Why Does Underneath My Eye Hurt? Common Causes & Relief

Pain underneath the eye usually traces back to one of a handful of common culprits: sinus pressure, eye strain, dry eye, or a minor infection of the tear drainage system. The area is packed with sensitive nerves and sits directly above the maxillary sinus, which makes it a crossroads for problems originating in places you might not expect, from your teeth to your computer screen. Most causes are treatable at home or with straightforward medical care, but a few deserve urgent attention.

Why This Spot Is So Sensitive

A major nerve called the infraorbital nerve runs right through the floor of your eye socket and exits through a small opening in the bone just below the rim of the orbit. It supplies sensation to the lower eyelid, the side of the nose, and even the upper lip and front teeth.¹ Because this nerve sits so close to the sinus wall, anything that swells, presses on, or inflames the tissue in that region can produce pain that feels like it is coming from directly under the eye. A cadaver study found that in about one in eight people the nerve actually dips down into the sinus cavity rather than staying embedded in the bony roof, which could make those individuals more vulnerable to sinus-related under-eye pain.²

The skin beneath your eye is also among the thinnest on your body, making it more reactive to allergens and irritants than, say, the skin on your cheek or forehead. And the tear drainage system, the small channel that carries tears from the inner corner of your eye down into your nose, runs through this same neighborhood. All of this anatomy crammed into a small space means a wide variety of problems can register as “pain under the eye.”

Sinus Congestion and Infection

The single most common reason for a dull, pressure-like ache beneath the eye is the maxillary sinus. This air-filled pocket sits directly below the eye socket, and when it fills with mucus or becomes infected, the swelling pushes against the thin bone separating the sinus from the orbit. You will usually notice the pain worsens when you bend forward, press on your cheekbone, or wake up after lying flat all night. A cold, allergies, or a full-blown bacterial sinusitis can all produce this pattern.

Acute sinusitis typically resolves on its own within a week or two. Nasal saline rinses, steam inhalation, and over-the-counter decongestants help relieve the pressure in the meantime. If the pain lasts longer than ten days, is accompanied by high fever, or gets dramatically worse after initially improving, those are signs of a bacterial infection that may need antibiotics.

Eye Strain From Screens

If the pain shows up after hours of computer work and fades once you step away, eye strain is the likely explanation. A study that tracked symptoms during two hours of visually demanding computer work found significant increases in eye-related pain and tiredness, along with measurable increases in the muscle activity of the orbicularis oculi, the ring of muscle that encircles the eye and controls blinking.³ When that muscle stays slightly contracted for long stretches, the ache tends to settle around and beneath the eye where the muscle fibers are thinnest.

The fix is usually behavioral. The 20-20-20 rule, looking at something 20 feet away for 20 seconds every 20 minutes, gives the muscles a chance to relax. Adjusting screen brightness so it roughly matches the ambient light in the room also helps, as does positioning your monitor so your gaze angles slightly downward rather than straight ahead, which reduces how wide you need to keep your eyelids open and cuts down on tear evaporation.

Dry Eye and Tear Film Problems

Dry eye often presents not as an obvious “dry” feeling but as a gritty, burning, or aching sensation that localizes under or around the eye. When the tear film breaks down, nerve endings on the cornea become exposed to air, and the body interprets that as pain. Research has linked lower eyelid laxity, where the lower lid pulls away slightly from the eyeball, to worse dry eye symptoms and signs, including more corneal surface damage and faster tear breakup.⁴ This matters because the lower lid is the structure that sits directly under the eye. If it is not sealing against the eyeball properly, tears pool unevenly and the under-eye area bears the brunt of the discomfort.

Artificial tears are the first-line remedy for most dry eye. Preservative-free formulations are gentler for frequent use. Warm compresses applied over closed eyelids for five to ten minutes can also help by softening the oils in the meibomian glands along the lid margin, improving the quality of the tear film. One study found that warm compress therapy significantly improved Schirmer test scores, a measure of tear production, compared with a control group.⁵

Blocked Tear Duct and Dacryocystitis

The lacrimal sac, the small pouch where tears collect before draining into the nose, sits at the inner corner of the eye, just under the lower orbital rim. When the nasolacrimal duct below it becomes blocked, the sac can fill with stagnant fluid and get infected, a condition called dacryocystitis.⁶ The hallmark is a tender, swollen lump near the inner corner of the lower eye area, sometimes with redness spreading along the side of the nose. Pressing on the lump may cause pus to reflux out of the tear duct opening in the lower lid.

Acute dacryocystitis usually calls for oral antibiotics and warm compresses. If blockages recur, an ophthalmologist can perform a procedure to create a new drainage pathway from the lacrimal sac into the nasal cavity, which permanently resolves the problem in most cases.

Periorbital and Orbital Cellulitis

Infections of the soft tissue around the eye can cause significant under-eye pain, and the distinction between periorbital cellulitis (infection in front of the thin wall of bone separating the eye socket from the surrounding tissues) and orbital cellulitis (infection behind that wall, within the socket itself) matters a great deal. Both present with swelling, redness, pain, and tenderness around one eye.⁷ Periorbital cellulitis is more common, especially in children, and often follows a sinus infection, insect bite, or skin wound near the eye. Orbital cellulitis is rarer but more dangerous; it can threaten vision and, in severe cases, spread to the brain.

Key warning signs that the infection may have moved behind the bone include pain with eye movement, bulging of the eye, double vision, and decreased visual acuity. Any of these symptoms warrant a same-day evaluation, usually with imaging, and sometimes intravenous antibiotics.

Dental Infections That Refer Pain Upward

Because the infraorbital nerve sends a branch down to the upper front teeth and canines, dental problems can produce pain that is felt underneath the eye rather than in the mouth. An abscess at the root of an upper premolar or molar can also erode through the thin bone separating the tooth roots from the maxillary sinus. Once infection enters the sinus, it can spread upward toward the orbital floor.⁸ This pathway is more common in children, whose deciduous molars sit closer to the sinus, but it can happen in adults with neglected dental decay as well.

If you have under-eye pain combined with a toothache, swelling of the upper gum, or a recently cracked or decayed upper tooth, your dentist should be one of your first calls. Treating the dental source often resolves the facial pain entirely.

Infraorbital Neuralgia

When the infraorbital nerve itself is damaged or irritated, the result is a distinctive form of facial pain called infraorbital neuralgia. It is described as sudden, severe, electric shock-like pain in the area the nerve supplies, which includes the lower eyelid, cheek, side of the nose, and upper lip.⁹ The pain can be triggered by light touch, chewing, or even wind hitting the face.

This condition can follow facial trauma, dental procedures, sinus surgery, or cosmetic injections, all of which can injure or compress the nerve. Treatment typically starts with medications used for other forms of nerve pain, such as carbamazepine or gabapentin. When conservative measures fail, procedures like nerve blocks or radiofrequency ablation at the infraorbital foramen can provide longer-lasting relief.

Cluster Headaches

Cluster headache is one of the most painful conditions in medicine, and it frequently announces itself as searing pain around or behind one eye, often described as radiating below it. Attacks are strictly one-sided, generally last 15 minutes to three hours, and come with distinctive autonomic symptoms on the same side: a watery or red eye, a drooping eyelid, nasal congestion, or a runny nose. People experience anywhere from one attack every other day to eight attacks in a single day, in bouts that last several weeks before fully remitting.¹⁰

If the pain under your eye is excruciating, comes in episodes, and is accompanied by tearing or nasal symptoms on the same side, cluster headache deserves consideration, especially if it recurs at the same time of day or the same season each year. High-flow oxygen and injectable triptans are effective for aborting individual attacks, and preventive medications can shorten or suppress entire bouts.

Trauma and Orbital Floor Fractures

A blow to the face, even one that seems minor, can fracture the thin bone forming the floor of the eye socket. These “blowout” fractures are reasonably common in facial trauma; in one study of 225 patients with blowout fractures, about one in five had associated eye injuries, though most were minor.¹¹ The main concern after a floor fracture, beyond pain and swelling, is whether one of the muscles that moves the eye has become trapped in the break. If it has, you may notice double vision, especially when looking up or down. Numbness of the cheek, upper lip, or front teeth is also common because the infraorbital nerve runs through the very bone that fractured.

Any significant facial blow followed by under-eye pain, numbness, or difficulty moving the eye warrants imaging. Small fractures often heal on their own, but trapped-muscle situations and large defects may need surgical repair.

Contact Dermatitis Around the Eye

Sometimes the pain is more superficial, coming from the skin itself rather than from deeper structures. Contact dermatitis is the most common skin eruption affecting the eyelids, partly because the skin there is so thin that allergens and irritants penetrate more easily than elsewhere on the face.¹² Common triggers include eye makeup, skincare products, nail polish transferred by touching, and airborne allergens like fragrances or cleaning product fumes. The under-eye area tends to swell first because gravity pulls the inflammatory fluid downward.

The discomfort is typically described as burning, stinging, or soreness rather than deep aching, and the overlying skin is usually visibly red or flaky. Identifying and eliminating the offending product is the cure. A short course of a mild topical corticosteroid, prescribed by a dermatologist, can calm a severe flare.

Eyelid Malpositions in Older Adults

As people age, the lower eyelid can turn inward (entropion) or outward (ectropion), both of which produce chronic irritation and pain in the under-eye region. A study of elderly populations found that involutional entropion affected about 2% and ectropion about 3% of older adults.¹³ Entropion turns the lashes against the eye surface, causing scratching, redness, and tearing. Ectropion exposes the inner lid to air, leading to dryness and chronic inflammation. Both conditions were associated with dry eye syndrome and corneal surface damage.

Lubricating drops provide temporary relief, but surgical correction of the lid position is the definitive treatment for either condition. If you are over 60 and notice persistent under-eye soreness along with a lid that looks turned in or sagging away from the eye, an oculoplastic surgeon can evaluate you.

Autoimmune and Systemic Inflammatory Causes

Under-eye pain that does not fit the usual categories and comes with other unexplained symptoms, like joint pain, dry mouth, rashes, or fatigue, may point toward a systemic inflammatory condition affecting the orbit. Non-infectious orbital inflammation commonly occurs with specific diseases including Graves’ disease, IgG4-related disease, sarcoidosis, Sjögren’s syndrome, and granulomatosis with polyangiitis, all of which have manifestations outside the eye as well.¹⁴ Thyroid eye disease (Graves’ orbitopathy) is the most common of these, and it can cause aching pressure behind and beneath the eye as the muscles and fat within the orbit swell.

These conditions are not something you would diagnose at home, but if your eye pain is accompanied by proptosis (the eye appearing to bulge), unexplained weight changes, or other systemic symptoms, blood work and orbital imaging can clarify the picture.

Cosmetic Filler Complications

The under-eye area, often called the tear trough, is one of the most popular sites for hyaluronic acid filler injections to reduce the appearance of hollowness or dark circles. While the procedure is generally safe, a review of complications found that the most commonly reported issues were immediate injection-site reactions like redness, swelling, and bruising, followed by contour irregularities and bluish discoloration of the skin.¹⁵ Persistent swelling and late-onset contour problems were less frequent but still reported. In rare cases, filler injected into or near a blood vessel can block blood flow to the retina, causing vision loss.

If under-eye pain begins within days or weeks of a filler treatment, especially if accompanied by increasing swelling, skin discoloration, or any change in vision, contact your injector and an ophthalmologist promptly. Hyaluronic acid fillers can be dissolved with an enzyme called hyaluronidase, which makes rapid reversal possible in emergencies.

When to See a Doctor Right Away

Most under-eye pain is benign and self-limiting. But a few patterns should prompt you to seek care quickly. The underlying causes of eye pain span conditions that range from harmless to vision-threatening or even life-threatening, and the clinical clues that separate the two are often straightforward.¹⁶ Seek same-day evaluation if you notice:

• Vision changes: blurriness, double vision, or sudden loss of vision in the affected eye
• Eye bulging: the eye appears to be pushed forward compared with the other side
• Pain with eye movement: especially if combined with swelling and fever, which suggests orbital cellulitis
• Severe, sudden-onset pain: particularly if it is the worst eye pain you have ever experienced, which could indicate acute glaucoma or an arterial problem
• Numbness spreading: loss of feeling in the cheek, lip, or teeth alongside the pain, suggesting nerve compression or fracture

For more chronic or recurrent under-eye pain, keeping a simple log of when it occurs, what triggers it, and what helps can be surprisingly useful at your appointment. Patterns in timing often point a clinician toward the right diagnosis faster than any single test.

Practical Approaches to Treating Ocular Pain

Treatment obviously depends on the cause, but clinicians who specialize in eye pain emphasize that a multimodal approach, combining local and systemic strategies, tends to work best for persistent cases.¹⁷ For surface-level problems like dry eye or mild strain, over-the-counter artificial tears and warm compresses are the sensible starting point. For nerve-related pain that does not respond to basic care, research into topical treatments is advancing. Investigators have been exploring topical corticosteroids for corneal nerve pain, autologous serum tears for light sensitivity, and even topical versions of medications like lacosamide and naltrexone for neuropathic eye pain.¹⁸ Most of these are still being studied, but the direction of the field is toward more targeted, locally applied therapies that avoid the side effects of systemic pain medications.

In the meantime, simple environmental adjustments can make a meaningful difference. Humidifying dry indoor air in winter, wearing wraparound sunglasses outdoors to block wind and allergens, and taking genuine screen breaks throughout the workday address several of the most common causes at once. If your pain is intermittent and mild, these low-tech measures are worth a serious two-week trial before you escalate to a specialist visit.