Red Eye

If the red eye is due to acute glaucoma, it generally presents as blurred vision or haloes around lights especially during the night. It is caused by blockage at the Canal of Schlemm resulting in an inability of aqueous to drain from the anterior chamber. It is treated by a drug to cause miosis (e.g., pilocarpine), which will open the blockage, by improving the drainage angle. Also a drug to reduce the formation of aqueous can also be given (e.g., acetazolamide).

The uvea is the vascular and pigmented part of the eye and includes the choroid, iris, and ciliary body. Collectively, the iris and ciliary body are referred to as the anterior uvea, with iritis typically involving the ciliary body too, hence the phrase anterior uveitis. The main aim of treatment is prevention of damage to the eye and steroids and a drug to help with any adhesions could be used (e.g., cyclopentolate). These types of problems should be discussed with a specialist, especially if there is any doubt with the clinician.

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The appearance of red eyes is caused by dilation of tiny blood vessels that are located between the sclera and the overlying clear conjunctiva of the eye. These tiny blood vessels (many of which normally are invisible) can become swollen because of environmental or lifestyle-related reasons or because of specific eye problems.

Red eyes usually are caused by allergy, eye fatigue, over-wearing contact lenses or common eye infections such as pink eye (conjunctivitis). However, redness of the eye sometimes can signal a more serious eye condition or disease, such as uveitis or glaucoma.

Environmental causes of red, bloodshot eyes include:

Red eyes occur when the blood vessels on the surface of the eye expand.

  • Airborne allergens (causing eye allergies)
  • Air pollution
  • Smoke (fire-related, second-hand cigarette smoke, etc.)
  • Dry air (arid climates, airplane cabins, office buildings, etc.)
  • Dust
  • Airborne fumes (gasoline, solvents, etc.)
  • Chemical exposure (chlorine in swimming pools, etc.)
  • Overexposure to sunlight (without UV-blocking sunglasses)

Common eye conditions that cause red eyes include:

  • Dry eyes
  • Eye allergies
  • Pink eye (conjunctivitis)
  • Contact lens wear
  • Digital eye strain

Serious eye conditions that can cause red eyes include:

  • Eye infections
  • Eye trauma or injury
  • Recent eye surgery (LASIK, cosmetic eye surgery, etc.)
  • Uveitis
  • Acute glaucoma
  • Corneal ulcer

Lifestyle factors also can contribute to your red eye risk. For example, smoking (tobacco or marijuana) definitely can cause red eyes, as can significant alcohol consumption. Sustained use of digital devices and insufficient sleep are other lifestyle-related causes of red eyes.

Born very premature (gestational age of 30 weeks or less), less than 1500 grams at birth, or history of retinopathy of prematurity (ROP) or unstable clinical course.

o   Increased risk of strabismus, amblyopia, decreased visual acuity

o   If history of ROP, esp. if higher severity – increased risk of the above and retinal detachment, visual field loss

·         History of maternal “TORCH” infection during pregnancy    (Toxoplasmosis,Other,  Rubella, Cytomegalovirus, Herpes Simplex Virus)

·         Family history of

o   high refractive errors,

o   congenital or juvenile cataract,

o   aniridia,

o   glaucoma,

o   strabismus,

o   amblyopia,

o   retinoblastoma,

o   congenital retinal dysplasia,

o   other congenital retinal and lenticular disorders,

o   metabolic or genetic diseases,

o   color vision deficiency,

·         Neurological and developmental disorders

·         Presence of systemic disease associated with eye abnormalities, e.g. juvenile rheumatoid arthritis

·         Use of medications associated with eye or vision abnormalities

If your eye redness is caused by a medical condition such as conjunctivitis or blepharitis, you may be able to treat your symptoms at home. Warm compresses on the eye can help reduce the symptoms of these conditions. You should also make sure that you wash your hands frequently, avoid wearing makeup or contacts, and avoid touching the eye.

If your eye redness is accompanied by pain or changes in vision, you need to see your doctor for treatment. Your doctor will ask you about your symptoms, your current health conditions, and problems that may have caused irritation to your eye. Your doctor may also examine your eye and use a saline solution to wash out any irritants in your eye.

Depending on your diagnosis, your doctor may prescribe treatment that helps to alleviate your symptoms. This would likely include antibiotics, eye drops, and home care as described above. In some cases, where the eye is very irritated, your doctor may suggest wearing a patch to limit light exposure and help your eye heal.

  • Blepharitis - a usually chronic inflammation of the eyelids with scaling, sometimes resolving spontaneously
  • Subconjunctival haemorrhage - a sometimes dramatic, but usually harmless, bleeding underneath the conjunctiva most often from spontaneous rupture of the small, fragile blood vessels, commonly from a cough or sneeze
  • Inflamed pterygium - a benign, triangular, horizontal growth of the conjunctiva, arising from the inner side, at the level of contact of the upper and lower eyelids, associated with exposure to sunlight, low humidity and dust. It may be more common in occupations such as farming and welding.
  • Inflamed pinguecula - a yellow-white deposit close to the junction between the cornea and sclera, on the conjunctiva. It is most prevalent in tropical climates with much UV exposure. Although harmless, it can occasionally become inflamed.
  • Dry eye syndrome - caused by either decreased tear production or increased tear film evaporation which may lead to irritation and redness 
  • Airborne contaminants or irritants
  • Tiredness
  • Drug use including cannabis
  • Episcleritis - most often a mild, inflammatory disorder of the 'white' of the eye unassociated with eye complications in contrast to scleritis, and responding to topical medications such as anti-inflammatory drops.

Usually urgent

  • Acute angle closure glaucoma - implies injury to the optic nerve with the potential for irreversible vision loss which may be permanent unless treated quickly, as a result of increased pressure within the eyeball. Not all forms of glaucoma are acute, and not all are associated with increased 'intra-ocular' pressure.
  • Injury
  • Keratitis - a potentially serious inflammation or injury to the cornea (window), often associated with significant pain, light intolerance, and deterioration in vision. Numerous causes include virus infection. Injury from contact lenses can lead to keratitis.
  • Iritis - together with the ciliary body and choroid, the iris makes up the uvea, part of the middle, pigmented, structures of the eye. Inflammation of this layer (uveitis) requires urgent control and is estimated to be responsible for 10% of blindness in the United States.
  • Scleritis] - a serious inflammatory condition, often painful, that can result in permanent vision loss, and without an identifiable cause in half of those presenting with it. About 30-40% have an underlying systemic autoimmune condition.
  • Tick-borne illnesses like Rocky Mountain spotted fever - the eye is not primarily involved, but the presence of conjunctivitis, along with fever and rash, may help with the diagnosis in appropriate circumstances.

Red eyes can develop suddenly or over time. Eye drops are helpful in many cases, and can be purchased over-the-counter or online. If the redness is not easing up and is accompanied by other symptoms, people should see a doctor.

Eye injuries, contact lenses, and frequent use of eye drops can all cause irritation leading to red eyes. A doctor can help a person to pinpoint the cause of their red eye problem and develop a treatment plan.

Common treatments include eye drops, antibiotics, creams, and oral medications. Most conditions are readily treatable and, if caught early, do not cause any permanent long-term damage.

Some serious medical conditions, including leukaemia, sarcoidosis, and juvenile idiopathic arthritis, can also cause a red eye. As a result, getting a proper diagnosis is critical.

People should not hesitate to contact their doctor with any questions or concerns if they have red eyes.

Most cases of eye redness can be prevented by using proper hygiene and avoiding irritants that can cause redness.

Follow these tips to prevent eye redness:

  • Wash your hands if you’re exposed to someone who has an eye infection.
  • Remove all makeup from your eyes each day.
  • Do not wear contact lenses longer than recommended.
  • Clean your contact lenses regularly.
  • Avoid activities that can cause eyestrain.
  • Avoid substances that can cause your eyes to become irritated.
  • If your eye becomes contaminated, flush it out immediately with water.

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