For many people, eye pain has a clear cause—dry eyes, infection, strain, or injury. But what happens when your eyes hurt, yet all tests come back normal? The surface looks fine, vision is intact, and your eye drops aren’t doing much. This frustrating experience is more common than people realize, and it may be a sign of something called neuropathic eye pain.

Unlike typical eye pain that starts in the eye itself, neuropathic eye pain comes from the brain. Think of it as a “misfiring” in the nerves. The brain misinterprets normal signals from the eye as pain, even when there’s no physical damage or inflammation present. It’s a bit like a fire alarm going off when there’s no smoke—the system is reacting as if there’s danger, but there’s nothing actually wrong at the source.

Because of this, the usual eye treatments often don’t help. In fact, aggressively treating the eyes—trying drop after drop, or procedure after procedure—can sometimes make things worse. Once neuropathic pain is suspected, the goal becomes maintaining appropriate (but minimal) eye care and shifting focus to the nervous system.

Awareness is key. Understanding that the pain is real, but its origin is neurological—not ocular—is the first and most important step in the healing journey.

Treatment for neuropathic eye pain typically involves a multidisciplinary approach:

• A GP or neurologist may prescribe medications like low-dose antidepressants or antiepileptics—not because they think it’s “all in your head,” but because these medications can calm overactive nerve signals in the brain.
• A behavioural psychologist can help you build coping tools to manage chronic pain and reduce its impact on daily life.
• Pain management specialists might use tools like TENS (transcutaneous electrical nerve stimulation) or magnetic stimulation therapies to help “reset” how your nervous system processes pain.