Eye pain has dozens of possible causes, ranging from something as simple as staring at a screen too long to serious conditions that need immediate treatment. The type of pain you feel, whether it’s a dull ache behind your eyes or a sharp, scratchy sensation on the surface, is the biggest clue to what’s going on.
Surface Pain vs. Deep Pain
Eye pain generally falls into two categories, and knowing which one you’re experiencing helps narrow down the cause. Surface pain feels like something is in your eye: scratching, burning, stinging, or grittiness. It typically involves the clear outer layer of the eye (the cornea) or the thin tissue covering the white part (the conjunctiva). Deep or orbital pain feels like a dull ache, pressure, or throbbing behind or around the eye. This type often involves structures further back in the eye socket, or it may be referred pain from somewhere else entirely, like your sinuses or a migraine.
A red, inflamed eye with pain usually points to an infection or inflammation affecting the surface tissues. A deep, boring pain without much visible redness can signal something more serious happening inside the eye.
Dry Eyes: The Most Common Culprit
If your eyes feel scratchy, gritty, or like they’re burning, dry eye disease is the most likely explanation. It affects an estimated 10 to 20 percent of people over 40, making it one of the most widespread eye conditions. The pain comes from a cycle that feeds on itself: your tear film becomes unstable, the surface of your eye gets too salty (hyperosmolar), and inflammation kicks in. That inflammation damages the surface further, which makes the tear film even less stable.
What makes dry eye tricky is that it doesn’t just involve tear production. Your nervous system plays a role too. Over time, the nerves on the surface of your eye can become hypersensitive, amplifying pain signals beyond what the physical damage would suggest. This is why some people with dry eye report significant discomfort even when their eyes don’t look particularly dry on examination. People with anxiety or depression also tend to experience more intense dry eye symptoms, likely because of shared pathways in how the brain processes pain signals.
Common triggers include low humidity, air conditioning, wind, aging, and certain medications like antihistamines and antidepressants. Artificial tears are the usual first step for relief, but persistent dry eye often needs more targeted treatment.
Screen Time and Digital Eye Strain
Spending just two hours of continuous screen time per day increases your chance of developing what’s known as computer vision syndrome. Symptoms include blurred vision, dry eyes, headaches, light sensitivity, and an aching pain behind the eyes. You may also notice neck, shoulder, and back stiffness alongside the eye discomfort.
The strain happens partly because you blink less while focusing on a screen, which dries out your eyes, and partly because your eye muscles are working constantly to maintain focus at a fixed distance. If your screen is too bright, too dim, or positioned at an awkward angle, the strain gets worse.
The practical fix is the 20-20-20 rule: every 20 minutes, look at something at least 20 feet away for about 20 seconds. Building in a 15-minute break every two hours also helps. If you can keep total screen time under four hours a day, your risk drops significantly, though that’s not realistic for everyone.
Sinus Problems, Migraines, and Referred Pain
Sometimes your eyes hurt even though nothing is wrong with them. The nerve responsible for sensation in and around your eye, the ophthalmic branch of the trigeminal nerve, also carries signals from your sinuses, nasal cavity, and portions of your skull. When your sinuses are inflamed or congested, pain can travel along that shared nerve pathway and register as pressure or aching behind your eyes.
Migraines work through a similar mechanism but with an added twist. People who get migraines tend to have a hyperexcitable visual processing area in the brain, which makes them more sensitive to light, sound, smells, and touch. This is why bright light physically hurts during a migraine. Research from the American Academy of Ophthalmology suggests that light-induced pain is actually driven by the trigeminal nerve system rather than the visual system itself. Cutting the optic nerve in animal studies didn’t stop light-triggered pain responses, but cutting the trigeminal nerve did.
If your eye pain comes with sinus congestion, facial pressure, or a headache that throbs on one side, the pain source is likely outside the eye itself.
Infections That Cause Eye Pain
Bacterial and viral infections can cause anything from mild irritation to severe pain. Conjunctivitis (pink eye) is the most familiar: redness, discharge, and a gritty feeling, but usually not intense pain. More concerning is keratitis, an infection of the cornea that causes sharp pain, light sensitivity, tearing, and sometimes blurred vision.
Contact lens wearers face a higher risk of bacterial keratitis. The two bacteria most commonly responsible are Pseudomonas aeruginosa, found in soil and water, and Staphylococcus aureus, which lives naturally on human skin and mucous membranes. Sleeping in contacts, swimming with them in, or cleaning them with tap water instead of sterile solution all increase the odds of infection. If you wear contacts and develop sudden pain, redness, or sensitivity to light, remove the lenses immediately.
Inflammation Inside the Eye
Two inflammatory conditions cause more intense eye pain. Scleritis, inflammation of the tough white outer wall of the eye, produces a deep, boring pain that gets worse when you move your eyes. The pain can be excruciating. If the inflammation spreads to nearby structures like the cornea, retina, or lens, it can cause permanent scarring and lasting vision changes. Scleritis is often linked to autoimmune conditions like rheumatoid arthritis.
Uveitis, inflammation of the middle layer of the eye, causes similar deep pain along with redness, light sensitivity, and blurred or cloudy vision. Both conditions need prompt treatment to prevent damage, and both tend to recur.
Acute Glaucoma: The Emergency
Most causes of eye pain are uncomfortable but not dangerous. Acute angle-closure glaucoma is the exception. It happens when fluid drainage inside the eye gets suddenly blocked, causing pressure to spike. Symptoms come on fast: severe eye pain, redness, blurred vision, halos or rainbow-colored rings around lights, headache, and nausea or vomiting. The combination of eye pain with nausea is a particularly important warning sign.
This is a genuine emergency. Without treatment within hours, the elevated pressure can permanently damage the optic nerve and cause irreversible vision loss. If you experience a sudden onset of severe eye pain with any of these accompanying symptoms, go to an emergency room.
Light Sensitivity and Eye Pain
Photophobia, where normal light levels cause pain or discomfort, accompanies many of the conditions above but can also appear on its own. The mechanism is tied to the trigeminal nerve system rather than the eyes’ light-detecting cells. This is why photophobia often affects people with migraines, concussions, and meningitis, not just those with eye surface problems.
If light has become consistently painful for you and you don’t have an obvious trigger like dry eyes or a recent eye injury, it’s worth investigating whether a neurological cause is involved. Tinted lenses can help manage symptoms, but they work best as a complement to treating the underlying cause rather than as a standalone fix.
What the Type of Pain Tells You
- Gritty or scratchy: dry eyes, a foreign body on the surface, or a corneal abrasion
- Burning or stinging: dry eyes, chemical irritation, or allergies
- Sharp pain with light sensitivity: corneal infection, uveitis, or a scratch on the cornea
- Deep ache or pressure behind the eye: sinusitis, migraine, scleritis, or eyestrain
- Severe pain with nausea and halos: acute angle-closure glaucoma
- Pain that worsens with eye movement: scleritis, optic neuritis, or orbital inflammation
Mild, occasional eye discomfort from dryness or screens typically responds well to breaks, artificial tears, and environmental adjustments. Pain that is severe, sudden, recurring, or accompanied by vision changes points to something that needs professional evaluation sooner rather than later.