Why Do My Eyes Hurt? Causes of Eye Pain, Aching Eyes and Sore Eyes Explained

The anatomy of eye pain

Pain in or around the eye can come from several distinct structures: the ocular surface (cornea, conjunctiva), the inside of the eye itself (iris, ciliary body, choroid), the extraocular muscles and orbital contents, the eyelids, the lacrimal (tear drainage) system, or referred pain from nearby structures such as the sinuses, teeth or cranial nerves.

The cornea — the clear dome at the front of the eye — is the most densely innervated tissue in the human body, with nerve density roughly 300–600 times that of skin. This is why even a tiny scratch on the cornea (a corneal abrasion) causes intense, immediate pain entirely out of proportion to the size of the injury.

Pain from inside the eye — intraocular pain — tends to feel deeper, duller and more pressure-like. Pain from the orbit (the bony socket) or the muscles tends to be aching and worse on eye movement.

The most common causes of sore, hurting eyes

The following causes account for the vast majority of eye pain presentations. They are arranged from most to least common in adults seeking advice about eye discomfort.

• Digital eye strain (asthenopia) — the single most common cause of aching eyes in adults. Prolonged screen use (computers, smartphones, tablets) reduces blink rate from ~15/minute to ~5/minute, causing the tear film to evaporate faster than it is replenished. Symptoms: tired, aching eyes, gritty or burning sensation, blurred vision after screen use, headache above or behind the eyes, and sensitivity to bright light. Both eyes are typically affected equally.
• Dry eye syndrome — closely related to digital eye strain and very common, especially in women over 50 and contact lens wearers. The tear film is either reduced in volume or poor in quality. Symptoms: gritty, sore, burning, or ironically watery eyes (reflex tearing). Often worse in air-conditioned or centrally heated rooms.
• Conjunctivitis — inflammation of the conjunctiva (the clear membrane covering the white of the eye and lining the eyelid). Causes: viral (most common — watery discharge, often follows a cold), bacterial (sticky yellow or green discharge), or allergic (itchy, watery, both eyes simultaneously). The eye is usually red and the eyelids may be swollen. Viral and bacterial conjunctivitis can be contagious.
• Foreign body / corneal abrasion — a dust particle, eyelash, metal fragment or contact lens debris caught on or embedded in the cornea causes sharp, intense, immediate pain often described as 'something stuck in my eye.' Symptoms: severe gritty pain, watering, light sensitivity, difficulty opening the eye. If you cannot remove the foreign body by blinking or rinsing, seek urgent review — do not rub.
• Styes (hordeolum) and chalazia — a stye is an acute infection of an eyelid gland at the lash root; a chalazion is a chronic blocked meibomian gland within the lid. Both cause a tender, red, swollen lump on the eyelid. Styes are painful to touch; chalazia are usually firm and less acutely painful.
• Contact lens problems — contact lenses are a significant cause of eye pain. Causes include a torn or inside-out lens, a lens left in too long, a protein-coated lens, a corneal ulcer (microbial keratitis — a serious complication), or contact lens-induced dry eye. Any eye pain in a contact lens wearer should be taken seriously.
• Blepharitis — chronic inflammation of the eyelid margins. Causes crusting at the lash base, morning grittiness, burning, and eyelids that stick together on waking. Both eyes are typically affected. Often associated with rosacea.
• Subconjunctival haemorrhage — a bright red patch on the white of the eye caused by a ruptured small surface blood vessel. Almost always painless (the 'eyes hurt' concern is usually worry rather than pain). Typically resolves spontaneously over 2–3 weeks with no treatment.

Serious causes of eye pain that need urgent assessment

The following conditions are less common but potentially sight-threatening. If you have eye pain with any of these accompanying features, you should be assessed urgently — the same day if possible. Do not wait for a routine GP appointment.

• Acute angle-closure glaucoma — sudden, severe pain in and around one eye, often described as 'the worst headache of my life' centred on the eye. Associated with nausea, vomiting, a fixed mid-dilated pupil, and dramatic loss of vision. The intraocular pressure spikes to 40–70 mmHg (normal: 10–21 mmHg). This is an ophthalmological emergency requiring same-day treatment to prevent permanent blindness. Go to A&E immediately.
• Corneal ulcer (microbial keratitis) — a bacterial, viral (especially herpes simplex) or fungal infection of the cornea. Causes intense pain, redness, photophobia, discharge, and a white spot visible on the cornea. Very common in contact lens wearers. Needs urgent corneal swabs and intensive antibiotic or antiviral drops. If untreated, can perforate the cornea.
• Iritis / uveitis — inflammation of the uveal tract (iris, ciliary body, choroid). Symptoms: aching, deep eye pain worse in bright light (photophobia), a small or irregular pupil, red eye (often circumcorneal — a purple-red ring around the cornea), and blurred vision. Associated with HLA-B27-related conditions (ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease). Needs urgent steroid eye drops.
• Orbital cellulitis — a bacterial infection spreading into the orbit. Causes a swollen, red, hot, painful eyelid, proptosis (eye appearing to bulge forward), restricted and painful eye movement, fever, and feeling systemically unwell. Requires urgent hospitalisation for IV antibiotics. A CT scan is needed. Medical emergency.
• Optic neuritis — inflammation of the optic nerve. Causes pain on eye movement (particularly important diagnostically), reduced colour vision (especially red desaturation), and central visual loss. Most commonly affects young adults aged 20–40 and is often the first presentation of multiple sclerosis. Requires urgent MRI and neurology/ophthalmology review.
• Scleritis — inflammation of the sclera (white coat of the eye). Causes severe, deep, boring eye pain that often wakes the patient from sleep and may radiate to the face, jaw or temple. The sclera appears dusky red or violaceous (purplish). Associated with autoimmune conditions (rheumatoid arthritis, vasculitis). Needs urgent systemic anti-inflammatory treatment.
• Herpes zoster ophthalmicus (shingles affecting the eye) — reactivation of the varicella-zoster virus in the ophthalmic division of the trigeminal nerve. Causes painful blistering rash on the forehead and around one eye, with eye involvement (keratitis, uveitis, raised IOP) in up to 50% of cases. Requires urgent antiviral treatment and ophthalmology review.

Eyes hurt after screen use — digital eye strain in detail

Digital eye strain is by far the most common cause of aching, tired eyes in modern life. UK adults spend on average 6–9 hours per day on screens, and the rate of blinking falls dramatically during screen use — from a resting rate of around 15 blinks per minute to as few as 3–5 blinks per minute. Each blink spreads a fresh tear film across the cornea; fewer blinks means the surface dries out faster.

Symptoms typically include: a heavy, tired sensation behind the eyes; aching that builds during the working day and eases overnight; mild blurring of near or distance vision that clears after blinking; a burning or gritty feeling; headache; and increased sensitivity to glare.

The 20-20-20 rule is the most evidence-supported self-help measure: every 20 minutes, look at something at least 20 feet away for at least 20 seconds. This relaxes the focusing muscle (ciliary body) and restores a more normal blink rate. Preservative-free artificial tear drops used 3–4 times daily during screen hours are also effective.

If symptoms persist despite these measures, the cause is often an underlying refractive error (particularly uncorrected astigmatism or early presbyopia) or genuine dry eye disease. A sight test with your optometrist, and if symptoms continue, a consultation with a consultant ophthalmologist, is the appropriate next step.

Eye pain in the morning — why do my eyes hurt when I wake up?

Eyes that hurt on waking, with stiff or stuck-together eyelids, are typically caused by blepharitis (lid margin inflammation) or nocturnal dry eye. During sleep, the eyes produce less tear fluid, and if the eyelids do not close fully (nocturnal lagophthalmos) or the meibomian glands are blocked (blepharitis), the ocular surface dries out overnight.

A related but distinct cause is recurrent corneal erosion syndrome — a condition in which the superficial corneal epithelium (surface layer) fails to adhere properly to the basement membrane. Patients experience sudden, intense, sharp eye pain on waking (when the eyelid peels away from the loosely attached epithelium) that resolves over hours. It can recur repeatedly. Treatment involves lubricating ointments at night, hypertonic saline drops, or in persistent cases, phototherapeutic keratectomy (PTK).

Eye pain on movement — what does it mean?

Pain specifically on moving the eye — pain when looking up, to the side, or on rapid movement — narrows the differential diagnosis considerably. The two main causes are:

Optic neuritis: inflammation of the optic nerve causes retro-orbital (behind the eye) pain that is distinctly worse on eye movement. It is typically accompanied by reduced vision and reduced colour saturation in the affected eye. Optic neuritis is an urgent diagnosis — it is the first presentation of multiple sclerosis in approximately 25% of cases. MRI of the brain and spine is essential.

Orbital myositis: inflammation of one or more extraocular muscles causes aching pain that is worse when the eye is moved in the direction of the affected muscle. The eyelid may droop and the affected eye may appear reddened over the insertion of the inflamed muscle. Usually treated with oral corticosteroids.

Eye ache with headache — sinuses, tension and migraine

Eye pain is frequently part of a wider headache syndrome rather than an isolated eye condition. Tension headache — the most common headache type — typically causes a bilateral pressing or tightening pain often described as being 'around or behind the eyes.' The eyes themselves are entirely normal on examination.

Migraine may begin with visual aura (zigzag lines, flashing lights, a scotoma) before the headache phase and is often described as an intense, throbbing pain 'behind one eye.' Cluster headache — predominantly in men aged 20–50 — causes severe, strictly unilateral periorbital or retro-orbital pain with ipsilateral eye watering, nasal congestion, and eyelid drooping, lasting 15–90 minutes in clusters of attacks.

Sinusitis (maxillary or frontal sinus inflammation) causes a constant, pressure-like ache in the cheekbones, forehead, and bridge of the nose that is frequently misperceived as eye pain. It worsens on leaning forward. Associated with nasal congestion, coloured nasal discharge, and facial tenderness to touch.

Distinguishing between these conditions requires examination. An ophthalmologist can confirm whether the eyes are structurally normal, referring to the appropriate specialist (neurologist, ENT) where necessary.

When should I be worried about eye pain?

The following features should prompt same-day urgent assessment — go to A&E or call your ophthalmology unit:

• Sudden severe eye pain (especially if it came on rapidly and is intense)
• Eye pain with significant vision loss or sudden blurring that does not clear
• Eye pain with a red eye and a fixed, non-reactive, or mid-dilated pupil
• Eye pain with nausea and vomiting
• Eye pain following a penetrating injury (anything entering the eye)
• Eye pain with proptosis (the eye appearing to bulge forward) and fever
• Eye pain specifically on eye movement with visual changes (possible optic neuritis)
• Intense photophobia (extreme light sensitivity) with a red, watery eye
• Chemical splash to the eye — irrigate immediately with water for 20+ minutes before attending A&E

Self-help for mild, non-urgent eye pain

For the vast majority of people whose eyes hurt due to digital eye strain, mild dry eye, blepharitis, or a simple stye, the following measures are safe and effective as a first step:

• Preservative-free artificial tears (e.g. Systane, Viscotears, HyloForte) — available over the counter, used 3–4 times daily or as required. The preservative-free formulation is essential if you use drops more than 4 times daily.
• Warm compresses — a clean flannel soaked in warm (not hot) water, held against the closed eyelid for 5–10 minutes, helps to liquefy blocked meibomian gland secretions in blepharitis and meibomian gland dysfunction.
• Lid hygiene — for blepharitis, use commercially prepared eyelid wipes or a cotton bud dipped in diluted baby shampoo to clean the lash margins once or twice daily.
• Screen breaks — follow the 20-20-20 rule. Reduce screen brightness, increase text size, and ensure your screen is below eye level to reduce exposed ocular surface.
• Contact lens rest — if you wear contact lenses, remove them and switch to glasses until the discomfort resolves.
• Avoid rubbing — rubbing the eyes when they hurt feels satisfying but introduces bacteria, risks corneal abrasion, and in susceptible individuals can thin the cornea (keratoconus).

When to see a consultant ophthalmologist about eye pain

You should see a consultant ophthalmologist — rather than just an optometrist or GP — if your eye pain is: recurrent, persisting for more than two weeks despite self-help measures, associated with any vision change, associated with redness that is not improving, suspected to be related to a systemic disease (autoimmune condition, diabetes, inflammatory bowel disease), or if you have been told by an optometrist or GP that your eyes appear normal but the pain continues.

Mr Mohamed Mohyudin offers private consultations at Spire Elland Hospital, Elland Lane, HX5 9EB — typically within 1–2 weeks. Call 01422 324000 or book online. A full slit-lamp examination, intraocular pressure measurement, and dilated fundus examination are performed at the consultation to identify the cause precisely.