Redness of the eyes

Redness of the eyes is usually accompanied by pain.

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Causes of Red Eyes

The causes of red eyes are varied, some of them threaten vision, and therefore the patient needs to be examined by a specialist (to exclude acute glaucoma, acute iritis, corneal ulceration). Other causes of red eyes (episcleritis, conjunctivitis, spontaneous conjunctival hemorrhage) are easier to eliminate. Carefully examine the reddened eyes and assess visual acuity, the condition of the cornea (use fluorescein eye drops), check the pupillary reflexes.

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Acute angle-closure glaucoma

This is a disease of middle-aged or elderly people. An acute attack of glaucoma in one eye is usually preceded by redness of the eyes, decreased visual acuity, or the appearance of a halo around luminous objects, especially at night. This is due to a blockage of drainage of the aqueous medium from the anterior chamber of the eye through the Schlemm's canal. Dilation of the pupils at night aggravates this drainage block. Intraocular pressure increases to 60-70 mm Hg, while the norm is 15-20 mm Hg. The patient experiences pain of varying degrees (it can be very severe, with accompanying nausea and vomiting), vision deteriorates, the cornea becomes somewhat cloudy due to its edema, the eye turns red mainly around the cornea, the pupil is fixed, dilated, and acquires an oval shape. Due to the increase in intraocular pressure, the eyeball becomes hard to the touch. In the other eye, the anterior chamber may be "shallow", which is considered a predisposing factor (illuminate the eye with a light source from the side, while half of the iris is in shadow). If you suspect this disease, the patient should be referred to the ophthalmologist.

Acute iritis (anterior uveitis)

The disease is characterized by an acute onset - pain in the eyes, photophobia, blurred vision (due to the presence of precipitates in the aqueous environment of the eye), lacrimation, redness around the cornea (ciliary congestion), the pupil is reduced (at first this is due to spasm of the iris, and later - uneven pupil dilation or its irregular shape due to the formation of adhesions). Talbot's test is positive (the pain intensifies with convergence of the eyes, and the pupils contract when the patient looks at the tip of his finger approaching the nose). With the help of a slit lamp, white precipitates on the back surface of the cornea and the presence of pus in the anterior chamber of the eye (hypopyon) can be seen. Young or middle-aged people are more often affected. The causes of the disease are varied: anterior uveitis occurs with joint lesions such as ankylosing spondylitis or Still's disease, with nonspecific ulcerative colitis, sarcoidosis, Behcet's disease and Stevens-Johnson syndrome. The disease may recur.

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More about red eye - cornea and conjunctiva

Redness of the eye associated with corneal disease

Keratitis is an inflammation of the cornea (it is recognized by the appearance of white dots, which indicates the accumulation of leukocytes in the cornea).

Corneal ulceration is a disruption of the epithelial lining of the cornea, and can occur in the absence of keratitis (e.g., as a result of trauma); in such cases, antibiotic ointment (e.g., 1% chloramphenicol ointment) is used prophylactically. Corneal ulceration associated with keratitis is called ulcerative keratitis and should be treated urgently. The disease is characterized by pain, photophobia, and sometimes blurred vision. It can occur as a result of contact lens use, trauma, and previous corneal diseases.

Ulcerative keratitis: Fluorescein should be used to confirm the diagnosis. The affected areas of the cornea are stained green (the drops themselves are orange). Ulcers can have various origins: bacterial (be especially vigilant with Pseudomonas, since the lesion progresses quickly), viral (Herpes simplex, Herpes zoster),fungal (fungi of the genus Candida, Aspergillus), protozoal (Acanthamoeba) or may appear as a result of vasculitis, for example, in rheumatoid arthritis.

In such cases, you should go to the hospital on the same day, since the treatment depends on the etiology of the ulcerative keratitis, and delay in treatment can cause vision loss. Any patient with corneal ulceration or stromal suppuration needs urgent diagnostics, for which diagnostic smears (for Gram staining) or scrapings are made (the procedure should be performed by an experienced specialist). It is also necessary to contact a microbiologist to obtain the results of a microbiological study.

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Conjunctivitis

Conjunctivitis is usually bilateral, but if the process is unilateral, consider other diagnoses, such as acute glaucoma. The conjunctiva is reddened. Visual acuity, pupillary response to light and corneal shine are not affected. The eyes itch, burn, and water. Sometimes photophobia appears. Purulent discharge from the eyes glues the eyelids together. The disease may have a viral etiology (adenovirus is extremely contagious), with tiny lymphoid clusters appearing as follicles on the conjunctiva; bacterial (in which case purulent discharge from the eyes is especially pronounced) or allergic in nature. This lesion is usually self-limiting (however, allergic reactions may be longer). In cases of prolonged conjunctivitis, especially in young people or in patients with sexually transmitted diseases, the possibility of chlamydial infection should be considered.

Read also: What is conjunctivitis and how to deal with it?

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Episcleritis

Inflammation under the conjunctiva, in the episclera, is often accompanied by the formation of inflammatory nodules, and redness of the eyes is observed. The patient experiences a dull pain in the eye, soreness when touched, especially in the area of inflammation. Steroid eye drops are effective [for example, clobetasone butyrate 0.1% solution every 6 hours].

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Scleritis

Sometimes the inflammation spreads to the sclera. This is a more generalized inflammation with conjunctival edema and thinning of the sclera (in severe cases, there is a risk of perforation of the eyeball). Scleritis can be combined with systemic damage to connective tissue (collagenoses). In such cases, you should contact specialists.

Subconjunctival hemorrhage

This harmless, though alarming, collection of blood under the conjunctiva that has leaked from a small blood vessel usually does not require treatment. Such a hematoma resolves on its own. If it recurs frequently, rule out hemorrhagic diathesis in the patient, check blood pressure.

Diagnosis of dangerous redness of the eye

Answer the following questions.

1. Is visual acuity impaired? This can be assessed fairly quickly and accurately by checking the patient's ability to read newspaper text. Refractive errors are corrected with glasses or a stenopenic aperture. A decrease in visual acuity may indicate a dangerous pathology.
2. Is the eyeball painful? The presence of pain is always an unfavorable symptom. There may also be a foreign body in the eye. Simple irritation rarely causes pain in the eyeball.
3. Does the pupil react to light? The absence of this reaction or its sharp slowing down are unfavorable signs.
4. Is the cornea affected or not? For this, fluorescein eye drops should be used. Corneal damage may be due to trauma or ulceration.

Ask the patient about the injury, eye discharge, health status, and medications he or she is taking; be sure to measure blood pressure.

If you have any doubts, consult a specialist immediately.

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Treatment of red eyes

Treatment of red eyes due to conjunctivitis

Antibiotics are usually used, such as chloramphenicol in the form of 0.5% drops, which are instilled into the eyes every 3 hours, and 1% ointment is used at night. For chlamydial infection, the patient is prescribed tetracycline 250 mg every 6 hours orally, and also in the form of 1% ointment, which is placed behind the eyelids every 6 hours for at least 1 month. For allergic conditions, sodium cromoglycate should be used in the form of 2% eye drops, which are instilled every 6 hours.

Treatment of eye redness due to keratitis

In Herpes zoster infection, acyclovir is indicated. In relation to branching ulcers in Herpes simplex infection. Cycloplegic drugs will help reduce the pain associated with ciliary spasm and prevent the development of adhesions with the iris.

Treatment of eye redness in closed-angle glaucoma

Pilocarpine - 4% solution is instilled into the eyes every hour (in case of miosis, the blocked drainage angle is opened); orally acetazolamide, 500 mg immediately (and intramuscularly in case of vomiting), and then 250 mg every 8 hours. Acetazolamide reduces the formation of water in the anterior chamber of the eye. After reducing the intraocular pressure with medication, peripheral iridectomy is performed (sometimes it is performed as an emergency intervention if it is not possible to reduce the intraocular pressure with medication). In this operation, a small piece of the iris is removed at the "12 o'clock" area in both eyes, which helps restore normal fluid circulation.

Treatment of eye redness in acute iritis

The goals of treatment are to prevent damage to the eye due to a long-term inflammatory process. In the latter case, there is a possibility of disruption of the flow of fluid into the eye, which may be due to the development of glaucoma, as well as the presence of adhesions formed between the iris and the lens. Treatment of eye redness is carried out with glucocorticoid hormones: for example, a 0.5% solution of prednisolone is instilled into the eye every 2 hours, which leads to a decrease in inflammatory changes (pain, redness, exudate formation). To prevent the appearance of adhesions (synechiae) between the lens and the iris, the pupil is kept dilated using a 0.5% solution of cyclopentolate (Cyclopentolate) 1-2 drops per hour until the signs of iritis decrease. The degree of inflammatory changes is assessed during regular examination of the eye with a slit lamp.