Red Eye

Red eye

Eye redness is caused either by infection or inflammatory condition of the eye.  There are many reasons that can cause the red eye, some are contagious and most are not contagious, some are painful and most of them are not painful.  Here are the varieties of red eyes.

1. 1.Viral conjunctivitis - It is very contagious, caused by viral infection, and also known as “pink eye”.  It is usually transferable by airborne respiratory droplets or direct transfer from touching of affected eye to the otherIt is accompanied by fever, sore throat, enlargement of the lymph nodes, and recent contact with a sick individual.  It started out in one eye, then transfer to other eye within one week or two.  Symptoms are tearing, irritation, and discomfort without pain.  Although it is contagious, it also is self-limiting.  Patients are usually instructed to stay home, and limit the sharing of daily utensils, till it is resolved.  Management usually ranges from cold compresses, artificial tears to prescription anti-viral and/or steroid eye drops.

1. 2.Bacterial conjunctivitis - It is not as contagious as viral conjunctivitis, and usually present with thick mucusPatients usually complain of eyes matted shut upon awakening, eye irritation, light sensitiveness without pain.  It is commonly caused by staph organisms that usually resides in the eye lids, common in nursing home patient population and sometime is associated with blepharitis.  It is usually treated first with broad spectrum antibiotic eye drops.  Additional culturing may be needed if it is recurrent and isn’t responsible to treatment. 

1. 3.Allergic conjunctivitis – it isn’t contagious and the main symptom isEye may be red, swollen, and itchy without pain.  It is very common in spring and fall weather.   Management is usually a prescription anti-allergic eye drops, but there are many prescription strength allergy eye drops available over-the counter.  Prescription steroid drops may be needed in advanced cases.

1. 4.Contact lens related red eye – Improper soft contact lens wear is very commonly related cause. Usually patients wear overwear them (more than 8hr/day, more than allowable time frame), slept in them, and/or dirty contact lens cases, andIf the soft contact lens is overworn, bacterial can adhere to the back surface of the lens, and can cause infection or inflammatory response to the cornea.  The source of the bacterial can be from anywhere, such as dirty cases, dirty hands, un-cleaned eye lids, and solution bottle tops.  It is vital to take the lenses off before going to sleep and thoroughly clean them before putting the lens on the eye.  Do not wash the contact lens with any form of water (especially tap water), and do not wear them to go swimming.  The contact lens related red eye (CLARE) can be benign (low grade inflammation) or very severe (microbial keratitis, corneal ulcers).  It can also be something other than bacterial such as fungal and acanthomoeba infection.  Most contact lens related red eye is presented with benign inflammation and can be treated very commonly with topical antibiotic/steroid combination drops.  However, for advanced fungal or microbial infection, further management such as culturing, fortified medications, and referral to secondary or tertiary treatment centers may be needed.

1. 5.Keratitis – Keratitis means infection of the cornea, and it is a sight threateningUsually it is very common in improper soft contact lens wearer, such as sleeping in with contacts, over-wear during the day time, using dirty cases and solutions, and cleaning contact lens with tap water.  Basically, contact lens acute red eye can lead to keratitis.  Symptoms are red, painful, photophobic eyes, and tearing with or without mucous discharge.  There are many types, such as bacterial, herpes, fungal and acanthomoeba.  However, all corneal ulcers and keratitis except herpes are treated first with broad spectrum antibiotic with very close follow up.   If not better by 1-2 days follow up, additional steps such as culturing and change in treatment plan is needed according to the culture results.  For example, certain bacterial organisms are susceptible to only certain types of antibiotics, fungal may need antifungal, herpes may need antiherpes drops and oral meds, lastly acanthomoeba may need a whole different approach.  Whether it is contact lenses related or not, very close follow up is much needed in this case.   Please do not stop the medications without consulting with the doctor, and do not wear any kinds of contact lens during the treatment period.

1. 6.Sub-conjunctival hemorrhage – Sometime, red and blood shot eye can happen suddenly overnight and looks very dramatic without any symptoms except red and blood shot eye, known as sub-conjunctivalIt may look very red and dramatic but it doesn’t harm the eye.  It may commonly be caused by the result of a strong sneeze or cough, heavy lifting, strong vomiting, violently rubbing of the eye, and minor eye injury that caused a broken blood vessel in the white part of your eye.  The blood will usually absorbed within 10-14 days by itself, and may use over the counter artificial tears drops to lubricate eye to relieve of any dryness and foreign body sensations.  Sometimes, it may be related to uncontrolled high blood pressure and rare bleeding disorder.  Typically, during the eye exam, the eyes will get dilated to look for any bleeding in the retina. 

1. 7.Corneal abrasion – It is caused by scratches to the front part of the eye called cornea, either with trapped conjunctival foreign body, or any other objects (tree branches, finger nails, pencils, etc..).  It is usually very painful, and photophobic with lots ofTreatment is first to take out any foreign bodies that can be trapped underneath the eyelid, then take the artificial tears lubricants till the abrasion is sealed.  Then, depends on the severity of the abrasion, either bandage contact lens and/or antibiotic drops are needed.  

1. 8.Corneal/conjuctival foreign body – When foreign body such as dirt, makeup, metal gets into the eye, sometimes it is trapped underneath the eyelid, and scratches theThe patient will feel pain, discomfort, tearing, and foreign body sensation. 

1. 9.Recurrent corneal erosion - When the corneal abrasion takes place in the morning, usually upon awakening, and has previous history of cornealThe symptoms are the same as corneal abrasion such as pain, photophobic and excessive tearing.  The treatment is basically the same as corneal abrasion that would need lots of artificial tears.  Bandage contact lens and/or antibiotic drops, sodium chloride drops are needed depends on the severity of the case.  Oral medication such as doxycycline may be needed for 1 month to prevent the reoccurrence.  In very severe cases, a trip to corneal specialist may be needed for a stromal puncture procedure.   

1. 10.Dry eye related – please refer to dry eye and blepharitis

1. 11.Anterior uveitis (Iritis) – This is due to inflammation of the uveal tissue inside the eye, mainly the iris and ciliaryIt may be related to underlying systemic disorders such as lupus, rheumatoid arthritis, sarcoidosis, Reiter’s syndrome, Syphilis, TB, Lyme, etc….  It may also be the result of blunt trauma to the eye.  Symptoms are commonly presented as a red eye with dull pain, photophobia and tearing.  Treatment includes anti-inflammatory steroid eye drops (pred forte) 1 drop every 1 to 6 hr a day with cycloplegic eye drops. The treatment may take up to a month with frequent follow up once a week.  Blood work is needed for most iritis cases except cases with blunt trauma.  A trip to a specialist may be needed for severe and persistent iritis cases.  If the blood work turns positive for any kinds of systemic conditions, co-management with primary care doctors and/or rheumatologist is required.

1. 12.Angle closure glaucoma – In angle closure glaucoma, the eye pressure rises sudden and sharply to the range of 40 to 60 mmHg (normal < 21 mmHg), due to blockage of the drainageThe risk of getting an angle closure attack is high in patient with anatomically narrow angle, and large mature age related cataract.  Even with the anatomically narrow angles, the angle closure attach doesn’t happen every day.  When it happens, the patients may suddenly experience eye, facial pain, decreased in vision, haloes around the lights, occasionally nausea, and vomiting.  There is no way to predict when and where the angle closure attack will occur.  However, there are many preventatives measures that can be taken such as laser peripheral iridotomy (LPI), and cataract surgery for mature large cataracts.  When the angle is narrow anatomically, LPI will protect the eye from getting angle closure attack in the future.  When the narrow angle is caused by a large mature cataract, cataract surgery is required.