Section Q Eye pain and visual disturbance

Nov 18, 2025
3 min read

Index

Introduction
Understanding Eye Pain and Visual Disturbance
Comprehensive History-Taking
Structured Clinical Examination
Appropriate Investigations
Formulating a Differential Diagnosis
Initial Management Strategies
Importance of Accurate Clinical Documentation
Conclusion

1. Introduction

Eye pain and visual disturbances are common yet potentially serious presentations in clinical practice. They range from benign, self-limiting conditions to ophthalmic emergencies that require immediate intervention. At Kraken Medical, we recognise the importance of confident, systematic assessment in early identification and management of these symptoms. This reflective piece outlines a structured approach to evaluating patients presenting with eye pain or changes in vision, drawing on core clinical skills and best-practice reasoning.

2. Understanding Eye Pain and Visual Disturbance

Eye discomfort and impaired vision can arise from a wide spectrum of ocular, neurological, or systemic causes. Patients may describe sharp pain, aching, a gritty sensation, blurred vision, or complete visual loss. Because of this variability, early assessment must be both broad and meticulous to ensure no vision-threatening diagnosis is missed.

3. Comprehensive History-Taking

A detailed and empathetic history remains the foundation of safe clinical decision-making. Establishing rapport allows patients to describe symptoms more clearly and contributes significantly to diagnostic accuracy.

Key aspects include:

Onset and duration – sudden changes may suggest retinal detachment, acute glaucoma, or trauma, while gradual symptoms may indicate infection or inflammation.
Character of pain – burning, aching, sharp, or pressure-like sensations can point toward specific conditions.
Associated symptoms – redness, discharge, photophobia, headache, halos around lights, or systemic symptoms like fever.
Visual changes – blurred vision, floaters, loss of fields, flashes of light, or reduced acuity.
Triggers or risk factors – foreign bodies, contact lens use, chemical exposure, recent infections, or previous eye disease.
Medical history – autoimmune conditions, migraines, diabetes, and vascular diseases may influence presentation.

This structured history allows clinicians to target the examination and investigations appropriately.

4. Structured Clinical Examination

A meticulous eye examination is essential to pinpoint the origin of symptoms and identify red flags.

Key components include:

Visual Acuity

The “vital sign” of eye assessment. Any reduction must be taken seriously, particularly if sudden.

External Inspection

Assessing eyelids, conjunctiva, sclera, and cornea for swelling, redness, discharge, or deformity.

Pupil Assessment

Checking size, symmetry, and reactivity can reveal neurological or ophthalmic emergencies such as acute glaucoma or optic nerve pathology.

Eye Movements and Alignment

Pain on movement may indicate optic neuritis or orbital cellulitis.

Ophthalmoscopy

Visualising the optic disc, retina, and vessels provides insight into conditions such as retinal detachment, papilloedema, or diabetic changes.

Combining these elements ensures a systematic evaluation capable of detecting subtle abnormalities.

5. Appropriate Investigations

Investigations should be guided by clinical suspicion and may include:

Tonometry – essential in suspected glaucoma to measure intraocular pressure.
Fluorescein staining – highlights corneal abrasions, ulcers, or foreign bodies under blue light.
Optical Coherence Tomography (OCT) – provides cross-sectional images of retinal layers to detect macular or retinal pathology.
Visual field testing – particularly relevant for neurological causes or glaucoma surveillance.
Cultures or swabs – if discharge suggests infection.

The goal is to support clinical findings and refine the differential diagnosis without delay.

6. Formulating a Differential Diagnosis

Eye pain and visual disturbances can have multiple causes, and constructing a thoughtful differential diagnosis ensures clinically safe reasoning.

Potential diagnoses include:

Conjunctivitis – infectious, allergic, or irritant.
Corneal abrasions or ulcers – often linked to trauma or contact lens misuse.
Uveitis – commonly presenting with pain, photophobia, and reduced vision.
Acute angle-closure glaucoma – a true emergency requiring rapid intervention.
Retinal detachment – classically associated with floaters, flashing lights, and a "curtain" across vision.
Migraine-related visual disturbance – may present without headache.
Neurological causes – such as optic neuritis or raised intracranial pressure.

Reflecting on possible diagnoses allows clinicians to work methodically and appropriately escalate care.

7. Initial Management Strategies

Management should always be tailored to the suspected underlying cause and severity of symptoms.

Examples include:

Infectious conditions → topical or systemic antibiotics.
Inflammatory conditions → corticosteroid or anti-inflammatory eye drops (ideally advised by ophthalmology).
Trauma or abrasions → analgesia, lubrication, and sometimes protective dressings.
Emergency conditions → urgent referral to ophthalmology for glaucoma, retinal detachment, or suspected orbital cellulitis.

Timely escalation is critical. Any sudden vision loss, severe pain, or abnormal intraocular pressure warrants immediate specialist assessment.

8. Importance of Accurate Clinical Documentation

High-quality documentation ensures continuity of care and protects both patient and clinician. Records must include:

Detailed symptom history
Examination findings, including visual acuity
Investigations performed
Working differential diagnosis
Treatment provided
Any referrals or safety-net advice

Clear notes support informed decision-making at follow-up and strengthen shared understanding among healthcare teams.

9. Conclusion

Managing eye pain and visual disturbance requires a structured, vigilant, and patient-centred approach. By integrating detailed history-taking, focused examination, targeted investigations, and safety-conscious management, clinicians can confidently identify both routine and high-risk presentations.