Photophobia

Photophobia is a subjective intolerance to light that causes discomfort, pain, or an urge to squint in bright environments. It is a symptom rather than a disease and can result from a wide range of ocular and systemic conditions. Light sensitivity may involve the eyes directly or reflect from brain pathways processing visual or sensory information.

Common signs and associated symptoms include eye pain or burning, tearing, reduced tolerance to daylight, squinting, headache, and sometimes blurred vision. Photophobia may occur acutely after eye injury or infection, or chronically in conditions such as migraine.

Causes are broad and can be grouped into ocular, neurologic, and systemic categories. Ocular causes include dryness and inflammation of the ocular surface (dry eye, conjunctivitis, blepharitis), corneal ulcers or abrasions, and intraocular inflammation (anterior uveitis). Neurologic and systemic associations include migraines and other headaches, meningitis or encephalitis, brain injuries, and certain medications or drug withdrawals. Less commonly, photophobia can be seen with cataracts, glaucoma, or after eye surgery. Environmental triggers such as bright artificial lighting can worsen symptoms.

Evaluation typically involves a clinical history and eye examination to identify treatable ocular causes and assess for red flag conditions (red eye with severe pain, fever, neck stiffness, or vision loss). Urgent care is warranted if photophobia is accompanied by fever and neck stiffness, severe eye redness or pain, traumatic injury, or sudden vision change.

Management focuses on treating the underlying cause and reducing light sensitivity. This may include lubricating eye drops for surface disease, antimicrobial or anti-inflammatory therapy for infections or inflammation, and specific treatments for migraines. Protective measures such as sunglasses, hats, and reduced lighting in the environment can provide symptom relief.