Emergency physicians are required to diagnose and treat patients who have a painful eye on a regular basis. This article focuses on ophthalmologic emergencies that range in presentation from mild to severe symptomatology and include vision and eye-threatening ailments. The etiology, pathophysiology, physical examination, and treatment of the following conditions are discussed: acute angle closure glaucoma, scleritis, anterior uveitis, optic neuritis, keratitis, and corneal abrasion. This article should provide the necessary information to allow for rapid diagnosis and initiation of appropriate treatment of the painful eye.