Photophobia

Photophobia, or light sensitivity, is when normal lighting conditions cause discomfort and/or pain to the eyes or head. A person experiencing photophobia will find it hard to keep their eyes open in a bright room or outside.

Photophobia is not to be confused with the sensation of adapting to changes in light when exiting a dark room (like a movie theater) or feeling dazzled after a camera flash. 

There are various causes of photophobia, ranging from minor all the way to life-threatening. The cause is typically ophthalmic or neurologic in nature. It is not normal to experience photophobia, so it is vital to address the issue with a doctor to discover the cause. 

What are the causes?

Causes of photophobia range from mild and treatable conditions to severe emergencies. Photophobia can arise from an issue with the eyes or the brain. 

Ocular causes include damage, inflammation, infection, and dryness of the eye. Any trauma to the cornea, the clear front part of the eye, can cause photophobia. This would include abrasions, burns, foreign bodies that caused scratches, or extreme exposure to UV light. An abrasion can occur from something as simple as sleeping in contact lenses not designed for overnight wear or wearing expired contacts.

Inflammation or infection of structures inside the eye causes photophobia and sometimes pain. Dry eye is a chronic condition that damages the cornea, resulting in some degree of photophobia. 

It is possible that photophobia can be present in an individual with otherwise healthy eyes if there is an abnormality. Albinism is an example; People with albinism can experience photophobia because they lack pigment in their iris that blocks excess light from entering the eye.

Neurologic causes of photophobia range from migraines to brain tumors. Photophobia is an extremely common symptom of migraines, but it is often not the only symptom. More neurologically severe conditions associated with photophobia are meningitis, optic neuritis, and subarachnoid hemorrhage.

Psychological conditions such as anxiety and depression can be associated with some degree of light sensitivity as well.

No matter the cause, photophobia is a symptom that must be addressed with a medical provider immediately so that you can be treated for it and to rule out more severe conditions.

How is photophobia diagnosed?

Diagnosing photophobia can be as simple as having a detailed conversation with a doctor, answering their specific questions. Patients usually report having eye pain in response to bright lights. Sometimes patients will feel like they have to wear sunglasses inside because the light level is so bothersome.

Photophobia may also accompany headaches or other symptoms that point to a specific cause. 

Since photophobia is a symptom of an underlying condition, doctors will also perform an exam to confirm the suspected diagnosis. An eye doctor will use a specialized microscope to examine the front and back of the eyes to look for signs of any condition that would cause photophobia. If photophobia leads a patient to a neuro specialist, they may suggest brain imaging to look for a cause involving the brain or spinal cord. 

How is photophobia treated?

Photophobia is a symptom, not a condition. To decrease or eliminate the symptom of photophobia, you must address the underlying cause. The treatment for photophobia will depend on what condition is causing it. 

When a neurological problem is suspected, specialized imaging may be used to detect abnormalities. Blood tests may also be ordered to aid in treatment. Some neurologic causes of photophobia require a lumbar puncture for diagnosis or treatment. The overall treatment plan can vary.

If the problem is eye-related, treatment often includes eye drops or ointments. Severe conditions may require the use of multiple kinds of ophthalmic medications, such as steroid drops and antibiotic drops. In addition, oral medication may be indicated in certain situations.

Are there other ways to reduce photophobia?

Other ways to reduce photophobia include tinted lenses. Sunglasses with a dark tint can be used outside, while red or amber tinted lenses can be used indoors. In addition, some tint colors may be more beneficial for specific conditions. 

Also, transition lenses can be helpful for people who need prescription glasses. Transition lenses turn regular glasses into sunglasses outside and fade back to clear when indoors. There are even transition contact lenses that get darker outside. They are a 2-week replacement lens called Acuvue Oasys with Transitions. 

Is photophobia permanent?

If the condition causing the photophobia is treatable, then it will not be permanent. Photophobia typically subsides when the cause is resolved, if not before. However, if it results from a permanent condition, then the symptom may be permanent. For example, when photophobia results from the lack of pigment in the iris in a person with albinism.

Can anxiety cause photophobia?

A particular type of anxiety disorder is known to be most associated with photophobia, agoraphobia. Agoraphobia is the fear of being in situations that cause stress, embarrassment, or discomfort. Patients with agoraphobia tend to find comfort in darkness or dimly lit spaces. Certain bright environments or lights trigger anxiety attacks in these patients.

Additionally, most anti-anxiety medications cause pupil dilation or mydriasis, resulting in photophobia. The pupil is a hole that controls how much light enters the eye, and mydriasis will prevent the pupil from constricting or getting smaller. Large pupils will be more sensitive to light than small pupils. Anti-depressants and anti-psychotic medications can also have this effect on the eyes, amongst others. 

Is photophobia a symptom of other underlying conditions of the eye?

The symptom of photophobia is a significant clue towards diagnosing certain ocular conditions. Specifically, photophobia is a tell-tale sign of uveitis. Uveitis is inflammation of the uvea, which includes internal structures of the eye like the iris. It can cause long-term damage to the eye and even put eyes at risk for developing glaucoma. 

There are many forms of uveitis that can manifest in the eyes. Most forms primarily affect the front half of the eye, while more severe forms can affect the back of the eyes. Causes of uveitis include many systemic conditions like arthritis, gout, and lupus, to name a few. In addition, some infectious causes of uveitis include tuberculosis, Lyme disease, and toxoplasmosis.

What are photophobia glasses?

Photophobia glasses have lenses that block light rays, similar to sunglasses. These types of glasses are known to block most of the blue wavelength light from the sun and some light sources. The lenses are often tinted. Tints can range from pink to red, or even amber and darker. These glasses can help people with mild to moderate photophobia and people who would like to use them solely for enhanced comfort. 

What are the symptoms of severe photophobia?

Severe photophobia is more than just feeling eye or head discomfort in bright environments. Patients with severe photophobia will find discomfort in even “normal” lighting. They may also experience nausea, headache, and eye pain. Photophobia that is this severe should not be ignored, for it can indicate a more serious underlying condition. 

Is phonophobia related to photophobia?

Yes. While photophobia is light sensitivity, phonophobia is sensitivity to sound. Both photophobia and phonophobia are known to be associated with migraines. However, not all types of migraines are known to cause these symptoms. Phonophobia and photophobia can turn certain visual and auditory stimuli into triggers for a migraine. People who experience these symptoms can suffer from emotional distress as well. Having increased sensitivity to light and sound can hinder individuals from driving or other activities of daily living. 

Can allergies cause photophobia?

Allergies can cause photophobia in the form of allergic conjunctivitis. Conjunctivitis is the typical pink eye caused by allergies, bacterial infections, or viral infections. Allergic conjunctivitis causes itching, watery discharge from the eyes, light sensitivity, or photophobia. Other symptoms may also be present, such as redness and extreme discomfort. 

Some anti-allergy medications can also cause photophobia if the specific drug causes mydriasis or large dilated pupils. 

What causes photophobia in meningitis?

Meningitis is a term that describes inflammation of the meninges in the brain. The inflammation irritates the meninges. The meninges of the brain are innervated by one of the cranial nerves that also innervates the eye. The sensation of photophobia arises from activation of that nerve from meningeal irritation. Photophobia can also be caused by a brain bleed or a brain tumor, not just meningitis. 

Can dry eyes cause photophobia?

Dry eyes can cause photophobia. Dryness can cause damage to the cornea, the clear part on the front of the eye. The cornea is highly innervated, which makes it a very sensitive surface. Corneal damage from dryness is mostly superficial, where most of the corneal nerves lie. Dry eye sufferers may also experience symptoms like burning, itching, or excessive watering. 

To reduce the symptom of photophobia secondary to dry eyes, treatment must be geared towards treating the dry eye itself. This could include artificial tears, ointments, or anti-inflammatory drops, whichever your optometrist decides is right for you. Not all dry eye treatment is made equal. 

Can contact lenses help photophobia?

While there are no contact lenses specifically made to treat photophobia, there are many great options available for patients to help reduce their symptoms. Acuvue Oasys with Transitions is a great option for patients who need tinted lenses while outside only. These soft contact lenses will not stay dark while indoors or get darker with artificial lighting. 

Specialty prosthetic contact lenses can be a great option for specific cases. Prosthetic lenses can be made with red tint on the entire lens or just over the pupil area. For complete light protection, the pupil can also be made black to prevent the most amount of light from entering the eye. 

To inquire about contact lenses for photophobia, one can visit their optometrist to decide which is best and explore all of the options that are available. 

References

Digre KB, Brennan KC. Shedding light on photophobia. J Neuroophthalmol. 2012;32(1):68-81. doi:10.1097/WNO.0b013e3182474548

Pinheiro, C.F.; Moreira, J.R.; Carvalho, G.F.; Zorzi, L.; Dach, F.; Bevilaqua-Grossi, D. Interictal Photophobia and Phonophobia Are Related to the Presence of Aura and High Frequency of Attacks in Patients with Migraine. Appl. Sci. 2021, 11, 2474. https://doi.org/10.3390/app11062474