Hello and thanks for your question.
One of the most common causes for this intermittent, sharp, stabbing pain, especially when a "normal" exam is seen is a dry, irritated eye. Dry eyes
can also produce symptoms of burning, tearing
, foreign-body sensations and general dry sensations.
Patients who have had surgery on their eyes can have dry eyes because of that. Women who are post-menopausal are more likely to get dry eyes. Some people have dry eyes because they don't make enough tears. Some have dry eyes because of inflammation in their eyelids and some because of allergies.
The first thing to dry with dry eyes is to use artificial tears. I recommend to my patient that they start by using them 4 times per day in each eye. The important thing is to use them consistently, in a scheduled fashion for 3-4 weeks before cutting down on them. If artificial tears are used for dry eyes only when you feel like you need them, then they usually only work for thirty seconds or so and don't help the overall hydration of the eyes.
Something else to consider outside of this, and if your trial of artificial tears doesn't change your symptoms at all is an entity called Trigeminal Neuralgia (TN). This is a disorder where the trigeminal nerve, the nerve that supplies sensation to the face and to the eyes, becomes irritated, usually from where the nerve exits the brain. This is happening inside the head, but affects your face and eyes. It can happen for no apparent reason, or do to problems inside the head relating to the brain. It can produce this sharp, electrical stabbing pain that you speak of.
Unfortunately there is not always a cure for trigeminal neuralgia, but sometimes a reason for having it can be found and eliminated by surgery or medical therapy. Sometimes amitriptyline is prescribed for trigeminal neuralgia. Another medicine that can be taken for this include Neurontin.
If this sounds like your symptoms and what your doctor diagnosed, you would be well served to be examined by a neurologist and possibly receive some kind of imaging of your head (MRI).
If this is trigeminal neuralgia, it usually does not result in shortening of life span, but it can give such intense pain that it can severely affect your quality of life. Uncommonly, however, it can be to due to a structural lesion inside the head, therefore necessitating the essential workup by the neurologist to make sure there isn't anything like that which can be life-threatening.
Most people have a reasonably positive response to one of a few oral medications such as amitriptyline, neurontin or carbamezepine.
In summary, I would do the trial of artificial tears as I mentioned earlier. If you have other symptoms of dry eye that I mentioned, then it would be worthwhile to see a corneal specialist to have an evaluation of dry eye. In the absence of this, though, I would recommend seeing a neurologist to get an evaluation for possible trigeminal neuralgia.
Does this make sense and does this help address your concerns?
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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.