10 Conditions that Cause Red Eye (And What to Do About Them!)
To some people they eyeball is foreign territory. The thought of touching they eye sends chills up their spine. Likewise, the thought of something gone wrong with this important structure leaves reason for concern. It is, after all, the incredibly complex organ, hooked directly to our brain, which allows us the wonder of vision.
As a doctor, I see eye problems frequently.
Most of these problems involve a common grouping of conditions called “the red eye.” A red eye always puts me on edge. While most of the patients I see with a red eye have a harmless cause, some conditions are very serious, leaving the potential for lost vision. As such, I feel it is important to communicate the differences between the serious and non-serious causes of the red eye, highlighting “red flag” symptoms which should prompt urgent medical care.
What Makes the Eye Red?
Redness in the eye is due to congestion or engorgement of blood vessels of the conjunctiva and sclera. The conjunctiva is the meaty part of the eye between the lid and the white of the eye and the sclera is the white of the eye. This congestion is usually driven by inflammation. These causes of inflammation are the causes of the red eye conditions.
Cause: Blepharitis occurs due to inflammation of the eyelids. The condition occurs most commonly when glands near the eyelashes become clogged and/or infected.
Identification: Blepharitis is usually distinguished from other red eye conditions by identifying the red, scaly and often mattering of the eyelid along the eyelashes.
Treatment: It is treated by scrubbing the eyelids along the eyelashes gently with water and baby shampoo. The baby shampoo opens the clogged glands without irritating the eye. Occasionally an antibiotic is also needed.
Stye and Chalazion
Cause: Styes and Chalazions are inflammatory conditions of glands of the eyelid. A stye occurs with swelling and inflammation of the outer lid glands while chalazions occur with deeper glands within the lid.
Identification: Both conditions involve a tender, mounded bump in the lid in addition to the eye redness. These conditions are often chronic. Vision is not altered by these conditions other than due to obstruction.
Treatment: Treatment involves applying a warm compress to the bump in hopes that the gland will open up. If present for several months, an ophthalmologist will consider surgically removing the stye or chalazion. This often requires patience in tolerating a painful and unsightly bump on the eyelid for this duration.
Cause: Dacrocystitis occurs when the tear duct becomes inflamed, most often from infection.In infants, dacrocystitis is most commonly caused from a kinked tear duct caused by a wide bridge of the nose. In adults, the cause is most often a communication of chronic sinus infection.
Identification: It presents as a painful bump in the mid-lower corner of the eye. Mucus or pus drainage can often be seen emerging from the inner corner of the eye. Vision is not affected by dacrocystitis other than perhaps due to drainage. The drainage and consistent location in the mid-lower corner of the eye differentiates dacrocystitis from a stye or chalazion.
Treatment: The treatment is most often antibiotic. Occasionally, surgery is required to straighten or re-open the tear duct.
Cause: Orbital cellulitis is caused by an infection of the tissue around the eye.
Identification: It is most common in children and rare in adults. The red eye symptoms are often overshadowed by the dramatic swelling and redness of the skin and tissue around the eye. Fever may also be present.
Treatment: Because of the potential for orbital cellulitis to spread into the eye socket and cause damage to the eye, emergent medical attention is recommended.
Cause: Keratitis is an inflammatory condition of the cornea (the transparent layer covering the lens of the eye). Various causes exist for keratitis, the most common being infection, injury and overuse of contact lenses (like falling asleep with them in).
Identification: Symptoms of keratitis beyond eye redness include blurred vision, sensitivity to light, grittiness in the eye and pain.
Treatment: See your doctor. If not treated correctly and in a reasonable time, scaring can occur, permanently affecting vision.
Cause: Anterior Uveitis is caused by an inflammatory condition in the iris and muscles that make up the colored part of the eye. Infection (namely herpes types) and immune conditions where the body’s immune system attacks the body (rheumatoid arthritis, sarcoidosis for example) are the main causes of anterior uveitis.
Identification: Symptoms pain in the eyeball, light sensitivity and blurred vision. An irregular pupil may be noted.
Treatment: See your doctor. If not treated correctly and in a reasonable time, permanent damage can occur affecting vision.
Cause: Acute glaucoma is an emergency condition associated with a sudden increase in pressure within the eye. It is most often caused by a blockage of the blockage of outflow of fluid that circulates through the eye.
Identification: Symptoms include severe pain in the eyeball, light sensitivity and blurry vision.
Treatment: See your doctor. If not treated properly and in reasonable time, vision loss can be permanent.
Pingueculum and Pterygium
Pronounce: (“ping-weck-you-lum”) and (“ter-rej-ee-um”)
Identification: These conditions involve growths that are seemingly stuck on the white part of the eye (sclera). They can contain blood vessels, but may simply exist as white tissue.
Treatment: They often raise alarm due to their location and appearance but in are generally considered harmless unless they grow toward the middle of the eye over the pupil to obstruct vision. If this occurs, they can be surgically removed.
Cause: Causes include trauma (minor), sneezing, coughing and straining. Sometimes these are noted in newborn babies, occurring as they pass through the birth canal.
Identification: Subconjunctival hemorrhage can also be a scary condition based on its drastic appearance. The condition occurs when a blood vessel on the white of the eye (sclera) ruptures causing bleeding under the clear overlying skin on the eyeball. It is quite drastic against the stark white of the eye.
Treatment: No treatment is necessary for subconjunctival hemorrhage and the blood collection resolves on its own after several days.
Conjunctivitis is the most common cause of a red eye. Three types of conjunctivitis exist and each is treated differently: bacterial, viral and allergic. See my previous blog on conjunctivitis for more information on identification and treatment. In general, conjunctivitis does not cause any permanent damage to the eye or vision.
Red Eye Red Flags
To sum it up, there are many causes of the red eye. Some are serious and scary! Some basic triage, however, can readily group the emergent from the non-emergent. If a red eye exists, heed the hallmark “red flag” symptoms to determine the urgency in seeking medical care:
- Eyeball pain
- Light sensitivity
- Gritty (sand-like) sensation in the eye
- Change in vision (other than due to a bump or discharge)
If urgent medical attention is needed, a slit lamp exam is often required to determine if any of the serious conditions are present. The slit lamp is a magnified, lit eye examining tool. Emergency physicians and ophthalmologic professionals are well versed in slit lamp exam. If you go to an urgent care, inquire as to whether there is a slit lamp and if the healthcare provider working is proficient on this devise.