Discomfort felt in the bone beneath the eye stems from a variety of connected structures. This anatomical area is complex, as the lower boundary of the eye socket is formed primarily by the maxilla and zygomatic bones. These bones sit directly over the maxillary sinus, the largest air-filled cavity in the face. Nerves providing sensation to the cheek and upper teeth also pass through this region, making it a crossroads for pain signals from multiple sources.
Sinus Pressure and Inflammation
The most common non-traumatic cause of pain beneath the eye is inflammation within the maxillary sinuses, which lie directly below the eye socket floor. When the mucous membranes lining these cavities become swollen due to infection or allergies, the resulting condition is known as sinusitis. This inflammation can obstruct the small natural openings, or ostia, that allow the sinus to drain into the nasal cavity.
This blockage traps air and mucus inside the hollow space, leading to an increase in internal pressure that pushes against the thin bony walls of the eye socket floor. The pain often presents as a dull, constant ache or a feeling of heaviness in the cheek, which intensifies with actions like bending over or lying down, due to the shift in pressure. Acute sinusitis typically arises from a viral or bacterial infection and lasts less than four weeks, while chronic sinusitis persists for twelve weeks or more.
Beyond direct pressure, the inflammatory process itself can irritate the local nerves, specifically the infraorbital nerve, a branch of the trigeminal nerve that runs along the sinus roof. Swelling and the presence of inflammatory mediators can create a hypersensitivity in this nerve, causing the facial pain to be felt more intensely in the area under the eye. Anatomical variations, such as a thin or absent bone covering the infraorbital nerve, can make the nerve more vulnerable to pressure changes. Allergies also contribute by causing chronic mucosal swelling, which can lead to prolonged, low-grade pressure and discomfort in the same region.
Direct Injury and Musculoskeletal Strain
Physical impact to the face can cause immediate and localized pain in the bone under the eye. Minor trauma, such as being struck by an object or experiencing a fall, can result in bruising and swelling of the periosteum, the thin layer of tissue covering the bone. This tissue is rich in nerve endings, and its inflammation is a direct cause of pain, often described as tenderness to the touch over the infraorbital ridge.
More significant blunt force trauma can lead to an orbital fracture, where the thin bone of the socket floor breaks. This type of injury, known as a blowout fracture, causes severe pain, often accompanied by bruising, numbness in the cheek due to infraorbital nerve damage, and difficulty moving the eye. Even without a fracture, localized tissue swelling from an injury can press on the infraorbital nerve as it exits the bone, leading to sharp, shooting, or tingling pain.
Pain in this area can also arise from musculoskeletal strain, particularly from prolonged eye fatigue. Extended periods of focusing, such as during continuous screen time, can lead to excessive tension in the small muscles surrounding the eye socket. This chronic tension can radiate outward and be perceived as a dull ache in the surrounding bone structure.
Referred Pain from Nearby Structures
Pain perceived in the infraorbital bone may not always originate there, but rather be “referred” from a different structure via shared nerve pathways. The trigeminal nerve is the primary sensory nerve of the face, with its maxillary branch providing sensation to the upper teeth, gums, and the area under the eye. Because of this neural connection, an issue in one area can be mistakenly registered as pain in another.
Dental problems in the upper jaw, specifically the molars and premolars, are frequent sources of referred pain to the eye socket. An infection or abscess in the root of an upper tooth can irritate the nerve endings that also supply the bone under the eye, causing the discomfort to radiate upward. This is why patients with a dental issue may initially believe they have a sinus infection, as the pain localization is confusingly similar.
Specific neurological conditions can also cause intense, localized facial pain. Trigeminal neuralgia involves irritation of the trigeminal nerve and is characterized by sudden, severe, shock-like episodes of pain that can focus around the eye, cheek, or jaw. Certain headache types, such as cluster headaches, are also known to cause intense pain focused in or around one eye. The sharp nature of these neurological pains often distinguishes them from the dull ache of sinus pressure.
Indicators That Require Medical Attention
While many causes of pain under the eye are manageable, certain accompanying symptoms suggest a more serious condition requiring prompt medical evaluation. The presence of systemic symptoms also warrants a visit to a healthcare provider. These symptoms may suggest a spreading infection, nerve damage, or a deeper issue. Seek prompt medical evaluation if you experience:
- Any sudden loss or change in vision, including double vision.
- A high fever, chills, or pain accompanied by significant swelling and redness around the eye.
- Persistent pain that does not improve after several days.
- New-onset numbness or tingling in the cheek, which may indicate nerve damage or a fracture.
- Any pain following significant facial trauma, even if symptoms seem mild initially.