Some patients complain of pressure in or behind the eye ‘as if the eyes want to pop out of the head’. This sensation is very seldom actually due to pressure in the eye but the only way to make sure is to carry out tonometry and to look for cellular flare in the anterior chamber to rule out raised intraocular pressure and iritis.

This vague symptom may be caused by ocular surface irritation, perhaps low-grade conjunctivitis or corneal irregularity. Lipid, calcium concretions and fluid-filled blisters can often be found in the everted lower lids of such patients. This shows that there is ongoing, low level, sub-clinical, inflammatory activity.

Management should include cool compresses, bedtime ocular lubrication with a viscous solution and regular artificial tears during the day.