. Corneal Abrasion
17. Refractive Errors
18. Eye Infections
19. Aqueous Humor Dynamics: A Review
20. Uveitis And Ocular inflammatory Disease
21. Eye Emergencies 
22. Synechia and Other Sequelae of Intraocular Inflammation
23. Eye, Iris – Synechia
24. Neovascularization of the Iris (Rubeosis Iridis)
25. Rubeosis
26. Rubeosis Iridis