Q A few days ago, I got a sudden pain in my eye. It felt like a stab or an electric shock. It was so bad it stopped me in my tracks. It went away just as fast and my eye looked normal afterwards. I am really worried about it but I don't know what to do about it now as everything is shut down. Normally I would make an appointment with the optician. Should I just forget about it unless it happens again or could it be something serious?
A In absence of trauma to the eye, assuming you are healthy, without any underlying eye disease or systemic illness, a single episode of unilateral (on one side only) eye pain, that lasted only a few seconds (like an electric shock), does not sound alarming to me. It is also good to hear that the eye pain has not recurred. I suggest you can watch and wait for now, unless you were to develop any of the following symptoms below.
The majority of serious eye conditions are associated with blurred/distorted vision, loss of vision, the white part of the eye turning red/pink in colour (red eye), changes in the pupil size or shape, or last but not least, eye pain.
In your case, you are right to think of attending an optician first, although most are closed due to Covid-19 but many will open for an emergency assessment by calling a number on the door. You may need to be referred to an eye doctor (ophthalmologist) for further tests. However, if everything looks normal, the optician may provide treatment/reassurance for easy-to-manage eye conditions such as dry eye or a burst blood vessel in the conjunctiva.
There are a few important things to consider when a patient presents with eye pain and minimal or no redness to the whites of the eye (red eye).
Firstly, visual acuity and peripheral vision should be assessed to ensure there are no new deficits such as a reduction in vision from baseline or a visual field defect. Secondly, eye pressure should be assessed because if it is elevated you may have a type of glaucoma called narrow-angle or angle closure glaucoma.
This type of glaucoma occurs suddenly, in one eye only (unilateral), causing severe eye pain you won't be able to ignore, that generally lasts a few hours. It may, or may not, be associated with one or more of the following; a severe headache, nausea/vomiting, blurred vision, seeing halos around lights, red eye, change in pupil size or sudden loss of vision. Often the eye itself feels hard or tender to touch (with your eyelids closed) as the pressure is elevated. The cornea (front of the eye covering the pupil and iris coloured part of the eye) can become hazy or cloudy. This is a medical emergency and you need to attend a hospital as soon as possible for more specialised eye tests to prevent permanent loss of vision.
Having a first-degree relative with a history of angle-closure glaucoma puts you at much higher risk of developing it. It can occur as a side effect of a few medications or certain prescribed topical eye drops.
Having a cataract, an eye tumour, uveitis or diabetic retinopathy also increases your risk of glaucoma.
If you have eye pain with visual disturbance but your eye pressures are normal, then auto-immune disorders causing inflammation in various parts of the eye, such as uveitis, scleritis or optic neuritis need to be ruled out.
If your vision and eye pressure are both normal but you still have eye pain, then systemic conditions may need to be considered, particularly if you are suffering with other neurological symptoms.
Lastly, if you are suffering with headache and eye pain, then a type of migraine, cluster headache, giant cell arteritis, sinusitis or elevated pressure within the brain (intracranial hypertension) may need to be considered as the underlying cause.
Dr Jennifer Grant is a GP with the Beacon Hospital HealthCheck