Dry Eye and Burning Eye Syndrome

One of the most common causes of burning eyes is dry eye syndrome. This happens when your eyes don’t produce enough tears or the tears evaporate too quickly, leaving the surface of your eye dry and irritated. This dryness can cause a burning, aching, or scratchy feeling. Sometimes, this condition develops into what doctors call burning eye syndrome, where nerve sensitivity causes ongoing pain, even if the dryness improves. ^{3, 5, 7}

Dry eye is not only a common standalone problem but also frequently occurs alongside other eye and systemic conditions, making it an important comorbidity. For example, people with autoimmune diseases, allergies, or after certain eye surgeries are at higher risk of developing dry eye. Studies show that dry eye can worsen the symptoms and outcomes of other ocular diseases, and treating dry eye is crucial for improving overall eye comfort and health.^{1, 3, 4, 5, 7} 

Inflammation of the Eye

Inflammation is another major cause of eye pain and burning. It can affect different parts of the eye:

• Keratitis: This is inflammation of the cornea, the clear front part of your eye. It can cause pain, light sensitivity, and redness. ^{1, 3, 4, 5}
• Uveitis: Inflammation inside the eye that causes moderate to severe pain along with redness and sensitivity to light. ^{3, 4, 5}
• Scleritis: A deeper inflammation of the white part of the eye (the sclera) that causes a severe, deep, boring pain, often worse when you move your eyes. ^{3, 4, 5}
• Conjunctivitis: Also known as “pink eye,” this inflammation of the thin layer covering the white of the eye causes discomfort and redness. ^{1, 3, 4}

Dry eye can also develop as a secondary complication of these inflammatory eye diseases, further intensifying discomfort and burning sensations.^{1, 3, 7}

Nerve-Related (Neuropathic) Pain

Sometimes, eye pain isn’t caused by surface problems but by nerve damage or irritation. This is called neuropathic pain, where the nerves themselves send pain signals even without obvious injury or inflammation. This can cause persistent burning or stabbing sensations and can be very challenging to treat. ^{1, 4, 5, 7}

Dry eye is increasingly recognized as a potential trigger for neuropathic eye pain, especially when chronic dryness leads to nerve sensitization or damage. In these cases, treating the dry eye component is essential for managing overall pain.^{2, 4, 5, 7}

Optic Neuritis

This is inflammation of the optic nerve, which carries visual information from your eye to your brain. It often causes pain that worsens when you move your eyes, along with vision problems. It can be a sign of neurological conditions like multiple sclerosis.^{1, 3, 4, 5}  

Headache and Facial Pain Disorders

Certain types of headaches can cause eye pain:

• Migraines and cluster headaches often produce severe, stabbing, or throbbing pain around or behind the eye. ^{1, 3, 4}
• Trigeminal neuralgia is a nerve disorder causing sharp, electric shock-like pain in the face and eye area. ^{1, 4}

Dry eye can also be present in patients with chronic headache disorders, potentially worsening their ocular symptoms and complicating diagnosis.³

Injuries and Foreign Bodies

If something scratches your cornea or a foreign object gets into your eye, it can cause sharp pain, a feeling like something is stuck in your eye, and sensitivity to light.^{1, 4} 

Infections

• Infections can cause painful eyes too:
• Herpes simplex keratitis is a viral infection causing painful sores on the cornea.  ⁴
• Adenoviral conjunctivitis causes severe eye discomfort and redness. ⁴ 

After Eye Surgery or Trauma

Eye surgeries or injuries can sometimes lead to ongoing pain or burning sensations as the eye heals.^{3, 5}

Dry eye is a common complication following many types of eye surgery, such as LASIK or cataract procedures. Addressing dry eye in these patients is important for optimal recovery and comfort.^{1 3 4}

Increased Eye Pressure

Conditions like acute angle-closure glaucoma cause a sudden rise in eye pressure, leading to severe eye pain, headache, nausea, and visual disturbances.^{1, 4} 

Orbital and Sinus Infections

Infections around the eye socket (orbital cellulitis) or sinuses can cause pain, swelling, and difficulty moving the eye.^{3, 4}

Referred Pain

Sometimes, pain felt in the eye actually comes from other parts of the head or face, such as the sinuses or teeth. This is called referred pain.^{1, 4}

COVID-19 and Burning Eye Syndrome

Recently, some people recovering from COVID-19 have reported burning eye symptoms. Experts believe this may be due to nerve irritation caused by the virus or the body’s immune response. ⁷

Dry eye has also been reported as a comorbidity in patients with COVID-19-related burning eye syndrome, indicating that viral infection may worsen pre-existing dryness or trigger new-onset dry eye symptoms.^{2, 7}

Dry eye disease and the importance of treatment as a comorbidity

Dry eye disease (DED) is a multifactorial condition that can either be a primary disorder or occur secondarily due to other systemic or ocular conditions. It is frequently found alongside other eye diseases (like blepharitis, uveitis, and after surgery), systemic diseases (such as autoimmune disorders), and even in patients with chronic headaches or after viral infections like COVID-19. ^{1, 2, 3, 4, 5, 7}

Recognizing and treating dry eye as a comorbidity is essential, as it can worsen the symptoms of other eye conditions and impact overall eye health and quality of life. ^{1, 2, 3, 4, 5, 7}

When to See a Doctor

If you experience persistent or severe eye pain, burning, vision changes, or redness, it is important to see an eye specialist or healthcare provider. Early diagnosis and treatment can prevent complications and relieve discomfort.

In a nutshell

Painful or burning eyes can have many causes, including dry eye syndrome, inflammation, nerve problems, infections, injuries, and even headaches. Understanding these causes can help you communicate better with your doctor and get the right treatment. If in doubt, always seek professional advice.