Eye pain can mean anything from a minor irritation to a serious condition that needs immediate attention. The key to figuring out what’s going on lies in the type of pain you feel, where exactly it’s located, and what other symptoms come with it. Most eye pain falls into two broad categories: pain on the surface of the eye and pain that feels deeper, behind or around it. Each points to a different set of causes.
Surface Pain vs. Deep Pain
Surface eye pain tends to feel like burning, stinging, itching, or the sensation that something is stuck in your eye. It usually involves the cornea (the clear front layer) or the conjunctiva (the thin tissue covering the white of the eye). Causes include dry eye, scratches, infections, and foreign debris.
Deep eye pain feels like aching, throbbing, or pressure behind or within the eye. It can radiate into the forehead, temple, or cheek. This type of pain is more likely to involve structures inside or behind the eye, including the optic nerve, the white outer wall of the eye (sclera), or the fluid pressure system that keeps your eye inflated. Deep pain that worsens when you move your eyes is a particularly important clue, as it narrows the possibilities significantly.
Dry Eye and Corneal Scratches
Dry eye is one of the most common reasons people experience ongoing, low-grade eye discomfort. It typically affects both eyes and produces a vague burning or gritty feeling, as though there’s sand under your eyelids. Wind, screen time, air conditioning, and certain medications all make it worse. A simple clinical test measures tear production over five minutes: anything under 10 millimeters of moisture on a small paper strip suggests some form of dry eye.
Corneal abrasions, or scratches on the surface of the eye, cause sharper pain. You might also notice watery eyes, redness, light sensitivity, and blurred vision. These scratches happen easily from a fingernail, a piece of dust, or rubbing your eyes too hard. Minor abrasions typically heal within 24 to 48 hours, though larger scratches take longer. Even small scratches can be surprisingly painful because the cornea is one of the most nerve-rich tissues in the body.
Infections and Contact Lens Risks
Bacterial or viral infections of the eye’s surface cause stabbing pain, redness, and discharge that may be thick or pus-like. Viral conjunctivitis (pink eye) is the most familiar version, but infections of the cornea itself are more serious and more painful.
Contact lens wearers face a specific risk for a rare but severe corneal infection caused by a waterborne organism called Acanthamoeba. The major risk factors are handling or storing lenses improperly, using tap water or homemade cleaning solutions, and wearing contacts while swimming, showering, or using a hot tub. A hallmark of this infection is pain that seems far worse than what the eye looks like on exam. It requires prompt treatment to prevent lasting damage.
Shingles can also affect the eye. Before the characteristic blistering rash appears, you may feel a burning or tingling pain around one eye and across one side of the forehead. This is the virus reactivating along the nerve that supplies sensation to that area of the face.
Deeper Causes: Scleritis and Uveitis
Scleritis is inflammation of the sclera, the tough white outer coat of the eye. It causes a piercing, boring pain that worsens with eye movement (because the muscles that rotate your eye attach directly to the sclera). The pain is often severe enough to wake you up at night and can spread across your face. Scleritis frequently signals an underlying autoimmune condition. Rheumatoid arthritis is the most commonly associated disease, but lupus, inflammatory bowel disease, and several other autoimmune disorders are also linked.
Uveitis is inflammation of the layer just beneath the sclera. It causes redness, blurred vision, significant light sensitivity, and moderate to severe pain concentrated within the eye that sometimes radiates into the face. Uveitis and scleritis can occur at the same time, but they involve different tissue layers and may require different treatment approaches.
Acute Glaucoma
A sudden spike in the fluid pressure inside your eye is a medical emergency. In acute angle-closure glaucoma, the drainage system inside the eye becomes blocked, pressure builds rapidly, and permanent vision damage can happen quickly. The pain is intense, often accompanied by nausea or vomiting, halos around lights, a red eye that feels hard to the touch, and blurry vision. It typically affects one eye at a time. This is one of the few eye conditions that genuinely requires an emergency room visit, because the window to prevent irreversible vision loss is short.
Optic Neuritis and Neurological Causes
Optic neuritis, inflammation of the nerve that carries visual information from the eye to the brain, causes pain behind the eye that gets worse when you look around. It usually comes with sudden vision loss or dimming in one eye. The vast majority of people with optic neuritis experience this movement-related pain, and it’s often felt as a deep ache behind the eye, around the eye socket, or as a frontal headache.
The connection to multiple sclerosis is significant. Optic neuritis is the first symptom of MS in about 20% of patients, and roughly half of all people with MS experience it at some point during the disease. Not everyone who gets optic neuritis will develop MS, but the association is strong enough that doctors typically investigate further with brain imaging.
Headaches That Center on the Eye
Both migraines and cluster headaches can produce pain in or around the eye, but they feel and behave quite differently.
Cluster headaches strike one side of the head, typically at the temple or directly around the eye. They’re intense but relatively brief, lasting 30 to 90 minutes. The affected eye often tears up and turns red, and you may get nasal congestion on that same side. These episodes tend to occur in bouts lasting weeks or months.
Migraines last much longer, often an entire day or several days if untreated. The pain can develop behind one eye, at the front or back of the head, or throughout the entire head. Migraines can also cause tearing, eye redness, and congestion, but these symptoms usually appear on both sides rather than just one.
Giant Cell Arteritis in Older Adults
For adults over 50, a specific vascular condition called giant cell arteritis deserves attention. It involves inflammation of the blood vessels in the temples and can cause sudden, permanent vision loss in one eye. Most people who develop it are between 70 and 80. Warning signs include a new headache (especially at the temples), scalp tenderness, jaw pain while chewing, and vision changes. The combination of eye pain or vision loss with jaw pain is a particularly important red flag.
Red Flags That Need Immediate Care
Most eye pain resolves on its own or with simple treatment. But certain combinations of symptoms point to conditions where delays can cost you vision. Seek emergency care if your eye pain is severe and comes with a headache, fever, or increased light sensitivity. The same applies if your vision changes suddenly, you start seeing halos around lights, you experience nausea or vomiting alongside the pain, or you notice blood or pus draining from your eye.
Other situations that call for urgent evaluation: you can’t move your eye normally or keep it open, there’s noticeable swelling in or around the eye, or the pain followed a chemical splash or a foreign object hitting the eye. In these cases, getting evaluated within hours rather than days can make a meaningful difference in outcome.