Red Eyes – Know the causes, precautions and alert signs

As the rains come down, we see the ‘red eye’ or ‘pink eye’ starting its rounds. At some-time, your friends, family members or you yourself may have suffered from conjunctivitis.

What is conjunctivitis?           

Conjunctivitis (‘itis’ means inflammation, here of the Conjunctiva – a thin transparent covering which covers the white portion of the eye: the sclera) is one of the common causes of red-eye.  Inflammation occurs due to an irritant source (like an infection, allergy, other irritating substances), and the redness occurs as the blood vessels enlarge (dilate) to increase blood supply to tackle the source of irritation.

Any inflammation in the body is accompanied by redness, swelling, warmth and pain/irritation, so similarly conjunctivitis typically presents with symptoms below:

Is conjunctivitis always contagious? Know the types of Conjunctivitis 

Infectious Conjunctivitis

Conjunctivitis caused by an infection (bacteria, or virus), is contagious (spreads by contact but does not spread by looking at the infected person’s eye!). However, there are non-infectious causes of conjunctivitis too which are not contagious.

Bacterial or Viral conjunctivitis typically spread from contaminated water and surfaces, so are common in the rainy season. Infective conjunctivitis generally lasts for a week or two.  It is sometimes a challenge to differentiate bacterial from viral conjunctivitis. Some clues include –

• Bacterial conjunctivitis can also be a result of ear and sinus infections, while viral conjunctivitis can start with or follow a common cold or sore throat (pharyngitis).
• Bacterial conjunctivitis can involve one or both eyes, while the viral one typically starts in one eye and then goes on to the other.
• The discharge is thick, sticky and yellowish in bacterial infections (lids crusting and sticking together especially in the mornings), while it is more clear, watery and teary, in the viral type.

Bacterial conjunctivitis is treated with antibiotic drops or ointment, whereas, viral conjunctivitis does not respond to antibiotics, but runs its course just like the common cold and resolves spontaneously. Supportive care like cold compresses and eye drops to bring symptomatic relief from the dry gritty feeling, and irritation, are often prescribed in viral conjunctivitis.

Sometimes, when the diagnosis of whether the conjunctivitis is bacterial or viral is in doubt.  In certain cases even though it is viral conjunctivitis, there is a risk of over added (secondary) bacterial infection developing (like in cases of a common cold with sinus or ear infections, low immunity, contact lens wear, etc). So in these people, antibiotic drops may be anyway prescribed.

Eyecare tips during bacterial/viral conjunctivitis for sufferers and caregivers:

Non-infectious conjunctivitis

These are not contagious. Allergy is the most common cause of non-infectious conjunctivitis. The clues which tell you it is allergic and not infective conjunctivitis are both eye involvement simultaneously, and high component and prominence of itching. Sticky discharge is usually absent.  There are signs of allergy (accompanying sneezing- hay fever/nasal allergies, sometimes the history of asthma, seasonality with pollen, or repeated attacks with known/unknown triggers) and absence of other infections of ear, throat, sinus infections alongside. Allergic conjunctivitis is treated with anti-allergic medicines orally or as eye drops.

Contact lens wearers may develop irritation or allergy to their lenses which causes conjunctivitis, requiring temporary discontinuation of lenses.

Conjunctivitis can also come on due to irritants like smoke, pollution, chemicals, sprays, cosmetics or some something (foreign body) entering the eye. The conjunctivitis is transient and settles down with eye washing and avoiding/removing the irritant.

Other causes of red-eye…..

Dry eyes can also cause the eyes to appear a dull red (sometimes seen after prolonged computer use which decreases blinking rate and tear circulation, in elderly, in drying environment, AC blast and other causes). Dry eyes can sometimes be difficult to differentiate from allergic conjunctivitis. There is a characteristic allergy history and prominence of itching in allergic conjunctivitis, while dry eyes feel more tired and have a ‘sandy’ sensation with worsening of symptoms after prolonged screen work/reading. Sometimes tear film tests may be carried out to confirm dry eyes.

Sometimes there may be a deep red prominent patch in one part or side of the eye with relatively much less redness in the rest of the eye. This is due to bleeding from rupture of one of the blood vessels (conjunctival blood vessels are thin and fragile and can rupture after a fingernail or other injury, a bout of strenuous cough or even straining at stool. Often no reason can be found). This is called subconjunctival hemorrhage and usually resolves on its own. Though it looks prominent it does not cause any symptoms.

Lid infections, called blepharitis (often associated with dandruff) along the lash line or stye (a focal swelling and collection of pus) can also make eyes appear mild or dull red (far less than the redness seen in conjunctivitis).

Eyes can also appear red due to lack of sleep, too much smoking, intake of alcohol or certain medicines.

Apart from surface causes of red eye (as seen above related to tears, lid and conjunctiva), red eyes could also represent a manifestation of diseases of other parts of the eye which may be more serious or concerning (like corneal abrasions/ulcer or keratitis, scleritis, uveitis, glaucoma, cellulitis or tension headaches/migraine).

The following alert signs are useful to suspect the same which require immediate consultation and referral to an eye specialist for detailed eye examination and investigation-

Also read-

Swollen Eyelid – Know the causes, remedies and alert signs

Glaucoma: What you need to know

For any query, additional information or to discuss any case, write to info@drvarsha.com, and be assured of a response soon.

References:

AAO Conjunctivitis-pink eye

NIH National Eye Institute- Dry eye