Pain and Chronic Dry Eye

The surface of the eye contains many nerves, and it is known to be one of the most powerful pain generators in the body. Any disruption to the normal balance of moisture on the surface of the eye may lead to pain, irritation, or discomfort.

You do not need to have severe dry eye disease to have discomfort from the condition. There are different types of pain that you can have due to chronic dry eye. Because dry eye disease can change and worsen over time, this pain or discomfort can also change.

Why and how do you experience pain?

Your nerves are cells that send and receive information in the body. Nerves in the skin and eye surface can send pain signals to the brain when they are damaged, irritated, or inflamed.1

When you sense pain, you pay attention to your body and the area that is in pain. This helps to alert you to protect your body from further pain or damage. Without pain, you could break your leg and never feel it. You might continue to walk on your broken leg, causing more damage.2

This is also true with your eyes. If you have pain or feel like something is in your eyes, you react by trying to remove whatever is hurting. However, with dry eye disease, you may feel like something is in your eye when there is not. You may also have pain in your eyes without a visible reason.

Pain related to dryness on the surface of the eye

Discomfort from dryness on the surface of your eyes can range from mild to severe. Chronic dry eye disease can make it feel like something might be in your eye. People who experience this may describe it as a gritty or sand-like feeling. Others may describe that it feels like a hair or eyelash trapped underneath the eyelids.3

A doctor will examine your eyes and may not find any particle that is causing your discomfort. This is common in dry eye disease.

Pain related to nerves

If your eyes are very dry, the nerves on the surface of the eye can become overly sensitive. This can cause pain signals to be sent to the brain, even from a small amount of irritation. Some people who have this type of pain can note burning even after using artificial tears eye drops designed to soothe the eye surface.4-6

Chronic ocular surface disease, such as chronic dry eye, may result in a condition called neuropathic ocular pain (NOP). In this condition, pain fibers on the surface of the eye send signals to the brain without being activated by anything that is irritating the eye. In other words, the pain happens even if there is not something directly causing the pain. This type of pain is usually described as severe and sudden. Neuropathic ocular pain usually happens if the corneal nerves on the surface of the eye are damaged. Other ways this pain may be described include:4-6

  • Burning or hot
  • Shooting
  • Electric-like

Neuropathic pain is not usually detected during eye exams, which can be frustrating for those who experience it. This may lead to years of misdiagnosis or being dismissed for the pain you are experiencing. Undiagnosed NOP can lead to chronic pain syndrome. Chronic pain syndrome may include:7

  • Pain lasting longer than 6 months
  • Mental health problems such as depression or anger

Referred pain

Referred pain is pain that happens somewhere else but is felt as discomfort in the eye. Sinus and dental problems can lead to referred pain in the eye. Those with certain types of headaches, such as cluster headaches, may also have referred pain in the eye.4

As you can imagine, this type of pain is also difficult for doctors to diagnose because the source of the pain can be hard to find.

Pain and chronic dry eye disease may go together. Be sure to talk to your doctor about any feelings or discomfort you are having to get the best treatment for your condition.

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Written by: Katie Murphy │Last reviewed: June 2021