[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Approach by symptom](https://durgical.com/en/ophthalmology/areas/approach/) › Eye pain and painful visual loss

# Eye pain and painful visual loss

- Clinical approach

Eye pain with reduced vision is almost always serious. Pain on the surface that a numbing drop relieves is different from deep pain or pain on moving the eye.

Updated Nov 5, 2026

**See it in 3D:** [Cornea](https://durgical.com/en/anatomy/cornea/) · [Sclera](https://durgical.com/en/anatomy/sclera/) · [Iris](https://durgical.com/en/anatomy/iris/) · [Optic nerve](https://durgical.com/en/anatomy/optic-nerve/)

## Key points

- Pain + reduced vision = same-day ophthalmology.
- Relieved by an anaesthetic drop = surface cause.
- Pain on eye movement + afferent pupillary defect = optic neuritis.
- Pain after eye surgery = endophthalmitis until proven otherwise.

## What it is

Eye pain ranges from a scratch on the cornea to conditions that destroy sight in hours. Where the pain is felt and whether vision is reduced sort the causes. Surface pain (gritty, watery, relieved by an anaesthetic drop in the exam room) comes from the cornea or conjunctiva. Deep aching pain comes from the uvea, sclera or a pressure rise. Pain on eye movement suggests optic neuritis or orbital disease.

## Red flags

- Reduced visual acuity together with pain.
- Pain after recent eye surgery or an intravitreal injection: endophthalmitis.
- Severe pain with nausea, halos and a hard eye: acute angle closure.
- Pain on eye movement with blurred vision and faded colours: optic neuritis.
- Proptosis, restricted eye movements or fever: orbital cellulitis.
- Pain not relieved by a topical anaesthetic drop: the cause is deeper than the surface.

## Step-by-step approach

- Measure visual acuity in each eye.
- Ask where the pain is (surface, deep, behind the eye), if it worsens with eye movement, and about surgery, injury and contact lenses.
- Examine the cornea with fluorescein and evert the upper lid to look for a foreign body.
- Check the pupil (afferent defect, fixed mid-dilated) and colour vision.
- Estimate eye pressure and look for proptosis, restricted movements and lid swelling.
- Examine the fundus: a swollen disc, vitreous haze or a red reflex lost to pus.

## Causes of eye pain

| Cause | Pain | Vision | Key sign |
| --- | --- | --- | --- |
| [Corneal abrasion or foreign body](https://durgical.com/en/conditions/corneal-abrasion-and-ocular-foreign-body/) | Surface, gritty | Normal or mildly reduced | Fluorescein stain; relief with anaesthetic drop |
| [Keratitis](https://durgical.com/en/conditions/keratitis-and-corneal-ulcer/) | Surface and deep | Reduced | Corneal infiltrate |
| [Acute angle closure](https://durgical.com/en/conditions/acute-angle-closure-glaucoma/) | Severe, deep, with headache and vomiting | Reduced, halos | Hard eye, fixed mid-dilated pupil |
| [Anterior uveitis](https://durgical.com/en/conditions/uveitis/) | Deep ache, photophobia | Mildly reduced | Ciliary flush, small pupil |
| [Scleritis](https://durgical.com/en/conditions/scleritis-and-episcleritis/) | Severe, boring, worse at night | Normal or reduced | Tender, deep violet redness |
| [Endophthalmitis](https://durgical.com/en/conditions/endophthalmitis/) | Increasing after surgery or injection | Markedly reduced | Hypopyon, vitreous haze |
| [Optic neuritis](https://durgical.com/en/conditions/optic-neuritis/) | On eye movement | Reduced over days, faded colours | Afferent pupillary defect |
| [Orbital cellulitis](https://durgical.com/en/conditions/orbital-cellulitis/) | Deep, on eye movement | Normal or reduced | Proptosis, fever, restricted movements |

## Keys to the differential

- Relief with an anaesthetic drop in the exam room places the pain on the ocular surface; the drop is diagnostic only.
- Optic neuritis in a young woman is often the first event of multiple sclerosis.
- Headache with a red eye and vomiting can be mistaken for migraine or a gastrointestinal illness: always look at the eye in acute angle closure.
- About half of patients with scleritis have an associated systemic disease, most often rheumatoid arthritis or ANCA vasculitis.

## Next step / Initial management

- Surface cause with normal vision (abrasion, foreign body): remove the foreign body, topical antibiotic, review in 24 to 48 hours if not healing.
- Pain with reduced vision: same-day ophthalmology.
- Pain and reduced vision after eye surgery or injection: emergency referral for endophthalmitis (intravitreal antibiotics within hours).
- Optic neuritis: MRI of the brain and orbits with contrast and referral to ophthalmology and neurology; intravenous corticosteroids speed recovery but do not change final vision.
- Orbital cellulitis: admission, intravenous antibiotics, contrast CT of the orbits and sinuses, ophthalmology and ENT.

## Test yourself

Think of the answer, then tap the question to see it.

## What does relief of pain with a topical anaesthetic drop suggest?

That the pain comes from the ocular surface, such as a corneal abrasion or foreign body, rather than from inside the eye.

## What is the main concern with pain and reduced vision two days after cataract surgery?

Endophthalmitis: an emergency needing same-day ophthalmology and intravitreal antibiotics.

## Which imaging is requested in optic neuritis and why?

MRI of the brain and orbits with contrast, to confirm the diagnosis and look for demyelinating lesions that predict multiple sclerosis.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/eye-pain-and-painful-visual-loss/)

## Elsewhere in DurgiPedia

- [Pupils: light reflex and abnormal pupils (Marcus Gunn, Horner, Argyll Robertson)](https://durgical.com/en/clinical-exam/pupils-light-reflex-and-abnormal-pupils/)

## Connections

## See it in 3D 4

The structures of Durgical's 3D anatomy where it is found.

- [Cornea](https://durgical.com/en/anatomy/cornea/)
- [Sclera](https://durgical.com/en/anatomy/sclera/)
- [Iris](https://durgical.com/en/anatomy/iris/)
- [Optic nerve](https://durgical.com/en/anatomy/optic-nerve/)

## Related 5

- [Red eye: what is serious and what is not](https://durgical.com/en/ophthalmology/red-eye-what-is-serious-and-what-is-not/)
- [Acute angle closure: what to do before the ophthalmologist](https://durgical.com/en/ophthalmology/acute-angle-closure-what-to-do-before-the-ophthalmologist/)
- [Corneal and subtarsal foreign bodies](https://durgical.com/en/ophthalmology/corneal-and-subtarsal-foreign-bodies/)
- [Proptosis and periorbital swelling](https://durgical.com/en/ophthalmology/proptosis-and-periorbital-swelling/)
- [Topical anaesthetics: why they are never sent home](https://durgical.com/en/ophthalmology/topical-anaesthetics-why-they-are-never-sent-home/)

## Related conditions 9

- [Corneal abrasion and ocular foreign body](https://durgical.com/en/conditions/corneal-abrasion-and-ocular-foreign-body/)
- [Keratitis and corneal ulcer](https://durgical.com/en/conditions/keratitis-and-corneal-ulcer/)
- [Acute angle-closure glaucoma](https://durgical.com/en/conditions/acute-angle-closure-glaucoma/)
- [Uveitis](https://durgical.com/en/conditions/uveitis/)
- [Scleritis and episcleritis](https://durgical.com/en/conditions/scleritis-and-episcleritis/)
- [Endophthalmitis](https://durgical.com/en/conditions/endophthalmitis/)
- [Optic neuritis](https://durgical.com/en/conditions/optic-neuritis/)
- [Orbital cellulitis](https://durgical.com/en/conditions/orbital-cellulitis/)
- [Multiple sclerosis](https://durgical.com/en/conditions/multiple-sclerosis/)

## In Pharmacology 3

- [Fluorescein](https://durgical.com/en/pharmacology/fluorescein/)
- [Tetracaine](https://durgical.com/en/pharmacology/tetracaine/)
- [Methylprednisolone](https://durgical.com/en/pharmacology/methylprednisolone/)

[← All of ophthalmology](https://durgical.com/en/ophthalmology/)

Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.

Sources: [Optic Neuritis](https://www.ncbi.nlm.nih.gov/books/NBK557853/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Scleritis](https://www.ncbi.nlm.nih.gov/books/NBK499944/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Corneal Abrasion](https://www.ncbi.nlm.nih.gov/books/NBK532960/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Orbital Cellulitis](https://www.ncbi.nlm.nih.gov/books/NBK507901/) (StatPearls Publishing (NCBI Bookshelf), 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/ophthalmology/eye-pain-and-painful-visual-loss/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/eye-pain-and-painful-visual-loss/