Chronic ocular surface pain (COSP) is a debilitating condition defined as eye pain lasting over three months, significantly impacting a patient's quality of life. Emerging understanding highlights COSP as a complex multifactorial issue, stemming from nociceptive, neuropathic, and nociplastic mechanisms. Nociceptive pain arises from actual tissue damage or inflammation, common in conditions like dry eye disease (DED), trauma, or ocular surface inflammation. However, a significant subset of DED patients experiences neuropathic ocular pain (NOP), characterized by severe symptoms—such as burning, hypersensitivity to light, wind, or cold—even when objective ocular signs are minimal or absent. This 'discordant phenotype' suggests dysfunction within the central and/or peripheral somatosensory nociceptive pathways. Research indicates a strong comorbidity between chronic eye pain and other systemic chronic pain syndromes, including fibromyalgia, irritable bowel syndrome, and pelvic pain. This suggests that chronic eye pain might be part of a broader central pain disorder, also showing associations with mental health. Diagnosing the source of chronic eye pain requires a thorough clinical evaluation that considers the pain's chronicity (over 3-6 months), refractoriness to standard treatments, and specific neuropathic descriptors. Advanced multimodal diagnostic tools are recommended to differentiate between pain pathways. Treatment for chronic eye pain necessitates a multimodal approach. Initial strategies focus on addressing nociceptive sources with therapies like artificial tears and anti-inflammatory agents. For neuropathic components, treatments include topical agents that improve nerve function (e.g., autologous serum tears), and systemic neuromodulators such as anticonvulsants (gabapentin, pregabalin), tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors. Additionally, nerve blocks, cognitive-behavioral therapy, emotional support, and lifestyle adjustments (e.g., improved sleep, stress management) are crucial components of comprehensive patient care. The European Medical Journal article highlights these contemporary insights, particularly referencing studies on central nervous system mechanisms in chronic ocular surface pain.