What is the cause of pain behind the eye and with extraocular movement (EOM)?

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Last updated: March 19, 2025View editorial policy

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Differential Diagnosis for Pain Behind the Eye and with Moving It

  • Single Most Likely Diagnosis
    • Migraine: This is often characterized by severe, unilateral headaches that can be accompanied by pain behind the eye. The pain can worsen with movement, including moving the eye. Migraines are relatively common and can cause significant discomfort.
  • Other Likely Diagnoses
    • Cluster Headache: These are extremely painful headaches that occur in cycles or clusters, often affecting one side of the head, including pain behind the eye. They can be exacerbated by movement.
    • Optic Neuritis: Inflammation of the optic nerve can cause pain behind the eye, especially with eye movement. This condition can be associated with multiple sclerosis.
    • Sinusitis: Infections or inflammation of the sinuses can cause pain behind the eyes, which may worsen with movement due to increased pressure.
  • Do Not Miss Diagnoses
    • Giant Cell Arteritis: This condition involves inflammation of the blood vessels and can lead to severe headaches, including pain behind the eye. It's critical to diagnose early to prevent complications like blindness.
    • Pituitary Apoplexy: A condition where the pituitary gland suddenly hemorrhages or becomes infarcted, leading to severe headache, including pain behind the eyes, and can be life-threatening if not promptly treated.
    • Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition involving a blood clot in the cavernous sinus, which can cause severe headache, including pain behind the eye, and requires immediate medical attention.
  • Rare Diagnoses
    • Tolosa-Hunt Syndrome: A rare disorder characterized by headache, including pain behind the eye, and ophthalmoplegia (weakness or paralysis of the eye muscles) due to inflammation in the cavernous sinus or superior orbital fissure.
    • Orbital Myositis: Inflammation of the muscles surrounding the eye, which can cause pain behind the eye, especially with eye movement. It's a rare condition that can be associated with systemic diseases.
    • Idiopathic Intracranial Hypertension (IIH): A condition characterized by increased pressure within the skull without a detectable cause, which can lead to headache, including pain behind the eyes, and vision changes.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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