Pain underneath the eye refers to discomfort originating from the lower orbital rim, the cheekbone area, or the lower eyelid. The source of pain is often not the eyeball itself, as this region contains bone, muscle, and nerve pathways. Pain in this area can range from a dull ache to a sharp, localized sting, and it has many diverse origins. Because some causes are benign and others signal a serious underlying condition, any persistent or severe pain warrants a professional medical assessment.
Pain Caused by Sinus and Allergy Pressure
The most frequent source of deep, aching pain beneath the eyes is inflammation within the nearby paranasal sinuses. The maxillary sinuses, located directly below the eye sockets, are particularly prone to causing this discomfort. When these sinuses become inflamed due to a cold, infection, or seasonal allergies, the normal drainage pathways for mucus are blocked. This blockage causes fluid and pressure to build up inside the confined bony spaces, which presses against the thin walls separating the sinuses from the orbit.
The resulting pain is often described as a generalized facial tenderness or a heavy pressure that concentrates beneath the eyes and across the forehead. Sinus-related pain tends to intensify when a person bends forward or lies down, as these positions increase the pressure. Addressing the underlying sinus congestion, typically with decongestants or nasal corticosteroids, is necessary to relieve this localized pressure.
Specific Ocular Surface and Eyelid Conditions
Pain localized to the skin and tissues beneath the eye often stems from conditions affecting the eyelids or the eye’s outer surface. A stye is a common localized bacterial infection of an oil gland near the base of an eyelash, causing a tender, painful, and reddish bump on the eyelid margin. A chalazion, a non-infectious blockage of an eyelid oil gland, can also cause localized swelling and a deep, dull ache in the lower lid area.
Chronic inflammation of the eyelid margins, known as blepharitis, can cause the eyelids to feel irritated, gritty, or sore, contributing to discomfort beneath the eye. Dry eye syndrome, a condition where the eyes do not produce enough quality tears, can lead to a constant sensation of grittiness, burning, or a deep ache. This discomfort occurs because the lack of proper lubrication causes micro-abrasions on the eye’s surface, triggering pain signals.
Referred Pain from Dental Issues and Muscular Tension
Dental Issues
Pain felt beneath the eye can be referred pain, where the actual source of the problem is remote from where the discomfort is perceived. This misdirection is possible because of the trigeminal nerve, a major sensory pathway that supplies the eyes, upper face, and jaw. For instance, an infection or abscess in an upper molar tooth can send pain signals that the brain interprets as originating from the area directly below the eye. Recent dental work can also temporarily inflame these nerve branches, leading to a temporary ache or pressure in the lower orbital region.
Muscular Tension
Muscular tension disorders, such as those related to the temporomandibular joint (TMJ), are another common cause of referred pain in the lower face and orbit. Dysfunction in the TMJ, which connects the jawbone to the skull, can cause strain in the surrounding facial and temporal muscles. This muscle tension irritates the nearby branches of the trigeminal nerve, causing a throbbing or persistent ache that radiates upward to the temple, cheekbone, and the area beneath the eye. Chronic eye strain or uncorrected refractive errors can also cause tension headaches that manifest as a deep pressure felt in the lower orbit as the muscles around the eyes and forehead tighten.
Recognizing Warning Signs and Seeking Care
While most pain underneath the eye is due to common, non-sight-threatening conditions, certain symptoms should prompt an immediate medical evaluation. Any sudden, severe onset of pain, particularly if accompanied by an abrupt change in vision, requires urgent professional attention.
Serious warning signs include:
- Double vision or the inability to move the eye fully in all directions.
- Severe swelling or bulging of the eye.
- Pain that rapidly worsens.
- A high fever alongside the discomfort.
- Pain following a facial trauma or accompanied by a colored discharge from the eye.