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Painful Blind Eye: Causes and Management

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In most cases, permanent or significant loss can be accompanied by pain, influencing one’s quality of life. The management includes varied approaches.

Medically reviewed by

Dr. Aditi Dubey

Published At December 14, 2023
Reviewed AtDecember 14, 2023

What Is a Painful Blind Eye?

The painful blind eye can be defined as a terminal disease characterized by irretrievable vision and poor and unfavorable responsive ocular discomfort. Management and caring for individuals with painful blind eyes can be challenging since it is considered the last stage of any ocular disease progression. However, managing a painful blind eye means addressing and amending the debilitating effects on the quality of one’s life.

What Are the Causes of Painful Blindness?

Painful and blind eyes can occur due to several varied causes.

The common conditions that result in ocular pain and blindness include the following.

  • Corneal Decompensation: Corneal decompensation is a rare yet vision-threatening complication that usually occurs after surgery. It can also be induced by trauma, dystrophy, or infection. This condition is typically characterized by edema and bullae formation in the most advanced stages.

  • Epithelial Defects: Epithelial cornea defects can sometimes contribute to the development of painful blind eyes. Corneal epithelial defects refer to focal areas of epithelial loss. The attributable factors for painful blind eyes include corneal dryness, mechanical trauma, post-surgical problems, infection, and neurotrophic disease. Moreover, non-healing and persistent epithelial defects can result from the failure of the mechanisms involved in promoting corneal epithelialization. Non-healing epithelial defects of the cornea can cause certain deteriorations like compromised vision, ocular damage, and total vision loss.

  • Uveitis: Uveitis, also known as chorioretinitis, is an inflammatory condition of the eye's middle layer called the uvea. The uvea is the pigmented layer within the inner retina and the outer fibrous layer. It encloses the cornea and sclera. This condition results in eye pain, inflammation, and red eyes. If left untreated, uveitis can lead to permanent vision loss, sometimes painful.

  • Elevated Intraocular Pressure: The pressure inside the eyes is referred to as intraocular pressure (IOP), and elevated intraocular pressure has the suspicion of glaucoma. Elevated IOP occurs due to the accumulation of fluid that flows inside the eye. The significantly elevated pressure in the eye can damage the optic nerve, resulting in gradual loss of vision or blindness.

  • Ocular Ischemia: Ocular ischemia is a rare condition caused by chronic ocular hyperfusion from stenosis or occlusion of the arteries (the common or internal carotid artery). Ocular ischemic syndrome is a visual function disorder that can induce painful blindness in its final stage.

  • Neovascular Glaucoma: Neovascular glaucoma is a severe type of the condition secondary glaucoma. It is characterized by anterior chamber (front part) or iris neovascularization associated with elevated intraocular pressure. The surgical approaches to managing this complicated glaucoma can result in poor visual outcomes or prognosis.

  • Bullous Keratopathy: Bullous keratopathy is an eye disease where the cornea has swollen permanently due to damage to the innermost tissue layer of the cornea. The most common causes of the deterioration of the cornea's inner (endothelium) layer are glaucoma, inflammation, and injury resulting from any surgical intervention. The cornea has partial or total involvement, giving an opaque or hazy appearance, sometimes with vision loss.

  • Angle-Closure Glaucoma: Angle-closure glaucoma is an eye health emergency resulting from the rapid and marked increase in the intraocular pressure due to outflow obstruction of clear fluid inside the eye called the aqueous humor. This condition can result in subsequent damage to the optic nerve, causing loss of visual fields.

  • Chronic Retinal Detachment: Retinal detachment is a potentially serious eye health condition in which the retina (light-sensitive layer present at the back region of the eye) is detached from its actual position. This is considered a severe condition as it affects one's vision, leading to blindness if left untreated.

What Are the Symptoms Associated With Painful Blind Eye?

Symptoms associated with a painful blind eye might incorporate severe eye pain, diminished or complete loss of vision, sensitivity to light (photosensitivity), redness, swelling, and potential discharge. Such symptoms can be indicative of various ocular conditions like glaucoma, infections, or trauma.

What Are the Treatment Options for Painful Blindness?

The primary goal of managing a painful blind eye is to address and reduce the pain while making the individual emotionally and physically stable.

The common non-surgical and surgical treatment options for pain-associated blindness include the following.

Medical Therapy:

Medical treatment is regarded as the first-line treatment for people with blind and painful eyes, particularly for those who do not have psychological or cosmetic concerns. The conditions secondary to elevated intraocular pressure can be effectively treated with glaucoma medication. The pain associated with blind eyes can be controlled with appropriate medication.

The medical agents involved in the regimen include:

  • Alpha agonists.

  • Beta-blockers.

  • Carbonic anhydride inhibitors.

  • Prostaglandin analogs.

EDTA:

Ethylene diamine tetraacetic acid (EDTA) assisted removal can benefit the blind, painful eye condition of band keratopathy. This treatment comprises the chelation of calcium deposits in conjugation with topical EDTA. This is a safe and effective treatment approach for band keratopathy.

Injection Therapy:

Retrobulbar injections of Ethanol or Chlorpromazine are effective in relieving ocular pain. It can also help with long-term pain management. The effects of such injections generally last for about three to six months.

Atropine:

Topical anti-inflammatory drugs can be great adjunct options for painful blind eyes due to uveitis, inflammation, ischemia, increased intraocular pressure, and other damage. The initial injections include Atroine (one percent) or Prednisolone acetate (one percent).

Surgical Intervention:

The surgical intervention for painful blind eyes mostly includes evisceration and enucleation. The evisceration approach is preferred for cosmetic concerns, while enucleation is effective for conditions with intraocular tumor problems.

The ophthalmologists perform a comprehensive diagnosis before finalizing the treatment options. This can be accompanied by medical therapies to contribute some relief from pain while supporting the individual's well-being in emotional and psychological aspects.

Conclusion:

A painful blind eye could possess various attributes, ranging from mild degrees of infection to severe underlying medical conditions. Many individuals with significant and irretrievable vision loss encounter mild to severe pain for various reasons. This condition negatively impacts one’s quality of life. So, the management of this condition also varies accordingly. It is pivotal to seek prompt medical attention for an appropriate diagnosis and treatment plan. Delaying or ignoring care might result in complications and further eye discomfort.

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Dr. Aditi Dubey
Dr. Aditi Dubey

Ophthalmology (Eye Care)

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eye painblindness and vision loss
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