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How To Seek Eye Pain Care

Jul 21, 2008
If you have eye pain, seek advice from an ophthalmologist.

More severe cases should be handled by your ophthalmologist. If your ophthalmologist is not available, go to a hospital's emergency department.

It is difficult over the phone for a doctor or a nurse to grade the severity of eye pain or problems without examining you.

Because of the specialized nature of eye examination equipment, most eye problems are usually handled best in your ophthalmologist's office. If the emergency department has the necessary eye equipment, your ophthalmologist may see you in the emergency department after hours.

Any eye pain related to burns (chemical or flash) needs immediate treatment.

Eye pain associated with loss of vision, loss of eye movement, painful eye movement, eye swelling, eye discharge, and severe headache are all significant findings that need to be evaluated by your ophthalmologist or in the emergency department.

Any eye pain related to a traumatic event (eg, an object puncturing the eye, a blow to the eye with a foreign object, a motor vehicle collision) needs to be evaluated by your ophthalmologist or in the emergency department.

Medical evaluation of eye pain begins with a thorough history and physical examination. The history consists of questions documenting the symptoms in detail.

Important questions asked include when the pain started, the location of pain, the duration of pain, the characteristics of pain, anything that makes the pain better or worse, timing of pain, history of contact lens use, and previous eye injuries or surgeries.

Other important questions are whether you have allergies to medications, current medications, past medical history, past surgeries, family history, and social history.

The physical examination pertaining to the eyes may consist of checking your vision, visual inspection of the eye and its surrounding tissue, eye movements, visual fields (peripheral vision), and the pupil's reaction to light.

The ophthalmologist may use instruments to get a better look at the eye.

An ophthalmoscope is used to examine the back of the eye and to view the optic disc and blood vessels.

A slit lamp is a microscope to view the surface of the eye to check for corneal abrasions and ulcerations and also to look into the anterior chamber, which is the area between the surface of the eye and the pupil.

Eye pressure can be checked using a tonometer on the slit lamp or a device known as a Tono-Pen. These 2 instruments are used if glaucoma is suspected.

The ophthalmologist will also normally put an anesthetic drop into your eye for both diagnostic and therapeutic purposes. This test helps to determine if the eye pain comes from the surface of the eye or from deeper structures in the eye. In most cases, pain can be relieved if it originates from the surface of the eye.

A dye called fluorescein may be put into the eye to detect abrasions, ulcerations, or any corneal defect.

You should seek medical attention if you have eye pain.

Most commonly, home care consists of flushing the eye with water. With exposure to a foreign body or chemical to the eye, it is important to flush the eye with lukewarm tap water or commercially prepared eyewash solution. See the home care section under eye injury for techniques on how to flush your eye with water.

If you think a foreign body is in your eye, do not rub your eye. This can seriously damage the eye. Do not attempt to remove a foreign body from your eye or someone else's eye. Treatment other than gentle eye irrigation is generally not recommended and should be reserved for medical professionals and eye doctors.

For mild cases of eye discomfort, rest your eyes, take over-the-counter pain relievers, and avoid bright light.

Treatment at your ophthalmologist's office or at an emergency department will vary widely, from giving you instructions to apply warm compresses on a sty or a chalazion to taking you into emergency surgery for acute glaucoma.

The bacterial form is treated with antibiotic eyedrops, eye ointment, and pain medication. Viral conjunctivitis (pinkeye) is typically treated the same as bacterial conjunctivitis, because it may be difficult to tell the difference between the 2 types. Allergic conjunctivitis is normally treated with antihistamines, such as Benadryl.

Corneal abrasions and ulcerations: These are treated with antibiotic eyedrops, eye ointment, and pain medication.

Foreign body in the eye: There are different techniques to remove foreign bodies: irrigation with eye wash, removal with a cotton tip applicator, removal with a small needle, or removal with an ophthalmologic drill. After foreign body removal, there may be an abrasion, which would be treated separately.

Chemical eye burns and corneal flash burns: Chemical eye burns are treated immediately with great amounts of water to wash out the eye and anesthetic eyedrops until normal levels of acid or alkali of the eye are reached. After thorough washing is complete, evaluation by an ophthalmologist is required for further treatment, depending on the extent of the chemical burn. Flash burns are treated as many small abrasions with antibiotic eyedrops, eye ointment, and pain medication.

You will be instructed to scrub the eyelid edges with mild shampoo on a soft washcloth twice a day to remove excess oil.

These can initially be treated conservatively by placing warm compresses, such as a washcloth, on the eye or eyes for 15-20 minutes, 4 times a day. An antibiotic ointment can be applied. If the chalazion does not go away in 3-4 weeks, your ophthalmologist may drain it.

Glaucoma has many treatment options depending on the type, severity, and duration of the attack. Severe glaucoma can be a true eye emergency with permanent eye damage occurring within several hours. Treatment begins with eyedrops, a topical beta-blocker (for example, timolol), a topical steroid drop, and a pupillary constricting eyedrop; other medicines may be given intravenously or in pill form. If these treatments fail to decrease intraocular eye pressure, surgery may be considered.

Iritis this condition may be treated with eyedrops that cause your pupils to dilate (get bigger) and with topical steroid eyedrops. In severe cases of iritis, oral steroids can be used.

Optic neuritis is gradual loss of vision and painful eye movement are normally signs of a disease throughout the body, which needs to be diagnosed. Most commonly, a thorough work-up needs to be performed with both ophthalmologists and neurologists to determine the cause of optic neuritis.

When sinusitis is determined to be a bacterial infection, it can be treated with antibiotics.

When migraines cause eye pain, both can be treated with routine over-the-counter medications, such as ibuprofen (Motrin) and acetaminophen (Tylenol), and also with prescription migraine medication.

Traumatic events to the eye penetrating injuries to the globe of the eye are always best managed by ophthalmologists.
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