Pain in your right eye when you look up usually means something is irritating or inflaming the structures that move your eye upward, whether that’s the muscle on top of the eyeball, the tendon that guides it, or the nerve behind it. The cause ranges from simple eye strain to conditions that need prompt treatment, and the other symptoms you’re experiencing alongside the pain are the key to telling them apart.
How Upward Eye Movement Works
Six small muscles attach to the outside of each eyeball and pull it in different directions. When you look up, the main muscle doing the work is the superior rectus, which sits on top of the eye. A second muscle called the inferior oblique assists. Both are controlled by a cranial nerve called the oculomotor nerve. Any inflammation, strain, or irritation affecting this muscle, its tendon, or the nerve supplying it can produce pain that’s most noticeable when you look upward, because that’s when those tissues are actively contracting or stretching.
Eye Strain From Overuse
The most common and least serious explanation is eye strain, sometimes called asthenopia. If you’ve been staring at a screen for hours, reading in poor light, or doing close-up work without breaks, the muscles controlling your eye can fatigue. This often produces a dull ache that worsens when you move your eyes in any direction, but it can feel worse looking up if the superior rectus is particularly fatigued. Resting your eyes, using artificial tears, and taking regular screen breaks typically resolves it within hours to a day.
Trochleitis: Tendon Inflammation Near the Brow
If the pain is concentrated in the upper inner corner of your eye socket, close to where your eyebrow meets your nose, trochleitis is a strong possibility. This condition involves inflammation of the trochlea, a small pulley-like structure in that corner of the orbit through which the superior oblique muscle’s tendon passes. Pain from trochleitis is specifically worsened by vertical eye movements, especially looking up. It often spreads into the forehead on the same side and can feel tender if you press on that inner upper corner of your eye socket.
Trochleitis is diagnosed mainly through a physical exam: if pressing on the trochlear region reproduces sharp, localized pain and the area feels swollen, that’s highly suggestive. Imaging with MRI or ultrasound can confirm it. The condition typically responds well to anti-inflammatory treatment.
Orbital Myositis: Inflamed Eye Muscles
Orbital myositis is a less common condition where one or more of the eye muscles themselves become inflamed. It most often affects people in their 20s and 30s, with a higher rate in women. The hallmark is moderate to severe eye pain that gets worse with movement, along with swollen eyelids, a red eye, and sometimes double vision. You might notice the affected eye looks slightly more prominent than the other.
If the superior rectus muscle is the one inflamed, looking up will be the movement that hurts most and may feel restricted. Visual sharpness is usually preserved, which helps distinguish this from more serious conditions. Orbital myositis responds to anti-inflammatory medication, but it needs a proper diagnosis first, typically through MRI imaging of the eye socket.
Optic Neuritis: Nerve Inflammation Behind the Eye
Optic neuritis is inflammation of the optic nerve, the cable that carries visual information from your eye to your brain. Over 90% of people with optic neuritis experience pain that worsens with eye movement. The pain tends to feel deep, behind the eyeball rather than on the surface, and it’s usually accompanied by vision changes: blurriness, dimming, washed-out colors, or a blind spot that develops over hours to days.
This condition is more common in younger adults and is sometimes the first sign of multiple sclerosis, though it can also occur on its own. Diagnosis involves a detailed eye exam that includes checking how your pupils respond to light (a pupil that dilates when light is shone directly on it, instead of constricting, can indicate optic nerve trouble). An MRI with contrast dye of the brain and orbits is the standard imaging test. Most people recover significant vision over weeks to months, but the condition warrants prompt evaluation.
Sinus Pressure and Infection
Your frontal sinuses sit directly above your eye sockets. When they’re congested or infected, the pressure and inflammation can radiate into the eye area, particularly the upper portion. This pain often worsens when you look up, bend forward, or press on your forehead. You’ll usually have other sinus symptoms too: nasal congestion, facial pressure, thick nasal discharge, or a recent cold. If sinusitis is the cause, the eye pain improves as the sinus issue resolves, either on its own or with appropriate treatment.
Less Common Causes
Posterior scleritis, an inflammation of the tough white outer coating at the back of the eyeball, can cause deep eye pain during movement along with vision loss. It’s rare but serious. Orbital cellulitis, a bacterial infection of the tissues around the eye, causes pain with movement alongside fever, swelling, redness, and sometimes restricted eye motion. It’s a medical emergency typically diagnosed with CT imaging.
Symptoms That Need Urgent Attention
Most cases of eye pain with upward gaze turn out to be strain or mild inflammation. But certain combinations of symptoms signal something more serious. Get medical help quickly if your eye pain comes with any of the following:
- Vision changes such as blurriness, double vision, dimming, or loss of color perception
- A bulging eye or noticeable asymmetry between your two eyes
- Fever or chills, which suggest infection
- Inability to move your eye through its full range of motion
- Vomiting or seeing halos around lights, which can indicate a pressure problem inside the eye
What You Can Do Right Now
If the pain is mild, came on gradually, and isn’t accompanied by vision changes or swelling, reasonable first steps include resting your eyes for several hours (avoid screens and close work), using preservative-free artificial tears to keep the eye surface lubricated, and applying a cool compress over the closed eye for 15 to 20 minutes. If you suspect sinus congestion is contributing, a warm compress over the forehead and nasal area may help relieve pressure.
Pay attention to whether the pain stays the same, improves, or worsens over 24 to 48 hours. Pain that resolves with rest was likely strain. Pain that persists, intensifies, or starts affecting your vision points to one of the inflammatory or nerve-related conditions described above, and an eye exam becomes important for sorting out the cause.