Sensation that Something is in the Eye
Ocular Symptoms and Conditions: Foreign Body Sensation
The sensation that something is in the eye commonly brings people to the ophthalmologist. This is referred to as a "foreign body sensation", as if a foreign object were scratching the eye. Usually this sensation originates from the cornea, which is the clear part of the eye through which we see. The cornea has a large number of nerve fibers that are normally covered by a lining. If this lining is breached, the sensation that something is in the eye results, whether or not anything is actually there.
Any condition which can cause a scratch on the cornea can lead to this symptom. Some causes are detailed on this page. There are also links to other Symptom and Diagnosis pages based on other symptoms in addition to the foreign body sensation.
Conditions Discussed on this Page:
- Dry Eye
- Corneal Abrasion (scratched eye)
- Inturned eyelash (trichiasis)
- Corneal foreign body
- Foreign body under eyelid
- Recurrent or Spontaneous corneal erosion
- Other conditions causing a foreign body sensation found on other pages
Dry Eye or Dry Eye Syndrome
"Dry eye" is a common ocular problem, as is evidenced by the large number of artificial tear preparations available over-the-counter. There may be a tendency for tear production to decrease with aging, and dry eye problems may be associated with certain arthritis syndromes, such as Sjogren's syndrome and rheumatoid arthritis. However, many people can develop a problem with ocular dryness with no apparent underlying cause.
Symptoms of dry eye include a sensation of dryness or grittiness, foreign body sensation, burning, redness, and generalized eye fatigue. The vision may blur or fluctuate. The eyes may seem sensitive to changes in temperature and to wind. Paradoxically, tearing may be a symptom of ocular dryness. Tearing can occur because the glands that produce tears in large quantities are not usually involved much in the minute to minute lubrication of the eyes. If the eye reach a certain level of dryness, this large tear gland becomes activated and produces excessive tears.
Symptoms of dry eye can have other causes than just reduced tear production. Oil producing glands in the eyelids provide a layer of oil on the surface of the eye which helps to prevent tears from evaporating. If this oil layer is deficient, as in certain types of blepharitis and acne rosacea, the eyes can become dry much too quickly. Similarly, mucous helps to lubricate the eye, and if this is deficient, dry eye symptoms can result. Oral antihistamines may dry the eyes in this way. The ophthalmologist can determine the principle cause of the dryness symptoms, and direct therapy in the right direction.
Supplemental lubrication of the eye is the main treatment for dry eye. There are numerous artificial tears available. Generally, preservative free eye drops are recommended in people who have to use eye drops frequently and on a daily basis. Some gel drop preparations, such as Systane Gel Drops and Refresh Liquigel, are thicker than most other artificial tears, and may provide more long lasting relief in some cases. Lubricant ointments are also available (such as Refresh P.M.). These are generally used at bedtime (since the vision is extremely blurred for a period of time after their use), but may give substantial relief.
Newer over the counter options for dry eye include Systane Ultra and Refresh Optive, which improves the ability of natural tears or other artificial tears to remain on the ocular surface, and Refresh Balance and Refresh Optive Advanced, which reduces the evaporation of tears from the eye.
Other options for treating dry eye include treating any other problems, such as blepharitis. Sometimes oral antibiotics may help. In severe cases, occlusion of the tear drainage system may help the tears to stay longer on the eye itself. Restasis is prescription eye drop which has been found to improve tear production when used over a period of weeks to months.
Often the treatment of dry eye requires a combination of different types of eye drops to promote healing of the ocular surface and to maintain lubrication. Avoiding situations that aggravate dryness, such as avoiding fans and moving air, may help. Increased humidity may also help, as dry eye symptoms are usually worse in the winter when the air is drier. Using a warm mist humidifier or whole house humidifier is most recommended.
Corneal Abrasion (scratched eye)
A corneal abrasion is a break in the surface layer of the cornea, which is the clear part of the eye through which we see. This usually follows obvious trauma, although an abrasion may occur from other causes, such as an inturned eyelash or from an eyelid infection (blepharitis).
Symptoms include pain, redness, tearing, sensitivity to light, and blurred vision. The "foreign body" sensation can be severe, and often people describe symptoms of a "rock were rolling around under the eyelid". What is actually being felt is this extremely sensitive exposed part of the cornea touching the inside of the lid as the eye blinks.
Diagnosis and treatment should be made by an ophthalmologist. If trauma is involved, the eye must be thoroughly examined to rule out and other injury. Treatment options vary, and may include patching of the eye with antibiotic ointment, frequent use of antibiotic ointment or lubricating medications, and even bandage contact lens use. There is risk of infection (corneal ulcer) and internal ocular inflammation (iritis) with this condition. Fortunately, under good circumstances, the cornea can heal rapidly, often even overnight.
Inturned Eyelash (trichiasis)
Trichiasis refers to misdirected eyelashes, where they point backwards and irritate the eye surface. Symptoms are usually of a foreign body sensation, but more severe symptoms of redness, pain, tearing, and light sensitivity are not uncommon. Treatment is by removing the offending eyelash (epilation), and by providing protective treatment for any corneal injury which may have occurred. With recurrent inturned eyelashes, electrolysis may permanently remove the eyelash, although more than one treatment may be necessary.
Corneal Foreign Body
A foreign object can lodge itself onto the cornea and cause significant symptoms of pain, tearing, light sensitivity, and blurred vision. Except in cases of obvious trauma where debris strikes the eyes, the most common corneal foreign body is a rusted metallic particle. Small shards of metal seem to have an almost magnetic attraction to the corneal surface, where they rapidly rust and become embedded. The use of safety goggles with any type of drilling, hammering, etc. can be preventative. As the rusted particle sits on the cornea, the eye becomes progressively more irritated over a period of days with redness, pain, light sensitivity, and tearing. Often the particle is visible on the eye, but it may be nearly microscopic. The ophthalmologist has the equipment necessary in the office to remove these foreign bodies. Usually a scar remains which rarely affects the vision, but there is a risk of infection.
Foreign Body Under Eyelid
Debris which gets into the eyes can become trapped under the upper eyelid. This will lead to worsening symptoms of foreign body sensation, pain, tearing, and redness. The debris can be nearly anything, and a paper thin fragment of plant material (wood) is not uncommon. A large foreign body under the lid rapidly becomes intolerable, with a corneal scratch occurring every time the eye blinks. Obviously, removal of the foreign body is curative.
Recurrent or Spontaneous Corneal Erosion
After the cornea is scratched, it can heal superficially very rapidly to cover the defect. However, a longer period of time (months) is required for this area of healing to become firmly bonded in place. In some people, an area of corneal injury may be permanently weakened. In this situation, minimal trauma to the eye may be enough to cause this area of weakening to slough off or pull open, leading to a corneal abrasion again. This "minimal trauma" can include things as simple as eye rubbing or the eye opening for the first time in the morning.
This second situation is the most common. Typically, people with a recurrent or spontaneous corneal erosion problem experience ocular pain upon awakening. The eye may tear and have foreign body sensation. The corneal defect rapidly heals over in most cases, and the symptoms resolve in minutes to hours. However, the process may repeat itself the next morning. Some people may have an underlying weakness of the cornea (map-dot-fingerprint dystrophy), and can develop these symptoms with no history of trauma in the past.
Some people experience severe pain at the time of a spontaneous or recurrent corneal erosion, with a severe sensation that something is in the eye and profuse tearing. The symptoms can be disabling in some cases. Other people develop a milder foreign body sensation which improves as the day goes on.
Treatment is first to diagnose the problem, and then initially to try using lubricating ointments on the eye at bedtime. Sometimes these have to be used for weeks to months. Commonly used lubricants include Refresh P.M. and Muro 128. These lubricants help to prevent the eyelid from pulling open the corneal scratch upon awakening in the morning. In cases where the problem continues in spite of treatment, there are procedures which can be done in the ophthalmologist's office to reinforce the weakened area.
Other Conditions causing a foreign body sensation found on other pages:
A link to each condition is listed along with other hallmark features of the condition.
- Blepharitis - itching, burning, eyelid irritation.
- Conjunctivitis - eye redness, itching, discharge.
- Contact lens related problems - may have pain, scratchy sensation, redness, lens intolerance.
- Ectropion (out-turning) of eyelid - scratchy sensation, pain, tearing.
- Entropion (in-turning) of eyelid - scratchy sensation, pain, tearing and discharge.
- Eye Medication toxicity - corneal irritation from eye drops can lead to scratchiness.
- Phlyctenulosis - sensation that something is in eye, burning, itching, blepharitis.
- Pterygium - a growth on the surface of the eye, often with redness.
- Ocular cicatricial pemphigoid - an autoimmune disorder that leads to conjunctival scarring and dry eye symptoms.