Eye pain can as sharp, stabbing or throbbing described and should be distinguished from superficial irritation or foreign body sensation. In some diseases, the pain worsened by bright light. Eye pain can be caused by a serious condition and require immediate evaluation. Many causes of eye pain also cause a red eye. Pathophysiology The cornea is rich innervated and very sensitive to pain. Many diseases involving the cornea or anterior chamber concerning (. Eg uveitis), also cause pain by ciliary muscle spasm; if such tension exists, bright light causes a muscle contraction that aggravates the pain. Etiology interference that may cause eye pain can be divided into those that affect the cornea in the first place, other eye diseases and disorders that exist in connection with the eye (s. Some causes of eye pain). The most common causes are generally corneal erosion debris However, most corneal disorders can cause eyestrain. A feeling of a scrape or a foreign body can be caused either by a malfunction of the conjunctiva or cornea. Some causes of eye pain cause suspicious findings * Diagnostic approach diseases that primarily the cornea affect contact lens keratitis eye pain, grittiness, prolonged wearing of contact lenses, bilateral red eyes, tearing, corneal edema Clinical evaluation corneal erosion or foreign bodies usually clear violation history, unilateral pain when blinking, foreign body sensation M ometimes a predisposing medical condition such as trichiasis In slit lamp visible lesion or foreign body Clinical evaluation, including eversion of the eyelid Corneal Stabbing pain, foreign body sensation, photophobia, red eye, gray corneal haze, followed (Editor’s note: in the corneal stroma) by a visible crater may anamnestic sleeping with contact lenses swabs for culture (by ophthalmologists) epidemic keratoconjunctivitis (adenovirus keratitis) in severe cases, eye pain, grittiness, bilateral red eyes, large-volume watery discharge, preauricular lymphadenopathy, Ch emosis (swelling of the conjunctiva), often eyelid edema puncturing staining of the cornea with fluorescein investigation Clinical evaluation ophthalmic zoster breakfast: Unilateral bubbles and crusts on an erythematous base in a V1 coverage area, sometimes this also affects the nose eyelid edema, red eye Later: redness, quite a lot of pain often associated with uveitis Clinical evaluation Viral culture when diagnosis is unclear herpes simplex keratitis acute: unilateral (classical dendritic Kornealäsion at slit lamp examination Usually: occurrence of conjunctivitis, blisters on the eyelid late acute or recurrent can in children or patients with atopy also be bilateral) Clinical evaluation Viral culture when diagnosis is unclear UV or Photokeratitis occurrence is hours after exposure to excessive UV light (eg. As by welding or bright sun on snow) Bilateral; Eye pain, grittiness Conspicuous injections and typical dotted Korneafärbung with fluorescein examination of the cornea Clinical Evaluation Other eye diseases Acute Angle-Closure Glaucoma Serious eye pain, headache, nausea, vomiting, halos (rings) around lights, corneal opacity (due to edema caused), erythema intraocular pressure in the usually> 40 mmHg Gonioscopy by ophthalmologists anterior uveitis eye pain, ciliary injection, photophobia, often a risk factor (eg. as autoimmune disease, post-trauma) cells and positive Ty ndall (flare) Clinical at slit lamp examination Rarely Hypopyon rating endophthalmitis eye pain, intense conjunctival hyperemia, photophobia, severely impaired vision, risk factors (usually recent intraocular surgery or trauma) Unilateral cells and positive Tyndall (flare) and usually a Hypopyon at slit lamp examination Clinical evaluation and cultures of aqueous humor or vitreous Light by ophthalmologists optic neuritis pain may be aggravated by eye movements visual loss that can range from a small scotoma and even blindness afferent pupillary defect (a be Sonder characteristic finding in case something visual acuity remains) eyelids and cornea normal, sometimes pulling a swollen optic disc gadolinium-enhanced MRI into consideration in order to look for papilledema and demyelinating lesions in the brain (most often by multiple sclerosis) orbital eye pain, periocular pain, red and swollen eyelids, exophthalmos, impaired extraocular movements, decreased visual acuity, fever unilateral Sometimes going symptoms of sinusitis requires CT or MRI Orbital pseudotumor eye pain, periocular pain (can be very difficult), unilateral Exoph thalmus Limited extraocular movements, periorbital edema, gradual onset computed tomography or MRI biopsy scleritis Very severe pain (often described as a dull described), photophobia, lacrimation, red or purple spots under bulbar conjunctiva, Skleralödem often anamnestic autoimmune disease Clinical Evaluation disorders pain radiating cause Cluster Headache or migraine Previous episodes characteristic temporal pattern (eg. B. cluster of episodes each day Clinical at the same time) Aura, stinging quality, throbbing, cold, watery eyes, facial flushing, sometimes photosensitivity or photophobia rating sinusitis Sometimes periorbital edema, but otherwise unobtrusive eye examination purulent rhinitis, headaches or eye or facial pain with the head position vary tenderness in the face, fever, sometimes productive night cough, bad breath sometimes computed tomography * routine examination should include slit-lamp examination with fluorescein staining and ocular tonometry. Most patients have watery eyes and a real photophobia (a light that shines in the unaffected eye, causing pain in the affected eye when the affected eye is closed). UV = ultraviolet; V1 = ophthalmicus service area of ??the trigeminal nerve. Assessing medical history questions about the current course of the disease should cover (daily episodes in such clusters. B.) the appearance, quality and severity of pain and any anamnestic occurrence of previous episodes. Important Accompanying symptoms include real photophobia (a light that shines in the unaffected eye, causing pain in the affected eye when the affected eye is closed), reduced visual acuity, foreign body sensation and pain when blinking and pain when moving the eye. The review of organ systems should look for symptoms that suggest a cause, such as the presence of an aura (migraine), fever and chills (infection) and pain when moving the head, purulent rhinitis, productive or nocturnal cough and bad breath (sinusitis). In the history should known diseases that are considered risk factors for eye pain, be requested, including autoimmune diseases, multiple sclerosis, migraine and sinus infections. Additional risk factors, which may be assessed include the use (and excessive use) of contact lenses (contact lenses keratitis), which Augesetztsein to excessive sunlight or welding (UV keratitis), hammering or drilling metal (foreign objects), and recent eye injuries or operations (endophthalmitis) .Körperliche investigation vital signs are checked for the presence of fever. The nose is checked for purulent rhinitis and the face is palpated on sensitivity. If the eye is red, the preauricular region is checked for adenopathy. Compliance with strict hygiene rules is very important in the study of patients with chemosis, preauricular adenopathy, dotted Korneafärbung or a combination of these symptoms, as these findings suggest an epidemic keratoconjunctivitis, which is very contagious. The eye examination should be as comprehensive as possible in patients with eye pain. The best corrected visual acuity is checked. Visual fields are tested in patients with eye pain usually with the confrontation technique, but this test is not sensitive (especially for small defects) and unreliable possibly due to poor patient compliance. A light is on the other hand, moves from one eye to check the pupil size and direct and consensual pupillary responses to light. In patients who have unilateral eye pain, a light in the unaffected eye directed, while the affected eye is closed; Pain in the affected eye are a real photophobia. Extraocular movements are checked. The orbital and periorbital structures are reviewed. Conjunctival injections that appear around the cornea and the limbus most intense and konfluierendsten are called ciliary injections. If possible a slit lamp examination is performed. The cornea is stained with fluorescein and observed under a magnification with cobalt blue light. If no slit lamp is available, the cornea after fluorescein staining with a Wood’s lamp can be examined using a magnification. An ophthalmoscope is performed, and the intraocular pressure ratios are measured (tonometry). In patients with a foreign body sensation or inexplicable Korneaerosionen eyelids are everted and debris untersucht.Warnzeichen The following results are of particular importance: vomiting, halos (rings) around lights or corneal edema signs of systemic infection (eg, fever, chills.) Decreased visual acuity proptosis Limited extraocular motility interpretation of the results Suspicious findings are listed in Some causes of eye pain. Some results indicate certain disease categories. Scratch or a foreign body sensation are most often caused by diseases of the eyelids, conjunctiva or the superficial cornea. Light sensitivity is possible. Superficial pain with photophobia are often accompanied by a foreign body sensation and pain when blinking and suggest a Kornealäsion, usually a foreign object or erosion, down. Deeper pain that is often described as boring or throbbing, usually indicate a serious condition such as glaucoma, uveitis, scleritis, endophthalmitis, an orbital or orbital pseudotumor. Within this group suggest a swelling of the eyelid, one or both exophthalmos and impaired extraocular movements or decreased visual acuity to an orbital pseudotumor, an orbital or possibly a severe endophthalmitis out. Fever, chills, and weakness point to an infection through (z. B. orbital cellulitis, sinusitis). A red eye suggests that the fault that caused the pain, rather eyepiece instead is radiating. If pain in the affected eye in response to a light that is directed into the unaffected eye, while the affected eye is closed develop (real photophobia), the cause is usually a Kornealäsion or uveitis. If topical anesthetic drops (z. B. Proparakain-POS®) eliminate the pain in a red eye, the cause is probably a Kornearkrankung. Some findings indicate specific diseases. Pain and photophobic days after a blunt trauma to the eye point to a post-traumatic uveitis. The hammering or drilling metal are risk factors for occult intraocular metal foreign body. Pain on movement of the extraocular eye muscles and a loss of pupillary reaction to light, which are out of proportion to the loss of visual acuity, point to an optic neuritis hin.Tests tests are generally, with some exceptions (see table: Some causes of eye pain) unnecessary. Gonioscopy is performed if glaucoma is suspected based on elevated intraocular pressure. Imaging, usually with CT or MRI, is used when an orbital pseudotumor or orbital cellulitis is suspected or if sinusitis is suspected, but the diagnosis is not clear clinically. MRI is usually performed when a optic neuritis is suspected and is sought after in the brain demyelinating lesions suggestive of multiple sclerosis. Intraocular fluids (vitreous and aqueous humor) can be cultured in suspected endophthalmitis. Viral cultures can be used to confirm an ophthalmic zoster or herpes simplex keratitis if the diagnosis is not clear clinically. Therapy The cause of the pain is treated. The pain itself will be addressed. Systemic administration of analgesics is applied if necessary. Pain caused by uveitis and many Kornealäsionen, by cycloplegic eye drops (eg., 4 times daily 1% cyclopentolate) are alleviated. Summary Most diagnoses can be made through a clinical evaluation. Precautions to avoid infection should be observed when patients are examined with bilateral red eyes. Important danger signs include vomiting, halos (rings) around lights, fever, impaired vision, proptosis and decreased extraocular motility. Pain in the affected eye, in response to light that is directed into the unaffected eye when the affected eye is closed (true photophobia), point to a Kornealäsion or uveitis. If a topical anesthetic (z. B. Proparakain-POS®) relieves the pain, the cause of pain is a Kornealäsion. Hammering or drilling metal are risk factors for occult intraocular foreign bodies.