The painful eye: external and anterior segment causes.

When a patient presents to a medical practitioner with a painful eye, the initial history is extremely valuable in determining the cause of the complaint. The patient should be questioned specifically about the onset and duration of symptoms; description of the pain; exacerbating and mitigating factors; associated pruritus, discharge, or photophobia; and any previous occurrences. It is important to inquire about the patient's past medical history, past ocular history (including surgeries, trauma, contact lens wear, and family history of glaucoma), systemic and ocular medications, and allergies. A careful examination of the patient's skin, face, eyelids, conjunctiva, sclera, cornea, and anterior chamber should be performed. In this article, the authors describe a variety of external diseases and anterior segment causes of a painful eye, many of which can be diagnosed from the initial history. The article works systematically, beginning externally with the eyelids and conjunctiva and progressing internally toward the cornea and anterior chamber.