Pain around the orbital bones is often described as a deep ache or pressure behind the eyes. This periorbital region includes the bone structure protecting the eye, surrounding soft tissue, nerves, and sinus cavities. Pain here is usually a manifestation of underlying pressure, inflammation, or neurological activity. While the discomfort can be alarming due to its proximity to the eye, the causes are varied and often treatable once the source is identified.
Pain Caused by Sinus Pressure and Inflammation
Inflammation within the paranasal sinuses is a common cause of pressure and aching around the eyes. The sinuses are air-filled pockets within the facial bones, intricately connected to the orbital structure. When these cavities become infected or inflamed (sinusitis), the mucous lining swells, preventing normal fluid drainage. This trapped fluid and swelling, especially in the frontal and ethmoid sinuses, exerts mechanical pressure on the thin bones of the eye socket. The resulting pain is a dull, throbbing ache or heaviness that intensifies when bending over or straining. Sinusitis pain is often accompanied by congestion signs, such as thick nasal discharge, post-nasal drip, and tenderness when pressing on the cheekbones or forehead.
Allergies (allergic rhinitis) can trigger a similar inflammatory response without infection. Exposure to allergens causes the immune system to release histamine, leading to swelling in the nasal passages and sinus membranes. This inflammation can build enough pressure to cause discomfort around the eyes. Referred periorbital pain can also stem from severe infections in the upper molars. Since the roots of these teeth are close to the maxillary sinus floor, an abscess can cause pain signals to travel along the trigeminal nerve pathway, which the brain interprets as pain near the eye.
Pain Stemming from Headaches and Nerve Activity
Pain concentrated around the orbital bone can originate from neurological or vascular events, distinct from mechanical pressure causes like sinus congestion. This discomfort is linked to the trigeminovascular system, which involves the trigeminal nerve innervating blood vessels and pain-sensitive structures of the face and head. Activation of this system releases neuropeptides that cause vascular changes and inflammation, leading to a throbbing sensation felt behind or around the eye.
Migraines often manifest as unilateral pain localized behind one eye, feeling throbbing or pulsating. These attacks are frequently accompanied by heightened sensitivity to light and sound, and sometimes preceded by visual disturbances called auras. Cluster headaches cause excruciating, sharp, stabbing pain focused intensely around or behind one eye. The pain is short-lived, lasting between 15 and 180 minutes, but occurs in cyclical clusters.
Cluster headaches are characterized by distinctive autonomic symptoms on the same side as the pain, including a tearing eye, a congested nostril, a droopy eyelid, or eye redness. These symptoms reveal the involvement of the autonomic nervous system. A less common but severe cause is Trigeminal Neuralgia, involving the ophthalmic division of the trigeminal nerve. This condition causes brief, shock-like bursts of searing pain that can be triggered by light touch, talking, or a cool breeze across the face.
Pain Related to Ocular Fatigue and Vision Changes
When the eyes are forced to work harder than normal, the resulting strain can lead to a dull ache or pressure sensation around the orbital bone, known as asthenopia or eye strain. This pain is muscular, caused by the prolonged contraction and fatigue of the extraocular muscles responsible for focusing and eye alignment.
Digital eye strain (computer vision syndrome) is a pervasive modern cause of muscular fatigue. Staring at digital screens causes individuals to blink less often, leading to dry eyes and surface irritation. Focusing on pixelated text requires sustained effort from the ciliary muscles, which refers tension pain to the surrounding bone structure. Uncorrected refractive errors, such as needing an updated prescription for nearsightedness, farsightedness, or astigmatism, also force the eye muscles to continuously strain for a clear image. This constant effort results in chronic muscular fatigue and associated headaches that often localize to the forehead and eye area.
To mitigate digital eye strain, follow the 20-20-20 rule. Every twenty minutes, look away from the screen and focus on an object at least twenty feet away for a minimum of twenty seconds. This action allows the focusing muscles inside the eye to relax and resets the blink reflex. Other practical measures include adjusting screen brightness to match room light and ensuring the computer monitor is positioned slightly below eye level.
Recognizing When to Seek Professional Medical Care
Mild periorbital discomfort, especially if suspected to be caused by sinus congestion or eye strain, can often be managed safely at home. Simple remedies include applying a warm, moist compress to the face to encourage sinus drainage and relieve muscle tension. Staying hydrated helps thin mucous secretions, making them easier to drain and reducing pressure buildup. However, certain symptoms indicate a more serious underlying issue requiring medical intervention.
The presence of specific “red flag” symptoms warrants immediate consultation with a healthcare professional.
Urgent Symptoms
Sudden, severe, or explosive pain that appears without warning.
Pain accompanied by a high fever and chills, indicating a severe infection.
Sudden changes in vision, such as blurriness, double vision, or partial loss of sight.
Noticeable swelling around the eye.
Inability to move the eye normally, or a bulging appearance of the eyeball.
If the pain persists for more than seven to ten days despite home care, or if it worsens, a medical evaluation is recommended to find the precise cause. A primary care physician may refer the patient to a specialist depending on the likely origin of the pain. Referrals may include an Ophthalmologist for vision issues or acute angle-closure glaucoma, an Otolaryngologist (ENT) for chronic sinusitis, or a Neurologist for complex headache disorders.