Eye pain when moving the eye: possible causes and when to get help

Pain on eye movement most often points to something affecting the nerve behind the eye, the tissues around the eye, or the sinuses that sit close to it. Because the eye itself may look entirely normal from the outside, the pain can be hard to explain without an examination.

The cause that matters most to rule out is optic neuritis, because of its association with changes to vision and with multiple sclerosis. The MS Trust describes it as a common eye problem in which inflammation or demyelination affects the optic nerve. It also stresses that not everyone who has optic neuritis goes on to develop other MS symptoms, so the diagnosis is a reason for assessment rather than for assuming the worst.

If the pain is new, goes with any change in how well you see, or is getting worse, arrange to be seen promptly by an optometrist, GP or eye casualty service. If your sight is suddenly worse, treat it as urgent.

According to the MS Trust, optic neuritis causes blind spots or areas of poor vision in one eye, and the colour vision or visual field can be severely affected. You might also have pain, particularly when you move your eyes. Colours may look washed out, and a patch of blur may seem like a dirty lens that cleaning does not fix.

The MS Trust says it generally gets worse over a few days and peaks about two weeks from onset, and that most people have recovered within 4 to 6 weeks, although some problems with vision can last longer. It adds that optic neuritis normally affects people aged between 20 and 40 and women more than men, and that it affects between one and five people in 1000 in the general population.

Because of the link with MS, the MS Trust says you are likely to be asked to undergo tests that could include blood tests, an MRI scan and visual evoked potential tests. It also mentions a rare condition called neuromyelitis optica, which is treated differently, so a doctor needs to confirm exactly what is happening.

The NHS describes sinusitis as swelling of the sinuses, usually caused by an infection, which is common after a cold or flu. The sinuses sit behind the cheekbones and forehead, close to the eyes, so pressure can be felt around or behind them.

The NHS lists pain, swelling and tenderness around the cheeks, eyes or forehead, a blocked or runny nose, a reduced sense of smell, green or yellow mucus and a high temperature as the main symptoms. A cold-like illness with facial pressure and congestion makes a sinus cause more likely than an optic nerve cause, although the two can look similar at first.

The NHS says sinusitis usually clears up on its own within 4 weeks, and that a pharmacist can give the same treatments as a GP. A swollen, red or closing eyelid, or a change in your vision, is not the usual picture and should be checked urgently.

The NHS describes uveitis, also called iritis, as a rare condition that causes inflammation inside part of the eye. It says symptoms can include eye pain that may feel worse when reading, red or watery eyes, reduced or blurred vision, sensitivity to light, and flashes and floaters.

It usually affects one eye but can affect both, and the NHS says symptoms can develop in hours and days or more gradually over weeks and months. The NHS advises an urgent GP appointment or NHS 111 for eye pain, sensitivity to light, changes in vision such as flashing or blurring, or very red eyes, and says a GP who suspects uveitis will refer you to an eye specialist.

The NHS also lists glaucoma, conjunctivitis, keratitis, scleritis and eye injury as conditions that can cause similar symptoms, which is why a hands-on examination with a slit lamp is useful.

This table is a rough guide for understanding what a clinician is weighing up. It is not a way to diagnose yourself.

The NHS says to call 999 or go to A&E if symptoms of glaucoma develop suddenly, as this is a medical emergency, and describes intense eye pain, a red eye, tenderness around the eyes, rainbow-coloured circles around bright lights, blurred vision, nausea and headache as the picture. The same NHS pages advise urgent same-day help for pain with light sensitivity or changes in vision.

For milder pain with no change in sight, an optician appointment or GP review within a few days is reasonable. Take note of when it started, whether one or both eyes are affected, whether vision, colour or the edges of your vision changed, and any recent cold, headache, injury or contact lens wear. Tell the clinician if you have been diagnosed with MS or have had unexplained numbness, weakness or balance problems.