Klinik Temasya
Primary Care Medicine

Red eyes

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Red eyes is a pretty common complaint of patients attending GP clinic. It could be due to minor and mild irritation but it can also be due to serious underlying issues that can result in impairment of vision.

Red eyes or 'bloodshot eyes occured when there is dilated and congested blood vessel between the white part of the eye (sclera) and the overlying clear layer in front of the eyes (conjunctivae). It can occur in one or both eyes and may be associated with several symptoms such as itchiness, irritation, burning sensation, dryness, pain, watery of yellowish discharge, blurry vision and sensitivities to lights.

Risk factor of red eyes including underlying atopy (often associated with other allergic conditions like asthma, eczema and allergic rhinitis), excessive straining to eyes from long hours in front of the computer, lack of sleep, wearing contact lens, trauma to the eyes, certain occupations (metal grinding, welding) and underlying autoimmune diseases such as rheumatoid arthritis and Sjogren's syndrome.

The most common cause of red eyes is conjunctivitis, often called 'pink eye'. It could be due to infections, environmental allergens, lifestyle factors and medical conditions. Viral conjunctivitis are usually similar to the virus that causes common cold and flu and is highly contagious. Often when people having cold and flu, they may also develop red eyes. This is often self-limiting and  relief with supportive treatment such as cold compresses and artifical tear drops and rarely need antibiotic. 

Bacteria  conjunctivitis is highly contagious and often caused by spread from direct contact with infected items and from rubbing the eyes. Symptoms also include copious amount of purulent eye discharge and discomfort. Treatment include use of topical antibiotic eye drops.

Environmental allergens and irritants such as pollen, dust and animal dander can allergic conjunctivitis often associated with intense itchiness and with sneezing and runny noses. Treatment includes avoidance to suspected allergens, using artificial tears and anti-histamine.

Dry eyes syndrome or keratoconjunctivitis sicca cause red eyes and very common in eldery patients (about 70% cases), wearing contact lens, meibomian gland dysfunction, post LASIK surgery, pregnancy, vitamin A deficiency and autoimmune disease like Sjogren' syndrome. This condition happens when the eyes do not produce enough tears and when the tears evaporate too quickly. It causes dryness, burning, sandy- gritty eye irritation and easily tired eyes. The symptoms usually made worsen by excessive eye blinking activties (computer usage, watching TV), smoking, air-conditioned area, fan and aeroplane. Treatment depends on underlying cause such as by use of artificial tears, lacrimal plugs and topical steroid or immunosuppresant.

 Corneal abrasion is a scratch to the cornea surface of the eye and usually as a result of a trauma. This can be due to poke by a fingernails, wearing dry contact lens or foreign body such as from certain occupational activities. It cause red eyes, sudden onset of pain after the traumatic exposure, eye sensitivity especially to light and sensation of foreign body in the eye. If foreign body is suspected, a good irrigation is needed for removal and treatment are usually supportive. 

Subconjunctival hemorrhage is another cause of red eyes and usually can be diagnosed clinically. It is harmless with blood reabsorption take place over the next few weeks and commonly no treatment is needed unless there is pain or visual impairment from physical injury (being punch, penetrating injury). Urgent review is needed to rule out corneal involvement and fracture. However, it can also happen when there is violent coughing or sneezing, straining, vomiting and rubbing of the eyes. Risk factors including having diabetes, uncontrolled high blood pressure or taking medication that can thin out the blood such as Aspirin, warfarin and NSAIDS.

There are many causes of red eyes. Talk to our doctor to determine the cause of your red eyes and the treatment available for you.

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