Pain Behind the Eye

Businesswoman with headache
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Do your eyes hurt? Pain, headache or achiness that occurs behind the eye is a common complaint. However, a proper diagnosis is not always easy.

Different Types of Eye Pain

Pain behind your eye can feel like a dull ache or sharp, intense pain. Some people complain of an explosive pain behind the eye or describe it as feeling like their eye is being stabbed with an ice pick.

Pain or headache behind the eye may be accompanied by:

Common Causes of Eye Pain

If you experience pain behind your eyes, you may wonder if a tumor or mass is growing behind your eye. Although that could be a cause, it is not very likely. Following are common causes of headaches or pain behind the eyes.

  • Vision problems: Although this seems logical, sometimes we do not equate the cause of frank eye pain with vision problems such as nearsightedness, farsightedness, astigmatism or presbyopia (the over-40 syndrome that causes blurred near vision). The cause of pain associated with vision problems stems more from our eye and brain trying to compensate for the disorder rather than the deficit itself. Squinting and intense focusing can cause pain to build up inside and behind the eye.
     
  • SinusitisSinus problems or infections can cause facial pain around the eyes. Because there are sinus cavities around the bony orbit that houses the eyeball, pain can develop in and around the eye. This pressure behind the eye is usually accompanied by facial headaches as well.
     
  • Scleritis: The sclera is the tough outer coating of the eyeball. Scleritis is inflammation that develops inside the sclera. Scleritis produces pain behind the eye or upon eye movement. There can also be redness and light sensitivity. Scleritis can develop with no underlying cause, but often it is a manifestation of an underlying systemic condition such as rheumatoid arthritis, lupus, scleroderma, connective tissue disease and inflammatory bowel disease. Scleritis is treated with oral and topical steroid medications and immune system modulatory medications.
     
  • Optic neuritis: Optic neuritis often causes pain behind the eye or pain upon eye movement. Optic neuritis is an inflammatory condition of the optic nerve, the cable that connects the eye to the brain. It inserts into the back of the eye and can be tugged slightly from side to side when the eye moves back and forth. When inflamed, pain occurs behind the eye. Although not entirely proven, optic neuritis is strongly linked to the development of multiple sclerosis in the future.
     
  • MigrainesMigraine sufferers often complain about throbbing pain behind one eye. Hormones can play a role in migraines but certain triggers can cause a migraine to develop. These triggers can be stress, certain smells, flashing strobe lights or even eating something you are allergic to. Some migraine sufferers also experience strange visual auras or hallucinations that can restrict their peripheral vision. Thankfully, these visual obscurations are short lived, usually lasting less than 10 to 20 minutes.
     
  • Cluster headaches: Cluster headaches are extremely painful headaches that cause pain behind the eyes. Cluster headaches can come on suddenly and reoccur almost on a clockwise basis within a 24-hour period. Doctors think the hypothalamus in the brain may be involved because of their reoccurrence and seasonal patterns. Cluster headaches affect men four times more often than women.
     
  • Dry eye syndrome: When we think of dry eyes, we imagine symptoms of pain, dryness and redness affecting the front part of the eye. However, when dry eye persists, light sensitivity, pain and general headaches can occur. This pain can cause pressure to build up around and behind the eye. Although dry eye syndrome treatment consists of many procedures and medicines, sometimes all it takes is instilling a good quality artificial tear into your eyes several times a day.

Source: Slamovits, Thomas. Neuro-Ophthalmology. Mosby, 1995.

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