Red eye syndrome

Red eye syndrome is a microcirculatory disorder caused by superficial enlargement of the scleral vasculature and is the most common symptom in ophthalmology.

There are many causes that cause the appearance of a red eye. This symptom accompanies various physiological conditions, or is a sign of pathological general and ophthalmic diseases. Reddened eyes caused by physiological causes do not require consultation of medical specialists. Redness, the cause of which is a pathological process, needs urgent treatment for medical help.

Normally, through the transparent conjunctiva of the visual organ, a white sclera is visible. Redness appears due to the enlargement and increase of the blood filling of the vessels feeding the eye, due to irritation or various diseases. The intensity of the vascular pattern is not related to the severity of the disease. If there is redness of the eyes, then the following factors should be alarmed: pain in the eye area, violation of visual acuity.

[1], [2], [3], [4], [5]

Causes of the red eye syndrome

The appearance of red eye syndrome can provoke the following factors:

• physiological character;
• environment;
• pathological processes occurring in the visual organ;
• diseases that have no connection with ophthalmologic pathology.

Physiological causes. The main distinguishing feature is the absence of the process of inflammation. Redness occurs without complications and negative consequences when removing physiological effects. Redness can occur with excessive physical exertion, sneezing, prolonged coughing, prolonged crying, lack of sleep, routine hard work, drinking alcohol, eye irritation with incorrectly corrected lenses or incorrectly selected glasses.

Environmental factors. They have a physical or chemical nature. Irritation when exposed to bright sunlight, strong winds carrying dust particles or sand, long-term exposure to severe frost, dim illumination, changing weather conditions, foreign bodies (sand, wool, dust) entering the eyes.

The red eye syndrome causes trauma to the visual organ with a blunt object or an irritating chemical. The chemical factors include - irritation of the eyes with cigarette smoke or smog, water, various aerosol substances, cleaning and detergents.

Pathology of the eye. Pathological processes occurring in the organ of vision are divided into infectious and aseptic.

To infectious include:

• conjunctivitis (bacterial, viral, mycotic, chlamydial, sensitive genesis),
• dacryoadenitis,
• dacryocystitis,
• blepharoconjunctivitis,
• keratitis,
• uveitis,
• panophthalmites,
• episclerites,
• iridocyclitis and others.

Aseptic processes accompanying red eye syndrome:

• keratopathy,
• keratotonus,
• thinning and ulceration of the corneal layer,
• hemorrhagic lesions of the eye tissues,
• tumors in the lacrimal gland,
• syndrome of the sluggish century,
• trichiasis,
• detachment of the mucous membranes of the eyes, glaucoma, etc.

In the presence of pathological eye processes of infectious or non-infectious origin, reddening of varying intensity and localization is observed, depending on the causes of their causes. Any ophthalmologic disease in addition to the red eyes is accompanied by a specific symptomatology. The red eye syndrome signals both non-dangerous diseases, and those that lead to a complete loss of vision.

Pathologies that are not related to ophthalmic diseases. Since the visual organs have a close connection with all body systems, some pathological processes provoke red eye syndrome. Red-eye syndrome, associated with acute or chronic diseases of other organs and systems, is present for a very long time and is not a consequence of inflammatory processes in the structures of the eye. Most often, red eye syndrome causes diseases that affect vascular tone, the use of anticoagulants direct and indirect effects and disorders of the blood coagulation system.

Diseases that often cause redness of the eyes:

• Hypertensive disease.
• Allergic conditions (allergic rhinitis, pollinosis, bronchial asthma), chronic diseases that occur with violation of outflow of blood from the eye's orbit, diabetes mellitus, arthritis, systemic vasculitis, dry mucous membranes, Béné-Beck-Schauman disease, Wegener's granulomatosis, long-term poisoning of the body smoking, alcoholism, toxicosis during gestation).
• An overdose of anticoagulants (hemophilia, thrombocytopenic purpura) along with redness causes injection of a sclera (small or spotted hemorrhages on the sclera).

[6], [7], [8], [9]

Risk factors

The risk factors provoking the occurrence of red eye syndrome include:

• climatic adverse conditions (bright sun, sharp wind, severe frosts);
• presence of autoimmune diseases;
• chemical irritation (water in the pool, spraying of aerosols);
• allergic conditions;
• continuous continuous eye strain (working at a computer, watching TV, working in poor lighting);
• mechanical injuries (scratches, foreign bodies, blows with blunt objects);
• the presence of disturbances in the endocrine system (diabetes mellitus, thyrotoxicosis);
• violation of the rules of wearing glasses and contact lenses;
• hypertension;
• age xerophthalmia (dryness of the eye membrane);
• chronic fatigue;
• excessive physical exertion;
• the use of substandard cosmetics (mascara, shadows, eyeliner);
• contact infection with dirty hands;
• presence of infectious diseases.

[10], [11], [12], [13]

Pathogenesis

Sclera, the mucous membrane of the eye and the eye of the eye are abundantly supplied with blood by means of a branched network of blood vessels. Redness of the eye is a consequence of the dilatation of the vascular wall, its thinning and filling with a large volume of blood than usual. The vascular pattern emerges on the white surface of the sclera, and becomes clearly visible.

When the integrity of the vascular wall is broken, a small hemorrhage occurs. The change in the balance of blood flow and the tension of the vascular wall is provoked by a violation of the outflow of blood from the visual organ. Causes that cause dyscirculation can be stagnant, inflammatory or allergic processes. Redness can cover the entire surface of the sclera or be localized in separate areas.

Reddening of the eyes can take place without outside interference or require urgent help of specialists. Consultation of an ophthalmologist is necessary if the process is long, painful and accompanied by purulent or serous discharge.

[14], [15], [16], [17], [18]

Symptoms of the red eye syndrome

Red eye syndrome does not arise as an independent manifestation of the disease. Usually there is a combination of several symptoms with reddening of the eyes. Complaints of patients depend on the underlying cause that caused the disease. Below are the symptoms of some diseases that occur with reddening of the eyes.

Red, inflamed eyes - conjunctival diseases

Allergic conjunctivitis - severe itching of the eyes, redness and swelling of the conjunctiva, as well as lachrymation accompanied by rhinitis, sneezing or irritation in the nose.

Infectious (bacterial) conjunctivitis - there are purulent discharge, edema of the conjunctiva, and sometimes only a century, yellow-gray spots on the conjunctiva.

Viral - swelling of the conjunctiva, itching and feeling of a foreign body, a vascular pattern in the eye is expressed.

Chemical conjunctivitis - appears when exposed to potential chemical stimuli (dust, smoke, aerosols, chlorine, phosgene).

Hyposfagma (bleeding from conjunctival capillaries) - proceeds asymptomatically, localized small hemorrhage subconjunctivally.

The dry eye syndrome is a sensation of "sand in the eyes", the image becomes blurred and foggy, the heaviness of the eyelids is noted. The disease affects people who spend a lot of time in front of a computer monitor, TV, in rooms with air conditioning with insufficient production of tear fluid.

Tumors of the conjunctiva - manifested by an itch slightly elevated above the surface of the formation, red eyes, blurred vision, burning sensation.

Red, inflamed eyes - corneal disease

Viral keratitis - a cornea with an uneven surface, red eyes, severe pain in the eyes accompanied by burning and tingling, severe swelling of the conjunctiva, lacrimation, photophobia, sensation of foreign matter in the eye.

Epidemic (adenovirus keratoconjunctivitis) - redness of the eyes, lacrimation, photophobia, swelling of the lymph nodes in front of the ears and annular edema of the conjunctiva.

Keratitis. Due to the prolonged use of contact lenses, dacryorea, red eye and corneal edema appear. It leads to thinning and ulceration of the cornea.

Corneal ulcer. There is a crater-like ulcer defect with opacity of the cornea. This can occur in people who do not remove contact lenses for the night, with the infection of the cornea by various pathogens.

Ophthalmic lichen (eye zoster) - a rash in the direction of the first branch of the trigeminal nerve, edema of the eyelids, redness of the eyes, severe pain, rarely bilateral.

Red, inflamed eyes - sclera diseases

Episleritis is more often one-sided, localized redness, slight irritation and lacrimation.

Scleritis is a disease of the organ of vision, which is accompanied by severe pain, photophobia and lacrimation. It can appear as reddish or bluish spots under the bulbar conjunctiva. The sclera is swollen, the compression of the eyeball is painful. Happens more often autoimmune origin.

Acute attack of glaucoma - there is severe pain in the eyes, cephalgia, nausea, colored "halos" around the light sources (halo), corneal opacity (with swelling), visual acuity reduction.

Anterior uveitis is a pain in the eyes, photophobia, ciliated outbreaks, a vascular pattern is expressed (reddening of the conjunctiva, mainly on the cornea). Often associated with autoimmune diseases, dull eye trauma. Perhaps worsening of the sharpness and clarity of vision or the presence of exudate in the anterior chamber of the eye (suppuration).

Stages

There are three stages of red eye syndrome:

Superficial - the greatest redness is noticeable in the peripheral region of the conjunctival sac. This type of hyperemia is manifested by the widening of the blood vessels in the conjunctiva, which indicates an inflammatory process developing on the surface of the eyeball. Here you need a specialist consultation, but not urgent (you can visit an ophthalmologist within 1-2 days).

Deep (ciliary) - around the limb stands a bright red border. This indicates inflammation inside the eye. There is such a situation with diseases of the cornea, iris, ciliary body. This condition requires urgent consultation.

Mixed - is present as a hyperemia of the vessels of the conjunctiva, and the vessels of the sclera around the limbus. This condition requires urgent professional advice.

It is worth considering which of the symptoms is dominant.

[19], [20]

Forms

Depending on the cause that caused the "red eye" syndrome and the localization of the process, the following types are distinguished:

1. Infectious (caused by viral, bacterial, fungal or chlamydial pathogens).

With the accompanying red eye syndrome, a burning sensation in the eyes, a sensation of sand under the eyelids, photophobia, it is very likely that the cause of the problems is conjunctivitis caused by various pathogens. It is necessary to take additional hygienic measures and inflammation to cease. When the purulent deposit begins to appear on the eyelids, it means that there is a bacterial infection and medical consultation is necessary.

2. Allergic.

Symptomatology is very similar to the above conjunctivitis, but with a predominance of burning and itching, eyelid edema, lacrimation, and concomitant allergic symptoms. The main difference between conjunctivitis (regardless of etiology) - sharpness and clarity of vision remains unchanged and there is no sharp pain.

3. Caused by ophthalmologic pathologies.

Acute attack of curled glaucoma. In case of sudden appearance of red eye syndrome accompanied by acute pain, foggy vision, nausea and vomiting, an attack of closed-angle glaucoma is more likely to be diagnosed. This is a condition in which there is a sharp increase in eye pressure, which can cause complete loss of vision. Thus, this condition requires immediate consultation of an ophthalmologist.

The presence of autoimmune conditions, chronic or diseases in the acute stage, disorders associated with coagulability of the blood system, etc., will also cause red eye syndrome. But the symptomatology of the underlying disease will prevail.

[21], [22], [23], [24], [25], [26]

Complications and consequences

The consequences and complications depend on the underlying disease that caused the red eye syndrome. In various cases, the prognosis will depend on the timeliness and effectiveness of the treatment started. Ignore the reddening of the eyes, lasting, more than, two days is not worth it. It is necessary to visit an ophthalmologist. If additional symptoms have joined the red eye syndrome (pain in the eye area, any pathological detachment, vision deteriorated, a burning sensation and a foreign body appeared in the eye). Do not need medical help only in case of physiological manifestation of red eye syndrome. It is enough to eliminate the cause and the vessels will gradually come to normal, without provoking any complications.

If the eyes are affected by chemicals, the prognosis depends on the nature of the damaging reagent and the duration of contact with the eye structures.

With conjunctivitis, the prognosis is favorable. Timely treatment started lasts from 5-7 days (viral conjunctivitis) to 1-2 weeks (bacterial). Conjunctivitis of allergic genesis disappears when the allergen is eliminated. But more serious consequences are possible (keratitis, threatening loss of vision), therefore, it is not worth neglecting the treatment of conjunctivitis.

Hyposphagmus. The forecast is favorable. In addition to cosmetic defects of other discomfort, the patient does not experience. Hemorrhages alone disappear by the end of the second week.

Dry eye syndrome. If you adjust the mode of work and rest at the computer in time or start using special drops, then complications do not arise. The started process is dangerous by scarring, amblyopia, development of conjunctivitis.

Keratitis is an unfavorable prognosis. Without proper treatment, it leads to a significant deterioration or complete loss of vision.

Episcleritis. The forecast is favorable. In 60% of cases self-healing occurs, but the consultation of the ophthalmologist does not hurt.

Scrolls. The prognosis depends on the reasons and tactics of therapy. Complications: keratitis, iridocyclitis, scar deformity of the eyeball, secondary glaucoma, endo- and panophthalmitis, opacity of the vitreous of the eye, detachment of the retina.

[27], [28], [29], [30], [31]

Diagnostics of the red eye syndrome

A detailed history and detailed ophthalmologic examination allow you to establish an accurate diagnosis.

After collecting an anamnesis, the doctor examines the eye. Inspection includes:

• assessment of visual acuity of the left and right eye separately,
• the study of eye movements in various directions,
• examination of the eye with a slit lamp, with special attention being paid to eyelids, conjunctiva, corneal changes (surface smoothness, transparency, pathological discharge), pupil shapes and their response to light,
• study of intraocular pressure,
• examination of the fundus.

To determine the causative agent of the pathology of the visual organ (conjunctivitis, ulceration of the cornea, keratitis) bacteriological analysis is used, including culture culture and its study. With combined glaucoma, tonometry and gonioscopy are shown. Scleritis is diagnosed with the help of specialized ophthalmic equipment.

Instrumental diagnostics

Most often, ophthalmologists use a slit lamp, with the help of which the doctor will be able to assess the structure of the eye, conjunctiva and the condition of the cornea. To diagnose dry eye syndrome, special tests should be performed.

The trial of Schirmer. It is based on checking the number of tears with the help of strips of special paper, which are laid in the lower part of the conjunctiva. It takes five minutes. An estimate is given of the degree of moistening of the strips. The length of the strip moistened with tears is measured. Before starting the procedure, use an anesthetic to prevent lacrimation due to irritation of the conjunctiva with paper.

Biomicroscopy of the eye. The study of the structures of the visual organ by non-contact methods of investigation with increasing. Diagnosis is carried out with the help of a special apparatus (an ophthalmic microscope) and a slit lamp.

Gonioscopy. Visual method, allowing to consider the structure of the anterior chamber of the eye, hidden behind the limb. To perform the procedure requires a special ophthalmic lens (gonioscope) and a slit lamp. As a result of this study, it is possible to assess the degree of openness of the anterior chamber angle, detect neoplasms, pathological fusion of the layers and structures of the organ of vision.

[32], [33], [34], [35], [36], [37]

Differential diagnosis

The most common eye diseases, in which there is redness:

• Conjunctivitis. This is the most common eye disease. It can be caused by bacteria, viruses, but also can occur with allergies.
• Keratitis. In many cases, it is caused by external factors (swimming with open eyes under water without eye protection, a prolonged stay in a bright intense sun without sunglasses).
• Inflammation of the cornea. It occurs as a result of infection, most often, herpetic.
• Dry eye syndrome. It arises due to a lack of tear fluid, which affects the proper functioning of the eye. It feeds the cornea and conjunctiva. Tears wash the surface of the eye, removing dust and small particles of foreign bodies. Possessing antiseptic properties, tears protect the eye from inflammation.
• The causes of dry eye syndrome include: environmental pollution, ozone, cigarette smoke.
• Acute attack of glaucoma. Glaucoma is a disease that has been insidiously developing for many years. Most patients do not notice this disease in the early stages of the disease. It does not cause pain or other symptoms.

[38], [39]

Treatment of the red eye syndrome

In the case of treatment of red eye syndrome, there is no general method or drug for all manifestations associated with the onset of this condition. It must be remembered that it can relate to any ophthalmic diseases, and consequently - different treatment tactics will be recommended.

With conjunctivitis, the treatment relies mainly on removing irritation. Apply a variety of eye drops, depending on the cause of inflammation of the conjunctiva.

To eliminate the symptoms of conjunctivitis of viral origin, a combination of warm compresses and drops of artificial tears (artificial tears - moisturizing drops for the eyes, for example, "Systemin", "Oksial" and other preparations of this pharmacological group) are used. A specific drug solution in the treatment of viral conjunctivitis is eye drops "Ophthalmoferon", the active ingredient of which is synthesized interferon. When there are signs of infection with bacterial etiology, drops containing antibacterial substances are used. With acute bacterial conjunctivitis, therapy is carried out using frequent ocular instillation (more than 3 times a day) with ophthalmic medicinal solutions (30% albucid, 0.25% levomycetin) and ointment forms containing antibiotics (tetracycline ointment 1%). Before the procedure of instillation, wash eyes with disinfectant broth (chamomile broth, tea black tea).

If suspicion of conjunctivitis caused by the herpes virus (ophthalmologic zoster), drugs with acyclovir are prescribed.

To eliminate the symptoms of conjunctivitis, ophthalmic drops containing corticosteroids are successfully used. In the treatment of allergic conjunctivitis, contact with the provoking agent is excluded, cool packs are applied to the eye area, drops "artificial tears" 2-4 times a day. Apply antiallergic drugs: azelastine, allergodyl; levocabastine, and also octanol, which can be used in children over 3 years of age. These funds can eliminate inflammation of the eyes, because of the short-term effects they should be used up to 4 times a day. Patients with polynomas during the flowering period should not wear contact lenses.

When glaucoma drug therapy is reduced to taking inhibitors of carbonic anhydrase, beta-blockers, pilocarpine. If the therapy is not successful, then resort to a surgical laser method of treatment.

Vitamins

With red eye syndrome, it is necessary to take vitamin and mineral complex preparations, antioxidants.

Retinol or Vitamin A. It is prescribed in a dosage of 100,000 IU daily for 1 month. Allows to strengthen the immune system.

Ascorbic acid or vitamin C. It is prescribed in a dosage of 2000-6000 mg daily.  Vitamin C has a wound-healing effect.

Zinc. The daily dose is 50 mg. Promotes the activation of the immune system.

OPC is an oligomeric proanthocyanidin, a powerful antioxidant derived from pine bark and grape seed. It is used for anti-inflammatory and anti-allergic therapy. At a one-time intake with ascorbic acid, the effectiveness of this drug increases. Recommended use of 100 mg of OPC 2 times a day.

Physiotherapeutic treatment

The main purpose of physiotherapy is to provide antiflogistic, bacteriostatic and anesthetic effects. In complex etiopathogenetic treatment of common diseases that provoked red eye syndrome, high-frequency therapy (UHF or microwave fields), diodinomotherapy and ultrasound that eliminate conjunctival hyperemia are used.

At the end of the anti-phlogistic therapy course, electrophoresis with antibiotics may be prescribed depending on the sensitivity of the bacterial flora to them.

In the presence of an inflammatory process that lasts a long time, electrophoresis after 1-1.5 months shows electrophoresis with vitamins C and B to stimulate the metabolism of tissues, tighten the walls of capillaries, improve the reactivity of tissues, and remove pain.

To increase the therapeutic effect, it is recommended to use electrophoresis with drugs and UHF therapy.

Alternative treatment

Quickly and easily remove eye strain, normalize the circulation of blood through the eye capillaries, eliminate swelling and redness of the eyelids can be, using alternative means:

• cool compresses with pure water or herbal infusions of chamomile or oak bark;
• ice cubes;
• slices of raw potatoes;
• lotions with black tea.

It must be remembered that the use of alternative drugs is recommended, in the event that there are no symptoms of serious ophthalmologic pathology.

With red eye syndrome, gymnastics for the eyes are allowed. The approximate complex of the exercise is as follows:

• Exercise # 1

If you take a long and close look at the monitor, every hour after hard work you need to perform the following - "outline" the shapes of various objects on the table and wall.

• Exercise 2

With hard work the eye muscle requires relaxation: for this it is necessary to go to the window and look into the distance and after a few seconds to look at any point near. This exercise will stimulate our eyes to develop a tear fluid that moisturizes the eyes, so that they will not be dry and red.

[40], [41], [42]

Herbal Treatment

With red eye syndrome, herbalists recommend the following recipes.

Compresses with wild cherry (bird cherry) - an alternative remedy for purulent ophthalmic diseases.

Prepare the infusion of flowers of wild cherries as follows: 60 g pour 2 cups of boiling water, insist in a warm place for 8 hours, then filter and use as compresses on the eyes several times a day.

Infusion of herbs and fennel seeds for the treatment of red eye syndrome: 1 tablespoon of ground raw material pour 200 ml of boiling water after 1 hour, drain. Use compresses at night.

Drops for eyes with cumin. One teaspoon of seeds of cumin pour 1 tbsp. Boiling water. Insist, cool, then strain and use as a lotion.

Homeopathy

Homeopaths advise using red eye syndrome to use such drugs:

Arnica. It is used for conjunctivitis caused by trauma.

Aconitum (Aconitum) - with diseases of the visual organ, which occurred as a result of mechanical damage, with catarrh of the eyes, due to ARVI.

Hepar sulfur (Gepar sulfur) will be useful for reddened, inflamed eyes, centuries, abundant purulent discharge.

Operative treatment

With certain diseases accompanied by red eye syndrome, surgical treatment is prescribed.

In keratitis, in severe cases of disease and improper treatment, the formation of scarring is possible, which leads to a deterioration of vision. In this case, you may need a corneal transplant.

In glaucoma, iridotomy is indicated, a treatment whose purpose is to create a connection between the anterior and posterior chambers of the eye, which leads to a decrease in intraocular pressure.

Prevention

You need to take care of your eyes throughout your life, from an early age. Basic rules of eye care:

• While working at the computer and when watching TV, you should take care of the lighting (light is preferred behind the screen).
• the correct distance of the eyes from the computer monitor is 40-50 cm.
• Use a protective filter that absorbs some of the electromagnetic waves that are harmful to the human eye.
• Do not rub your eyes with your hands.

In the case of infectious diseases, several basic rules should also be observed:

• When touching the eye area, wash hands thoroughly.
• Do not use a common towel (it is better to use paper napkins) or bedding.
• do not use shared utensils and hygiene products.
• during an infectious disease, do not wear contact lenses.
• It is not recommended to use eye drops and ointments with the same names.

[43], [44], [45], [46], [47]

Forecast

The prognosis in most cases is favorable, but depends on the underlying disease causing the red eye syndrome.

[48], [49], [50]