Updated 11 February 2013

Eye pain

Eye pain can be defined as intense, severe, faded, grainy, scratchy, painful, pounding or acute.


Eye pain can be defined as intense, severe, faded, grainy, scratchy, painful, pounding or acute.

Eye pain can be divided into two groups, namely painful red eye and a painful eye without redness. 

1. A painful red eye can be a symptom of either conjunctivitis (Pink Eye), episcleritis, scleritis,iritis,keratitis or UV keratitis. These various conditions are explained below.

  • Conjunctivitis

  • This presents with painful redness of the eye, as well as irritation.  There is usually a thin puss discharge and the patient is normally sensitive to light and has decreased vision.  Treatment at home can be done by applying a cool compress.  It is, however, best to consult a doctor to establish if it is a bacterial or viral conjunctivitis.  A viral conjunctivitis can be treated symptomatically by the doctor.  Bacterial conjunctivitis needs topical antibiotics, namely erythromycin ointment etc.
  • Episcleritis
    This presents with a painful red eye and inflammation of the white area of the eye.  It is usually non-infectious and will not have to be treated, as it is normally self-limiting.  Non-steroidal anti-inflammatories, namely ibuprofen, can be taken orally to treat the symptoms.

  • Scleritis

    This presents with a red eye and severe pain radiating to the head.  The eye will be very tender to palpitation.  Scleritis is usually associated with other conditions, such as gout.  You can treat this condition at home with oral non-steroidal anti-inflammatories, but it is advisable to consult your doctor in order to confirm this diagnosis.  Scleritis is an inflammatory process of the eye and does not need topical antibiotics.

  • Iritis
    Iritis is inflammation of the iris (coloured part of the eye) that causes deep-seated pain.  It is most commonly an idiopathic (no reason at all) inflammation and is often associated with trauma of the eye.  This usually presents with a one-sided painful red eye with photophobia (sensitivity to light).  The pupil will appear to be small. There are no home remedies and treatment should be given by an ophthalmologist as soon as possible.

  • Keratitis (inflammation of the cornea)
    Keratitis presents with a painful red eye, usually also one-sided.  Sometimes there is a discharge of the eye that can be watery or contain puss.  There can also be decreased or blurred vision on the affected eye.  Treatment is dependent on the underlying cause of the keratitis.  There are multiple causes for keratitis, i.e.  varicella-zoster, herpes simplex and staphylococcus.  It is essential to consult a doctor, in order to make proper diagnosis and to start with the correct treatment.

  • UV Keratitis (welder’s flash)
    This condition usually presents 6 to 12 hours after exposure to welding or UV tanning lights.  The symptoms are redness and pain of the eyes, tearing, foreign body sensation and light sensitivity.  You can treat this with cold compression at home and by taking oral non-steroidal anti-inflammatories, but it is once again advisable to seek assistance from a doctor as soon as possible.

2. A painful eye without redness is usually a symptom of glaucoma.

  • Glaucoma:
    Glaucoma presents with severe pain, hazy vision or halos, a steamy (cloudy) cornea, a dilated unreactive pupil, photophobia (painful reaction to light), nausea and vomiting.
    This is a condition that needs to be treated immediately by an ophthalmologist.  There are no home remedies to treat these symptoms or this condition.  The medication used is pilocarpine, topical alpha-blockers and intravenous Manitol.
  • Written by Dr Anrich Burger, MB ChB (Stell), on 31 January 2008


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