Pain Behind the Eye: Common Causes and Emergency Signs

Pain behind or around the eye can come from a headache, the sinuses, eye strain or the eye itself. Migraine causes throbbing pain, usually on one side of the head, cluster headache strikes behind or around one eye, and a sinus infection can cause facial pain or pressure. Optic neuritis, an inflamed optic nerve that causes pain with eye movement and vision loss, needs a same-day exam (an emergency room when we're closed), and sudden loss of vision means calling 911. Acute angle-closure glaucoma, a sudden rise in eye pressure with severe eye pain, headache, blurred vision and nausea, needs care right away: call us immediately or go to an emergency room. A headache with signs of a stroke means calling 911.

Key takeaways

Headaches, sinus problems and eye strain can all cause pain behind the eye, and so can problems inside the eye or along the optic nerve.
Migraine usually throbs on one side of the head, cluster headache strikes behind or around one eye, and a sinus infection can cause facial pain or pressure.
Sudden, severe eye pain with blurry vision, halos or nausea can signal a rapid rise in eye pressure: call us immediately or go to an emergency room.
Call 911 for sudden double vision or vision loss, even if it comes back, or a headache with face drooping, arm weakness or speech difficulty.

What causes pain behind the eye?

Causes include headaches, sinus problems, eye strain, and problems inside the eye or along the optic nerve. What the pain feels like, and what comes with it, helps tell them apart.

Cause	What the pain is like	Other clues	When to get help
Migraine	Throbbing, usually on one side of the head	Nausea, sensitivity to light and sound, sometimes a visual aura	See a doctor; call 911 for a sudden, severe headache with no known cause
Tension-type headache	Constant pressure, or like a belt tightening around the head	Stress, postures that strain the head or neck	See a doctor if you use pain medicine regularly
Cluster headache	Sudden, extremely painful attacks behind or around one eye	Red, swollen, teary eye and nose on the same side	See a doctor for diagnosis and treatment
Sinusitis	Facial pain or pressure, headache	Stuffy or runny nose, mucus down the throat	See a doctor if it lasts more than 10 days or is severe; same day if your vision changes (an emergency room when we're closed)
Eye strain	Eyestrain and headaches during long hours at a screen	Blurred vision, dry eyes, neck and shoulder pain	Routine eye exam
Optic neuritis	Pain when the eye moves	Vision loss	Same day (an emergency room when we're closed); 911 if vision is suddenly lost
Acute angle-closure glaucoma	Sudden, severe eye pain or a headache	Blurry vision, halos around lights, nausea or vomiting	Now: call us, or go to an emergency room

Why do I get a headache behind my eyes?

A headache behind the eyes may be a primary headache, meaning one that is not caused by another medical condition, such as a migraine, tension-type headache or cluster headache.

Migraine

Migraine brings moderate to severe throbbing pain that usually happens on one side of the head. Nausea, vomiting and sensitivity to light, smell and sound commonly come with it, and some people see an aura of dots, zigzags or sparks. An episode may last from hours to days.

Tension-type headache

Tension-type headache is the most common type of headache. It feels like constant pressure on the face, head or neck, and most people feel it on both sides. It can also feel like a belt being tightened around the head. Emotional stress is an important trigger, and so are postures that strain the head or neck, such as reading, working on a computer or staring at a phone screen.

Cluster headache

Cluster headache causes sudden, extremely painful attacks, often behind or around one eye, that can last up to three hours. The eye and nose on that side may get red, swollen and teary, and men get cluster headaches more often than women. It's common to have one to three attacks a day, often at the same time of the day or night, for several weeks.

Can sinus pressure cause pain behind the eyes?

Sinusitis can cause facial pain or pressure and a headache. Sinusitis means your sinuses are inflamed, and a sinus infection can also cause a stuffy or runny nose and mucus dripping down the throat.

For relief at home, the CDC suggests a warm compress over the nose and forehead, a decongestant or saline nasal spray, and breathing in steam from a bowl of hot water or a shower. See a healthcare provider for severe symptoms such as a severe headache or facial pain, symptoms that get worse after improving or last more than 10 days without getting better, or a fever longer than 3 to 4 days. Swelling or redness around the eye or any change in vision during a sinus infection is a warning sign that needs care the same day (an emergency room when we're closed), and sudden loss of vision means calling 911.

Can eye strain cause pain behind the eyes?

Yes, it can bring on aching eyes and headaches. Headaches, blurred vision, dry eyes, and neck and shoulder pain are among the most common symptoms of digital eye strain, and poor lighting, screen glare and poor posture can all play a part.

Uncorrected or under-corrected vision problems can be major contributing factors, and even a current glasses or contact lens prescription may not suit the distance of your screen. Many of the symptoms are temporary and ease after you stop screen work, though some people go on having blurred distance vision. To help, follow the 20-20-20 rule: every 20 minutes, take a 20-second break to look at something 20 feet away.

If screen headaches keep coming back, a computer vision evaluation checks your focusing, eye alignment and dry eye. When a small misalignment of the eyes is behind end-of-day headaches, Neurolens lenses build in a contoured prism that is often used to relieve that strain.

Could pain in one eye be optic neuritis?

It could be if the pain comes when you move your eye and your vision changes too. Optic neuritis is an inflammation of the optic nerve, and sometimes the cause is unknown. It causes pain with eye movement and vision loss, and it is one of the eye problems multiple sclerosis (MS) can cause.

Get a same-day exam for pain with eye movement and blurred vision, or go to an emergency room when the office is closed. If you suddenly lose vision in one eye, even if it comes back, call 911.

Can eye pressure cause a headache?

Usually not. Many people with glaucoma have high eye pressure, but at first glaucoma doesn't usually have any symptoms, which is why half of people with glaucoma don't know they have it. Eye doctors check for it as part of a comprehensive dilated eye exam. Primary open-angle glaucoma often develops slowly and painlessly, with no early warning signs.

Acute angle-closure glaucoma is the exception. The outer edge of the iris (the colored part of the eye) blocks fluid from draining out of the front of the eye, and the pressure rises suddenly. An attack brings sudden, severe pain in one eye or a headache, with blurry vision, rainbow-colored halos around bright lights, nausea and vomiting, and it is an eye emergency.

Some eyes have a narrow drainage angle, which we can see at a routine exam and then monitor; read more about narrow angles.

When is pain behind the eye an emergency?

Call 911 for sudden double vision or sudden loss of sight in one or both eyes, even if it comes back, or for a headache with other stroke warning signs such as face drooping, arm weakness or speech difficulty. A sudden severe headache with no known cause is also a stroke sign that calls for 911. The same goes for double vision or a droopy eyelid together with a pupil that looks different, eye pain or a severe headache.

For sudden, severe eye pain or a headache with blurry vision, halos around lights, nausea or vomiting, call us immediately during office hours or go straight to an emergency room; it can be acute angle-closure glaucoma, an eye emergency.

If you are over 50, new headaches with pain and tenderness over the temples or jaw pain can be giant cell arteritis, a disorder that causes inflammation of your arteries, usually in the scalp, neck and arms. See your doctor promptly, because early treatment matters: without it there is a risk of permanent vision loss or stroke. If you suddenly lose vision or see double, even if it comes back, call 911.

For other eye pain, such as intense pain with blurry vision or a very red, watery or light-sensitive eye, call us at 310-828-2010. We offer same-day urgent eye care during office hours, Monday 10 to 5 and Tuesday through Friday 8 to 5. Outside those hours, sight-threatening symptoms belong in an emergency room.

How we check pain behind the eye at Cohenmehr Optometry

When you call about eye pain, a person answers, triages what you describe and holds a same-day slot when it's urgent (an emergency room when we're closed).

The urgent work-up includes a slit lamp exam (a microscope view of the front of the eye), eye pressure testing and a check of the cornea, plus dilation, OCT imaging of the retina and optic nerve, and visual field testing when the symptoms call for them. Most urgent problems are treated on the spot. When a surgeon or retina specialist is needed, the referral and records move the same day.

Our optometrists in Los Angeles also check eye pressure at every comprehensive exam, and Dr. Kevin Cohenmehr leads our glaucoma care when the pressure or the optic nerve needs a closer look.

Questions patients ask

Can allergies cause pain around the eyes?

Indirectly, yes. Allergies can cause pink eye, which usually affects both eyes and can bring intense itching and teary, swollen eyes. Allergies can also cause sinusitis, and a sinus infection can bring facial pain or pressure and a headache.

Is pain behind the eye a sign of dry eye?

It isn't one of the usual signs. The dry eye symptoms the National Eye Institute lists are surface ones: a scratchy feeling as if something is in your eye, stinging or burning, red eyes, sensitivity to light and blurry vision. If the ache feels deep behind the eye, the headache, sinus and optic nerve causes above are worth ruling out. Screens can bring on both, and a dry eye evaluation shows how much of the discomfort is on the surface.

How can I relieve pain behind my eyes at home?

At home, you can ease a familiar headache that comes with no change in vision. For a tension headache, over-the-counter medicines like aspirin, ibuprofen or acetaminophen can help with pain, but regular overuse of headache medicines can make headaches worse. New pain, or pain with blurred vision, needs an exam the same day (an emergency room when we're closed); for severe eye pain with nausea, a headache or halos, call us immediately or go to an emergency room, and for sudden loss of vision or double vision, call 911.

Could iritis cause pain behind my eye?

It can cause eye pain. Inflammation that affects the iris at the front of the eye is called anterior uveitis, the most common type of uveitis (inflammation inside the eye). Symptoms usually start suddenly and include eye pain, red eyes, sensitivity to light, blurry vision and floaters; if you notice them, see your eye doctor right away, or go to an emergency room when the office is closed, because uveitis can cause vision loss if it isn't treated. We see a painful red eye the same day; read more about uveitis.

Sources

Written by

Dr. Kevin Cohenmehr, OD

Medical eye care: glaucoma, diabetic eye exams, macular degeneration and eye infections, plus vision therapy for children. A graduate of UCLA and SUNY College of Optometry.

About Dr. Kevin →

Pain Behind the Eye: What Causes It and When to Worry