STRUCTURES SURROUNDING
THE EYE

The eyes are moved by six eye muscles. Normally the eyes move so that both eyes look on the same object. The control of eye movements is usually very accurate.

Fig.9. Eye muscles. Right eye as seen from above. Two muscles below the eye are not seen.

If the coordination of eye movements is disturbed and the eyes look at different objects, the person has strabismus or squint. If the eye turns in, the person is cross-eyed. If the eye turns out, the person is wall-eyed.

The space between the eye muscles and the bony wall of the orbit is filled with loose fat tissue. This soft tissue functions like a cushion if the eye is hit by an object. Fat tissue decreases in the elderly persons, the eyes sink into the orbit and the eyes look smaller but they are not smaller.

The bony orbit surrounding the eyes contains several small cavities, sinuses. They are located in the forehead, in both cheeks and between the eyes.

Fig.10. The sinuses: above the eyes the frontal sinuses, between the eyes the ethmoidal sinuses, and below the eyes the maxillary sinuses.

Inflammation in the nasal sinuses may cause pain. Inflammation in the sinuses between the eyes often radiates into the eye or both eyes. The eye itself looks normal, with no redness or other signs of irritation. Vision is normal. If one presses against the aching eye, the pain is relieved as long as the hand presses the eye. The pain is felt again as soon as the pressure is removed. This is typical pain caused by poor ventilation of the sinuses. If such a pain is felt, it is usually possible to relieve the pain by using nasal spray or pills that decrease swelling of the mucous membranes in the nose and by inhaling warm vapor.

If pain around the eye is related to an inflammation in the eye itself, the eye is usually red. A similar pain can be caused by inflammation of the optic nerve, but it usually causes a decrease in central vision and the pain gets worse when the eye moves or it is pressed.

Pain in or around an eye may radiate from the muscles of the neck or - more rarely - from the facial muscles, especially from the temporal muscle. The most common areas from where the pain radiates to the eye are seen in the Figure 10a.

Figure 10a. When muscles in the different layers of neck are irritated, the pain radiates to the skin and bones around the eye and to the outer part of the eye itself.

Pain related to muscle tension in the neck decreases when the muscles are warm in a hot shower or during a sauna bath and then gently stretched.

Positions of teeth may change and cause change in the function of the maxillar joint and/or in the function of the muscles. This possibility should also be kept in mind when there occurs pain around the eyes.

Pain in and around the eye Inflammation: Iritis - the eye is red and photophobic Optic neuritis - the eye looks normal, movements cause pain behind the eye, vision is blurred Episcleritis - often wedge shaped redness of the sclera, recurrent Acute glaucoma - the eye is red, vision may be blurred Sinus problem, decreased air pressure in the sinuses Muscle pain radiating from the neck or from the temporal muscle Changes in teeth, requires consultation by a dentist.