The experience of pain in the bone structure beneath the eye, especially when blinking aggravates it, is a localized and often concerning symptom. This discomfort points toward irritation or pressure involving the delicate network of bone, nerves, and soft tissues in the upper facial region. While the sensation is felt distinctly in the bone, the actual source of the pain frequently originates from nearby structures affected by eye movement or muscle contraction. Understanding the potential causes requires looking beyond the surface to the underlying anatomy.
Understanding the Anatomy Under the Eye
The structure commonly felt as the “bone under the eye” is the orbital rim, primarily formed by the maxillary and zygomatic bones. This bony framework creates the floor and lower boundary of the orbit, the socket protecting the eyeball. The orbital floor is a thin layer of bone, and its relationship with surrounding cavities is important for understanding referred pain.
Directly beneath this floor lies the maxillary sinus, a large air-filled cavity that is part of the paranasal sinus system. The ethmoid sinuses are also nearby, separated from the eye socket by a paper-thin bone called the lamina papyracea. Inflammation or fluid accumulation in these sinuses can exert pressure upward onto the orbital floor, making the bone feel tender. Furthermore, the infraorbital nerve, a branch of the trigeminal nerve, runs along this area, providing sensation to the lower eyelid, cheek, and upper lip.
Primary Causes Related to Blinking and Movement
When pain under the eye is specifically triggered or intensified by blinking, it suggests a mechanical factor activated by the movement. Sinusitis is a frequent cause of this mechanically-induced pain. Swelling and congestion within the maxillary and ethmoid sinuses cause pressure against the bony walls of the orbit. Blinking or subtle eye movements can briefly change the pressure balance or cause muscle contraction that presses against the inflamed tissue, registering as pain in the surrounding bone.
Dry eye syndrome is another common culprit, leading to inflammation of the ocular surface and surrounding tissues. When the eyelids sweep across a poorly lubricated or irritated cornea during a blink, the resulting friction and inflammation can radiate pain to the nearby bone structure. Chronic irritation can trigger a neuropathic response in the sensory nerves of the face.
Irritation of specific nerve branches, particularly the infraorbital nerve, is also a direct cause of movement-related pain. The act of blinking involves facial muscles that can briefly compress or tug on an already inflamed or irritated nerve pathway. This nerve irritation can be a symptom of a larger issue like trigeminal neuralgia, where even minor facial movements produce sharp, shooting pain. Inflammation of the optic nerve (optic neuritis) can also cause pain that is worse with eye movement, though this typically feels deeper and is associated with vision changes.
Other Non-Movement Related Sources of Pain
Not all pain in this area is directly caused by blinking; some conditions create constant pain that simply feels worse when the eye moves. Referred dental pain from the upper molars is a common source of discomfort beneath the eye. The roots of the upper back teeth are in close proximity to the maxillary sinus and share nerve pathways with the facial region via the trigeminal nerve. An abscess or deep cavity in an upper tooth can transmit pain that is incorrectly perceived as originating in the orbital area.
Localized trauma, even minor events, can result in a contusion or minor fracture of the thin orbital floor. While the initial injury may heal, residual swelling or the healing process can cause persistent tenderness aggravated by any muscle movement, including blinking. Inflammatory conditions like orbital cellulitis, a serious bacterial infection behind the orbital septum, cause deep, unrelenting pain and swelling. Although the pain is constant, the inability to move the eye without severe discomfort is a characteristic symptom.
Systemic inflammatory issues and certain types of headaches can also manifest as pain in the bone under the eye. Ocular migraines, for example, often present with intense, throbbing pain concentrated behind or around the eye. This pain is generally constant during an episode, but surrounding muscle tension can make blinking feel painful. Similarly, severe allergic reactions can cause significant tissue swelling in the sinuses and face, leading to a dull ache and pressure.
When to Seek Medical Evaluation and Treatment Options
A persistent or worsening pain in the bone under the eye requires professional medical evaluation to determine the underlying cause. Several symptoms serve as “red flags” that indicate a potentially serious condition needing immediate attention. These include:
- A sudden loss or change in vision.
- Fever.
- Noticeable swelling of the eye or surrounding area.
- An inability to move the eye fully in all directions.
Severe pain accompanied by nausea or vomiting also warrants an immediate visit to an emergency department or ophthalmologist.
For less urgent, chronic pain, the first step is consulting an optometrist or ophthalmologist who can perform a comprehensive eye and orbital exam. Depending on their findings, a referral may be made to an Ear, Nose, and Throat (ENT) specialist for potential sinus issues, or a dentist for suspected referred dental pain. Diagnostic imaging, such as a CT scan, may be necessary to visualize the sinuses and the orbital bone structure.
Treatment is entirely dependent on the accurate diagnosis. Pain caused by sinusitis may require antibiotics or decongestants to reduce inflammation and pressure. Dry eye syndrome is managed with lubricating eye drops and therapeutic treatments to improve tear quality. For simple irritation or muscle strain, temporary relief can be found using over-the-counter pain relievers and applying a warm or cold compress to the area.