Eye pain has dozens of possible causes, ranging from a dry surface that stings when you blink to a pressure buildup inside the eye that needs emergency treatment. The type of pain you feel, whether it’s a sharp surface sting or a deep ache behind the eye, is the single best clue to what’s going on. Understanding where your pain falls on that spectrum helps you figure out how urgent it is and what to do next.
Surface Pain vs. Deep Pain
Pain on the surface of the eye tends to feel like burning, stinging, grittiness, or the sensation that something is stuck under your eyelid. It’s usually tied to conditions affecting the cornea (the clear front layer) or the conjunctiva (the thin membrane covering the white of your eye). Surface pain often gets worse when you blink, rub your eye, or expose it to light or wind.
Deep or aching pain feels like it’s coming from inside or behind the eye. It can be harder to pinpoint and is more likely to signal a problem with the internal structures of the eye, or even something happening outside the eye entirely, like a sinus infection or a type of headache. Deep pain is more often associated with nausea, vision changes, or headache, all of which raise the urgency level.
Common Surface Causes
Dry Eye
Dry eye is one of the most common reasons for chronic eye discomfort. More than 16 million U.S. adults have been diagnosed with it, and prevalence rises sharply with age, from about 2.7% among 18-to-34-year-olds to nearly 19% in people 75 and older. Women are roughly twice as likely to be affected as men.
Your eyes stay comfortable because a thin tear film, made of oils, water, and mucus, coats the surface every time you blink. When any layer of that film breaks down, the surface dries out and becomes irritated. The result is stinging, burning, redness, and sometimes watery eyes (your body’s overcorrection for the dryness). Common triggers include aging, antihistamines, antidepressants, blood pressure medications, contact lens wear, and spending long stretches in air conditioning or wind.
Corneal Abrasion
A corneal abrasion is a scratch on the clear front surface of the eye. It typically causes sharp pain, tearing, redness, light sensitivity, and that unmistakable feeling of something stuck in your eye. Scratches can come from dust, sand, a fingernail, a makeup brush, or a poorly fitting contact lens. Wearing contacts when your eyes are dry is a particularly common culprit.
Most small corneal abrasions heal within one to three days because the cornea regenerates its surface cells quickly. Your eye doctor may prescribe antibiotic drops to prevent infection during healing. Until the scratch closes, light sensitivity and tearing can be intense.
Conjunctivitis
Conjunctivitis, commonly called pink eye, inflames the membrane over the white of the eye. It produces redness, itching, discharge, and a gritty feeling. Viral and bacterial forms are contagious, while allergic conjunctivitis is not. The pain is usually mild compared to a corneal abrasion, but the irritation can be persistent.
Causes of Deep or Internal Eye Pain
Acute Angle-Closure Glaucoma
This is one of the most urgent causes of eye pain. It happens when the drainage channels inside the eye get blocked, usually because the lens thickens with age and pushes the iris forward. Fluid backs up, and pressure inside the eye spikes rapidly. Normal eye pressure ranges from 10 to 21 mmHg; during an acute attack, it can climb far beyond that threshold.
The pain is severe and comes on suddenly, often with nausea, vomiting, blurred vision, seeing halos around lights, and a visibly red eye. This is a medical emergency. Without treatment to relieve the pressure, permanent vision loss can happen within hours.
Uveitis
Uveitis is inflammation of the middle layer of the eye. It causes a deep, aching pain along with redness, light sensitivity, and blurry vision. It can be triggered by infections, autoimmune conditions like rheumatoid arthritis or lupus, or sometimes no identifiable cause. Unlike conjunctivitis, uveitis affects deeper structures and carries a higher risk of complications if left untreated.
Optic Neuritis
Optic neuritis is inflammation of the nerve that carries visual signals from the eye to the brain. It typically causes pain that worsens when you move your eye, along with blurred vision or a noticeable loss of color perception. It’s most common in adults under 45 and is sometimes an early sign of multiple sclerosis.
Pain Behind the Eye From Other Sources
Not all eye pain starts in the eye. The eye’s sensory signals travel through the ophthalmic branch of the trigeminal nerve, a major nerve that also serves the forehead, sinuses, and parts of the nasal cavity. Because these areas share nerve pathways, problems elsewhere in the head can produce pain that feels like it’s coming from the eye.
Cluster Headaches
Cluster headaches cause extreme, stabbing pain in, behind, or around one eye. The pain can spread to the face, head, and neck. Attacks come in clusters, often at the same time of day for weeks or months, then disappear for a period before returning. They are rare but among the most intense pain conditions known. Cluster headaches are sometimes misdiagnosed as sinus infections or migraines, especially in women.
Migraines
Migraines frequently involve throbbing pain around or behind one eye. They may come with light sensitivity, nausea, and visual disturbances like flashing lights or blind spots. The pain often builds over minutes to hours and can last a full day or longer.
Sinus Infections
Inflamed sinuses, particularly the ones located above and between the eyes, create pressure and aching that radiates into the eye area. Sinus-related eye pain typically worsens when you bend forward, and it comes with congestion, facial tenderness, and sometimes fever.
Screen Use and Digital Eye Strain
Prolonged screen time is an increasingly common cause of eye discomfort. When you look at a screen, your eyes constantly refocus to read text made of tiny pixels, and they work harder because of the low contrast between text and background. On top of that, you blink about a third less often than normal, sometimes only three to seven times a minute, and your blinks may not fully close your eyelids. The combination of constant refocusing and reduced blinking dries out and fatigues the eyes.
Glare from windows or overhead lights bouncing off your screen adds to the strain. The resulting symptoms, sometimes called computer vision syndrome, include aching, burning, blurred vision, and headaches that develop after extended periods of screen work. These symptoms are typically temporary and improve with breaks, but they can become chronic if your screen habits don’t change.
Red Flags That Need Immediate Attention
Most eye pain resolves on its own or with simple treatment, but certain patterns signal a potential emergency. Seek immediate care if your eye pain is severe and comes with a headache, fever, or pronounced light sensitivity. Sudden vision changes, nausea or vomiting alongside eye pain, seeing halos around lights, or having trouble opening or moving your eye all warrant urgent evaluation. Blood or pus coming from the eye, swelling around the eye, or pain caused by a chemical splash or foreign object embedded in the eye are also reasons to call for emergency help.
How Eye Pain Is Diagnosed
An eye exam for pain usually starts with a slit lamp, a specialized microscope that lets your doctor view every layer of the front of the eye in three-dimensional detail. It can reveal scratches, inflammation, signs of infection, or structural problems. A fluorescein stain, an orange dye dropped onto the eye, highlights scratches or ulcers on the cornea under blue light.
If glaucoma is suspected, your doctor will measure the pressure inside your eye with a device called a tonometer and may use a special lens to inspect the drainage angle where fluid exits the eye. Visual field testing checks for blind spots, and imaging scans can provide detailed views of the optic nerve and retinal layers. For pain that doesn’t match any eye-specific cause, your doctor may investigate headaches, sinus disease, or neurological conditions as the source.