Chapter 102 My child seems to have a pain in the eye
In a young child, pain may manifest as eye rubbing, light sensitivity, excessive blinking, and irritability. The older child is able to complain of eye pain when the underlying cause may be anything from a foreign body to an attention-seeking device.
Two fiber systems, myelinated and unmyelinated, transmit pain. The former transmits sharp transient pain, and the latter dull aching pain. Pain fibers innervating the eye and periorbital structures arise from the trigeminal or fifth cranial nerve. Although pain is most commonly generated at the site of the insult, referred pain may occur if the sensory pathway is stimulated in other regions: dural stimulation may result in retrobulbar pain.
The cornea has one of the areas of greatest density of pain nerve endings with the greatest concentration in the central cornea. The retina and optic nerves do not contain pain fibers. Eyelids, caruncle, and conjunctiva show less sensitivity than the cornea. Other ocular structures that can be associated with pain include the uvea, sclera, and optic nerve sheaths. Eye pain may occur with childhood optic neuritis. The pain is initiated by looking from side to side; this causes the inflamed nerve sheath to stretch, eliciting pain. Chronic distension of the nerve sheath such as with optic nerve glioma does not cause pain. Orbital pain may result from local irritation of pain fibers. Such pain usually implies an acute event, such as rapidly expanding mass or infection.
Some patients are left with no pathology to explain their eye pain and one is left with a diagnosis of eye strain, atypical facial pain, or attention seeking. Careful review and working with the parents and child is necessary to achieve a satisfactory outcome.
Where is the pain? When did it start? How long has it been there/occurring? How often is it occurring? What type of pain is it? Are there any other symptoms − e.g. photophobia, visual disturbance, head pain, family history of pains, general health, and recent problems or infections? What does it stop you doing? Have any other family members had problems?