Brief Answer:
A corneal scratch or glaucoma are possible causes- more information is needed

Detailed Answer:
Hello and welcome to "Ask a Doctor" service,

I carefully read your query and here is my advice.

Eye pain in the circumstances that you explain may happen if the eye was scratched by the pillow. This would be the case if the cornea, which is the outer layer of the apple of the eye, gets scratched. This may cause pain in the eye, tearing, mild uniform redness of the eye and also sensitivity to light. On the other hand, this is very rare in the case as generally, the eyelids do offer good enough protection to prevent this.

An important cause of eye pain is increased pressure in the eye or also called glaucoma. In the times that we are for a long time under low light exposure, the apple of the eye may dilate and cause pressure in the eye to build and trigger an attack of glaucoma. This may cause pain in the eye, haloes around lights, may affect the vision, some patients feel nauseous, and the eye gets red around the apple of the eye.

I would kindly ask you of the following information so I can better determine which is the cause of the eye pain in your case:

- for how long have you had the pain in the eye?

- is the eye red or is it tearing? Do you have secretions from the eye?

- do you see haloes around lights, especially at night?

- do you have nausea as well?

- are you sensitive to the light?

- did you have any trauma on the eye (something hit against the eye or something fell in the eye) recently?

- are the eyelids red, swollen or have any lesion?

- do you suffer from any chronic conditions and do you use any medications (glaucoma is more common in certain patients with certain chronic conditions and that use certain medications).

As a general rule, anytime a patient has eye pain or vision changes (any of these), he/she should see the eye doctor as soon as possible to rule out serious eye diseases that may permanently damage the vision and need urgent treatment (in a timely manner) to prevent this. Glaucoma, for instance, is a medical emergency, which means patients should seek medical help as soon as possible as the high pressure in the eye may press against the back of the eye and cause permanent damages and cause vision loss. So, ruling it out by seeing the eye doctor as soon as possible is crucial.

I hope to hear back from you, with the above information, as soon as possible.
I remain at your disposal for further medical assistance.

Regards,
Dr. Antoneta Zotaj
General and Family Physician

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Brief Answer:
Detailed answer below

Detailed Answer:
Hello and welcome back,

If you are sure that the pillow scratched the inside of the eye and this initiated the pain, then very likely this is the cause of the pain. Very likely the cornea got scratched. The fact that the pain is better is a good and reassuring sign. And because the eye is not red, this is another reassuring sign.

As a doctor, I generally prefer to:

- see these patients in my office to try to understand how large the scratch is and if it is in the center of the cornea or it is at the periphery and how likely it is that the scar will affect the vision after the scratch heals. The visit will also rule out other causes for the pain (such as glaucoma).
- then I gently flush the eye with saline solution for a few minutes helps relieve the pain and remove any remaining dust or foreign material in the eye
- After that, I give the patients an antibiotic ointment (this can be any eye ointment with an antibiotic such as chloramphenicol for instance, but should not contain any steroids as steroids should be given only under the supervision of the eye doctor). The antibiotic ointment causes a thin layer over the eye and offers longer protection against potential infections compared to eye drops.
- then I ask the patients to come for a review in a few days (to see how the abrasion/scratch is healing) or if they have any worsening.

In your case, you will need to decide depending on how severe the pain is and your possibility to see a doctor. Even seeing your GP is enough in 90% of the cases. The GP is going to do the things I already mentioned above (examine, flush the eye, prescribe an antibiotic ointment for the eye and ask for a review), or may refer you to the eye doctor is the abrasion is large.

If you are not able to see the doctor at all, then please gently flush the eye with tap water or saline solution you may access from your local pharmacy, gently dry the eye (do not press on the eye), and acquire for a chloramphenicol ointment in the pharmacy and apply it in the eye twice a day (you apply it in the inside of the lower eyelid as a 0.5 cm thin line and then you close the eye and move the eye to spread the ointment).

In any case, if you are not getting better from hour to hour or you notice any worsening (worsening in pain or changes in vision, you see haloes around lights or the eye gets red) please see your doctor as soon as possible.

I hope this answers your query.
I remain at your disposal for further medical assistance.

Regards,
Dr. Antoneta Zotaj
General and Family Physician

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