Some patients complain of a stabbing, momentary intense eye pain, ‘as if a needle has been pushed into my eye.’ The pain may be bilateral but rarely affects both eyes simultaneously. The typical patient profile for this complaint is female, post-menopausal, with a history of migraine when younger and a history of systemic hypertension and/or diabetes.

This pain has been termed ophthalmodynia. Its pathophysiology is unknown however it is not associated with a threat to sight and the patient needs to be reassured of this. It has been theorised that this symptom occurs in people who have a neurovascular sensitivity, a dry eye tendency and hypoperfusion around the pain-sensitive fibres of the Vth cranial nerve. The formation of a dry spot on the cornea or conjunctiva may activate the Vth nerve leading to intense but only momentary pain, as the dry spot is lubricated by fresh tears when the subject blinks.

Aggressive use of ocular lubricants beneath the lower lid, especially at bedtime, followed by less viscous solutions during the daytime along with good lid hygiene is very likely to stop this from occurring.