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==Background==
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
*Eye pain with an unremarkable external exam and normal slit-lamp findings poses a diagnostic challenge
*Key concern: must rule out sight- and life-threatening conditions that may not show early external signs
*'''High-risk diagnoses to consider:''' [[optic neuritis]], [[temporal arteritis]], [[acute angle closure glaucoma]] (early), posterior [[scleritis]], ocular ischemic syndrome

==Clinical Features==
*Normal external eye exam (no injection, no discharge, no corneal findings)
*Patient reports significant eye pain, periorbital pain, or retrobulbar pain
*May have associated symptoms guiding diagnosis (see below)

==Differential Diagnosis==
===Ocular/Orbital===
*[[Optic neuritis]] — pain with eye movement, decreased visual acuity, afferent pupillary defect
*Posterior [[scleritis]] — deep aching pain, may have decreased VA; scleral thickening on B-scan US
*[[Acute angle closure glaucoma]] (early) — elevated IOP may be only finding before conjunctival injection develops
*Ocular ischemic syndrome — dull ache, carotid disease, may have low IOP

===Referred Pain===
*[[Sinusitis]] — frontal/maxillary tenderness, nasal congestion, worse with bending
*[[Temporal arteritis]] — age >50, scalp tenderness, jaw claudication, elevated ESR/CRP
*[[Migraine]] or [[cluster headache]] — headache history, associated aura or autonomic symptoms
*Trigeminal neuralgia — lancinating pain in V1 distribution
*[[Shingles]] (herpes zoster ophthalmicus) — may precede rash by days (prodromal pain)

===Systemic===
*Diabetic cranial neuropathy (CN III, IV, or VI)

==Evaluation==
*Complete [[eye exam]]: visual acuity, pupil exam (APD?), IOP, slit-lamp, dilated fundoscopy
*'''IOP measurement''' — critical to rule out early angle closure
*'''ESR and CRP''' if age >50 or concern for [[temporal arteritis]]
*Consider CT/MRI orbits if orbital or retrobulbar process suspected
*MRI brain/orbits with contrast if [[optic neuritis]] suspected

==Management==
*Treat underlying condition
*If no diagnosis after thorough workup: ophthalmology follow-up within 24-48 hours

==Disposition==
*Urgent ophthalmology referral for decreased visual acuity, elevated IOP, or APD
*Emergent workup for suspected [[temporal arteritis]] (ESR/CRP, start empiric steroids pending biopsy)

==See Also==
{{Eye algorithms}}

==References==
<references/>

[[Category:Ophthalmology]]
[[Category:Symptoms]]