My Eye Feels Weird, What Should I Do? and Top 10 most common causes of eye pain and The Top 5 Most Common Causes of Itchy Eyes

A friends just called saying her son in law’s eye all of a sudden got red and looked a little swollen.

After a few iphone photos were sent from Florida and I spoke to her son in law, we were able to surmise that it was likely an allergic reaction.

It can be very scary when to feel eye pain. It is not normal to feel your eye when you blink, so when you have pain, especially when you feel it every time you blink, it can be frightening.

Here is a list of the most common causes of general eye pain (not associated with previous eye surgery or previous trauma) going from most common to least common.

1. Dry eye [can be due to a long list of causes like #2 & 3 below; also from rosacea, medications (oral and drops), diabetes, autoimmune disease, Sjogren’s syndrome (if also have arthritis, dry mouth), season allergies, other viruses, HIV]
2. Blepharitis
3. Meibomian Gland Dysfunction
4. Allergic Conjunctivitis: usually, though, associated with itchiness or glassy look to eye or swelling of conjunctiva (clear part of eye).
5. Corneal Causes: Contact Lens Over Wear (CLOW); Abrasion; Foreign Body (eyelash, contact lens piece, metal, plastic, etc); Ulcer from bacteria, virus, fungus; keratitis (from dryness, virus, bacteria, post LASIK, PRK, PTK)
6. Infection: Virus: contagious (classic “pink eye”; lasts usually for solid 2 weeks no matter what you use) or less-contagious like most Herpes Simplex, Herpes Zoster;  Bacterial: can be due to usual bacteria on body or dangerous bacteria; Fungal infection; Parasite: Toxoplasmosis, Cysticercosis, etc.
7. Chemical exposure: Bases are worse than acid in the eye & should be washed out for many hours till pH of eye is 7.0.
8. Inflammation: Can be due to underlying systemic diseases so may need to be worked up if very severe or recurrent.
a. iritis: of just iris
b. episcleritis: of just episclera (clear part over sclera); using phenylephrine will blanch redness and “make eye white.”
c. scleritis: inflammation of sclera (real white part of eye): phenylephrine will NOT make eye white. This can be due to other systemic diseases which need to be evaluated asap. Same for d, e, f, below.
d. vitritis: inflammation of vitreous
e. retinitis: inflammation of retina
f. choroiditis: inflammation of choroid
9. Eye Pressure issues: acute high pressure; Acute Narrow Angle Glaucoma; end stage glaucoma
10. Other less common causes:
-Optic Neuritis (increased risk of Multiple Scleritis)
-Pseudotumor Cerebri
-Thyroid Ophthalmopathy
-Brain tumor

The Top 5 Most Common Causes of Itchy Eyes:
1. Allergic Conjunctivitis
2. Viral Conjunctivitis: Adenovirus, Molluscum
3. Blepharitis
4. Meibomian Gland Dysfunction
4. Foreign Body
5. Demodex mites

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