Red eye syndrome

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

There are many reasons for the appearance of red eyes. This symptom accompanies various physiological conditions, or is a sign of pathological general and ophthalmological diseases. Reddened eyes caused by physiological reasons do not require consultation with medical specialists. Redness caused by a pathological process requires immediate medical attention.

Normally, the white sclera is visible through the transparent conjunctiva of the visual organ. Redness appears due to the expansion and increase in blood filling of the vessels that feed the eye, due to irritation or various diseases. The intensity of the vascular pattern is not associated with the severity of the disease. If redness of the eyes appears, the following factors should alert you: pain in the eye area, impaired visual acuity.

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Causes red-eye syndrome

The appearance of red eye syndrome can be provoked by the following factors:

• physiological nature;
• environment;
• pathological processes occurring in the visual organ;
• diseases that are not related to ophthalmological pathology.

Physiological causes. The main distinguishing feature is the absence of an inflammatory process. Redness passes without complications and negative consequences when physiological effects are removed. Redness can appear with excessive physical exertion, sneezing, prolonged coughing, prolonged crying, lack of sleep, routine stressful work, alcohol consumption, eye irritation from improperly adjusted lenses or incorrectly selected glasses.

Environmental factors. They have a physical or chemical nature. Irritation from exposure to bright sunlight, strong wind carrying dust particles or sand, prolonged exposure to extreme cold, dim lighting, changes in weather conditions, foreign bodies (sand, wool, dust) getting into the eyes.

Red eye syndrome is caused by trauma to the visual organ with a blunt object or an irritating chemical substance. Chemical factors include eye irritation from cigarette smoke or smog, water, various aerosol substances, cleaning and washing agents.

Eye pathologies. Pathological processes occurring in the visual organ are divided into infectious and aseptic.

Infectious diseases include:

• conjunctivitis (bacterial, viral, mycotic, chlamydial, sensitive genesis),
• dacryoadenitis,
• dacryocystitis,
• blepharoconjunctivitis,
• keratitis,
• uveitis,
• panophthalmitis,
• episcleritis,
• iridocyclitis, etc.

Aseptic processes accompanying red eye syndrome:

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

In the presence of pathological processes of the eyes of infectious or non-infectious origin, redness of varying intensity and localization is observed, depending on the causes that caused them. Any ophthalmological disease in addition to red eyes is accompanied by specific symptoms. Red eye syndrome signals both harmless diseases and those that lead to complete loss of vision.

Pathologies not related to ophthalmological diseases. Since the visual organs are closely connected 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 eye structures. Most often, red eye syndrome is caused by diseases affecting vascular tone, the use of direct and indirect anticoagulants, and disorders of the blood coagulation system.

Diseases that often cause red eyes:

• Hypertension.
• Allergic conditions (allergic rhinitis, hay fever, bronchial asthma), chronic diseases that occur with impaired blood outflow from the eye socket, diabetes mellitus, arthritis, systemic vasculitis, dry mucous membranes, Besnier-Beck-Schaumann disease, Wegener's granulomatosis, long-term poisoning of the body (smoking, alcoholism, toxicosis during gestation).
• Overdose of anticoagulants (hemophilia, thrombocytopenic purpura), along with redness, cause scleral injections (small or pinpoint hemorrhages on the sclera).

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Risk factors

Risk factors that provoke the occurrence of red eye syndrome include:

• unfavorable climatic conditions (bright sun, strong wind, severe frosts);
• presence of autoimmune diseases;
• chemical irritation (pool water, aerosol sprays);
• allergic conditions;
• prolonged continuous eye strain (working at a computer, watching TV, working in poor lighting);
• mechanical injuries (scratches, foreign bodies, blows from blunt objects);
• the presence of disorders in the endocrine system (diabetes mellitus, thyrotoxicosis);
• violation of the rules for wearing glasses and contact lenses;
• hypertension;
• age-related xerophthalmia (dry eye membrane);
• chronic fatigue;
• excessive physical exertion;
• use of low-quality cosmetics (mascara, eye shadow, eye pencils);
• contact infection from dirty hands;
• presence of infectious diseases.

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Pathogenesis

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

When the integrity of the vascular wall is damaged, 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. The causes that caused the discirculation may be stagnant, inflammatory or allergic processes. Redness can cover the entire surface of the sclera or be localized in certain areas.

Eye redness may pass without outside intervention or require urgent help from specialists. Consultation with an ophthalmologist is necessary if the process is long, painful and accompanied by purulent or serous discharge.

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Symptoms red-eye syndrome

Red eye syndrome does not occur as an independent manifestation of the disease. Usually, there is a combination of several symptoms with redness of the eyes. Patient complaints depend on the underlying cause that caused the disease. Below are symptom complexes of some diseases that occur with redness of the eyes.

Red, inflamed eyes - conjunctival diseases

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

Infectious (bacterial) conjunctivitis - purulent discharge, swelling of the conjunctiva, and sometimes the entire eyelid, yellow-gray spots on the conjunctiva.

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

Chemical conjunctivitis – occurs when exposed to potential chemical irritants (dust, smoke, aerosols, chlorine, phosgene).

Hyposphagma (bleeding from the conjunctival capillaries) is asymptomatic, with small hemorrhages localized subconjunctivally.

Dry eye syndrome - a feeling of "sand in the eyes", the image becomes blurred and foggy, there is heaviness of the eyelids. 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.

Conjunctival tumors - manifested by itching slightly raised above the surface of the formation, redness of the eyes, blurred vision, and a burning sensation.

Red, inflamed eyes - corneal disease

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

Epidemic (adenoviral 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 prolonged use of contact lenses - dacryorrhea, redness of the eyes and swelling of the cornea appear. Leads to thinning and ulceration of the cornea.

Corneal ulcer. A crater-shaped ulcerative defect appears with clouding of the cornea. This can happen in people who do not remove contact lenses at night, when the cornea is infected with various pathogens.

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

Red, inflamed eyes - diseases of the sclera

Episcleritis is usually one-sided, with localized redness, slight irritation and lacrimation.

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

An acute attack of glaucoma - severe pain in the eyes, headache, nausea, colored "halos" around light sources (halo), clouding of the cornea (with edema), decreased visual acuity.

Anterior uveitis is pain in the eyes, photophobia, flickering flashes, a pronounced vascular pattern (reddening of the conjunctiva, mainly on the cornea). Often associated with autoimmune diseases, blunt trauma to the eye. Possible deterioration in visual acuity and clarity 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 area of the conjunctival sac. This type of hyperemia is manifested by the expansion of blood vessels in the conjunctiva, which indicates an inflammatory process developing on the surface of the eyeball. A specialist consultation is necessary here, but not urgent (you can visit an ophthalmologist within 1-2 days).

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

Mixed - there is both hyperemia of the conjunctival vessels and the scleral vessels around the limbus. This condition requires urgent professional consultation.

It is worth considering which symptom is dominant.

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Forms

Depending on the cause of 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).

If the "red eye" syndrome is accompanied by a burning sensation in the eyes, a feeling of sand under the eyelids, photophobia, it is very likely that the cause of the problem is conjunctivitis caused by various pathogens. It is necessary to take additional hygienic measures and the inflammation will stop. When purulent plaque begins to appear on the eyelids, this means that there is a bacterial infection and a medical consultation is necessary.

2. Allergic.

The symptoms are very similar to the above-mentioned conjunctivitis, but with a predominance of burning and itching, swelling of the eyelids, lacrimation, and accompanying allergic symptoms. The main difference of conjunctivitis (regardless of the etiology) is that the acuity and clarity of vision remains unchanged and there is no sharp pain.

3. Caused by ophthalmological pathologies.

Acute attack of angle-closure glaucoma. If the red eye syndrome suddenly appears, accompanied by acute pain, blurred vision, nausea and vomiting, the diagnosis is most likely an attack of angle-closure glaucoma. This is a condition in which there is a sharp increase in eye pressure, which can cause complete loss of vision. Therefore, this condition requires immediate consultation with an ophthalmologist.

The presence of autoimmune conditions, chronic or acute diseases, disorders associated with blood coagulation, etc., will also cause red eye syndrome. But in this case, the symptoms of the underlying disease will prevail.

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Complications and consequences

The consequences and complications depend on the underlying disease that caused the red eye syndrome. In different cases, the prognosis will depend on the timeliness and effectiveness of the treatment started. You should not ignore redness of the eyes that lasts more than two days. You should visit an ophthalmologist. If additional symptoms join the red eye syndrome (pain in the eye area, any pathological discharge, worsened vision, a burning sensation and a foreign body in the eye). Medical assistance is not required only in the case of a physiological manifestation of the red eye syndrome. It is enough to eliminate the cause and the vessels will gradually return to normal, without causing any complications.

In case of eye damage caused by chemicals, the prognosis depends on the type of damaging agent and the duration of contact with the eye structures.

With conjunctivitis, the prognosis is favorable. Timely treatment lasts from 5-7 days (viral conjunctivitis) to 1-2 weeks (bacterial). Conjunctivitis of allergic genesis disappears when the allergen is eliminated. But more severe consequences are possible (keratitis, threatening loss of vision), so you should not neglect the treatment of conjunctivitis.

Hyposphagma. The prognosis is favorable. Apart from cosmetic defects, the patient does not experience any other discomfort. Hemorrhages disappear on their own by the end of the second week.

Dry eye syndrome. If you adjust your work and rest schedule at the computer in time or start using special drops, it will not cause complications. A neglected process is dangerous due to scarring, amblyopia, and the development of conjunctivitis.

Keratitis - the prognosis is unfavorable. Without appropriate treatment it leads to significant deterioration or complete loss of vision.

Episcleritis. The prognosis is favorable. In 60% of cases, self-healing occurs, but a consultation with an ophthalmologist will not hurt.

Scleritis. The prognosis depends on the causes and tactics of therapy. Complications: keratitis, iridocyclitis, cicatricial deformation of the eyeball, secondary glaucoma, endo- and panophthalmitis, opacification of the vitreous body of the eye, retinal detachment.

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Diagnostics red-eye syndrome

A detailed anamnesis and a detailed ophthalmological examination allow an accurate diagnosis to be made.

After collecting the anamnesis, the doctor examines the eye. The examination includes:

• assessment of visual acuity of the left and right eyes separately,
• study of eye movements in different directions,
• examination of the eye with a slit lamp, with special attention paid to the eyelids, conjunctiva, changes in the cornea (smoothness of the surface, transparency, presence of pathological discharge), the shape of the pupils and their reaction to light,
• intraocular pressure test,
• examination of the fundus of the eye.

To identify the causative agent of the pathology of the visual organ (conjunctivitis, corneal ulceration, keratitis), a bacteriological analysis is used, including culture sowing and its study. In case of combined glaucoma, tonometry and gonioscopy are indicated. Scleritis is diagnosed using specialized ophthalmological equipment.

Instrumental diagnostics

Most often, ophthalmologists use a slit lamp, with its help the doctor will be able to evaluate the structure of the eye, conjunctiva and the condition of the cornea. To diagnose dry eye syndrome, special tests must be carried out.

Schirmer's test. It is based on checking the amount of tears using strips of special paper, which are placed in the lower part of the conjunctiva. It takes five minutes. An assessment is made of the degree of moistening of the strips. The length of the strip moistened with tears is measured. Before the procedure, an anesthetic is used to prevent lacrimation due to irritation of the conjunctiva by the paper.

Biomicroscopy of the eye. Study of the structures of the visual organ by non-contact methods of examination with magnification. Diagnostics is carried out using a special device (ophthalmological microscope) and a slit lamp.

Gonioscopy. A visual method that allows one to examine the structure of the anterior chamber of the eye, hidden behind the limbus. The procedure requires a special ophthalmological lens (gonioscope) and a slit lamp. As a result of this examination, one can evaluate the degree of openness of the angle of the anterior chamber, detect neoplasms, pathological adhesions of layers and structures of the organ of vision.

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Differential diagnosis

The most common eye diseases that cause redness are:

• Conjunctivitis. This is the most common eye disease. It can be caused by bacteria, viruses, but can also occur due to allergies.
• Keratitis. In many cases, it is caused by external factors (swimming with open eyes underwater without eye protection, prolonged exposure to bright intense sun without sunglasses).
• Inflammation of the cornea. Occurs as a result of infection, most often herpes.
• Dry eye syndrome. Occurs due to a lack of tear fluid, which affects the proper functioning of the eye. It nourishes 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.
• Causes of dry eye syndrome include: environmental pollution, ozone, cigarette smoke.
• Acute attack of glaucoma. Glaucoma is a disease that develops insidiously over many years. Most patients do not notice this disease in the early stages of the disease. It does not cause pain or other symptoms.

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Treatment red-eye syndrome

In the case of treating red eye syndrome, there is no general method or medicine for all manifestations associated with the occurrence of this condition. It is necessary to remember that it can relate to any ophthalmological diseases, and therefore - different treatment tactics will be recommended.

In conjunctivitis, treatment is mainly based on removing irritation. Different eye drops are used depending on the cause of the conjunctival inflammation.

To eliminate the symptoms of viral conjunctivitis, a combination of warm compresses and artificial tear drops is used (artificial tears are moisturizing eye drops, such as "Systane", "Oxial" and other drugs of this pharmacological group). A specific medicinal solution for the treatment of viral conjunctivitis is "Ophthalmoferon" eye drops, the active ingredient of which is synthesized interferon. When signs of bacterial infection appear, drops containing antibacterial substances are used. In acute bacterial conjunctivitis, therapy is carried out using frequent eye drops (more than 3 times a day) with ophthalmic medicinal solutions (albucid 30%, chloramphenicol 0.25%) and the application of ointment forms of drugs containing antibiotics (tetracycline ointment 1%). Before the instillation procedure, rinse the eyes with a disinfectant decoction (chamomile decoction, black tea).

If conjunctivitis caused by the herpes virus (ophthalmic zoster) is suspected, medications containing acyclovir are prescribed.

To eliminate the symptoms of conjunctivitis, ophthalmic drops containing corticosteroids are successfully used. When treating conjunctivitis of allergic genesis, contact with the provoking agent is excluded, cool compresses on the eye area are prescribed, drops of "artificial tears" 2-4 times a day. Antiallergic agents are used: azelastine, allergodil; levocabastine, as well as opatanol, which can be used in children over 3 years old. These agents help eliminate eye inflammation, due to the short-term effect, they must be used up to 4 times a day. Patients with pollenosis during the flowering period of plants should avoid wearing contact lenses.

In glaucoma, drug therapy is reduced to taking carbonic anhydrase inhibitors, beta blockers, pilocarpine. If therapy is unsuccessful, then resort to surgical laser treatment.

Vitamins

For red eye syndrome, it is necessary to take vitamin and mineral complexes and antioxidants.

Retinol or vitamin A. Prescribed in a dosage of 100,000 IU daily for 1 month. Helps strengthen the immune system.

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

Zinc. Daily dose - 50 mg. Promotes activation of the immune system.

OPC is an oligomeric proanthocyanidin, a powerful antioxidant obtained from pine bark and grape seeds. It is used for anti-inflammatory and anti-allergic therapy. When taken simultaneously with ascorbic acid, the effectiveness of this drug increases. It is recommended to take 100 mg of OPC 2 times a day.

Physiotherapy treatment

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

At the end of the course of antiphlogistic therapy, 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 for a long time, after electrophoresis, 1-1.5 months later, electrophoresis with vitamins C and B is indicated to stimulate tissue metabolism, thicken the capillary walls, improve tissue reactivity, and relieve pain.

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

Folk remedies

You can quickly and easily relieve eye strain, normalize blood circulation in the eye capillaries, and eliminate swelling and redness of the eyelids using folk remedies:

• cool compresses with clean water or herbal infusions of chamomile or oak bark;
• ice cubes;
• raw potato slices;
• black tea poultices.

It is important to remember that the use of folk remedies is recommended if there are no symptoms of serious ophthalmological pathology.

In case of red eye syndrome, eye exercises are allowed. The following is an approximate set of exercises:

• Exercise #1

If you look at the monitor for a long time and intently, then every hour after intense work you need to do the following - “outline” with your eyes the shapes of various objects located on the table and wall.

• Exercise 2

When the eye muscle is working hard, it needs to be relaxed: to do this, you need to go to the window and look into the distance and after a few seconds, move your gaze to any point nearby. This exercise will stimulate our eyes to produce tear fluid, which moisturizes the eyes so that they are not dry and red.

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Herbal treatment

For red eye syndrome, herbalists recommend the following recipes.

Compresses with wild cherry (bird cherry) are a folk remedy for purulent ophthalmological diseases.

An infusion of wild cherry flowers is prepared as follows: pour 60 g with 2 cups of boiling water, leave in a warm place for 8 hours, then filter and use as a compress on the eyes several times a day.

Infusion of herbs and fennel seeds for the treatment of red eye syndrome: 1 tablespoon of crushed raw materials is poured with 200 ml of boiling water after 1 hour, strain. Use compresses at night.

Eye drops with caraway. Pour one teaspoon of caraway seeds with 1 cup of boiling water. Infuse, cool, then strain and use as a compress.

Homeopathy

Homeopaths recommend using the following medications for red eye syndrome:

Arnica (Arnica). Used for conjunctivitis caused by trauma.

Aconitum (Aconitum) - for diseases of the visual organ that occur as a result of mechanical damage, with catarrhal inflammation of the eyes, due to acute respiratory viral infections.

Hepar sulfur (Gepar sulfur) will be useful for reddened, inflamed eyes, eyelids, and profuse purulent discharge.

Surgical treatment

For some diseases accompanied by red eye syndrome, surgical treatment is prescribed.

In keratitis, in severe cases of the disease and improper treatment, scarring may occur, which leads to deterioration of vision. In this case, a corneal transplant may be necessary.

In glaucoma, iridotomy is indicated - a treatment aimed at creating a connection between the anterior and posterior chambers of the eye, which leads to a decrease in intraocular pressure.

Prevention

Eyes need to be taken care of throughout life, from an early age. Basic rules for eye care:

• When working at a computer or watching TV, you should take care of the lighting (lighting is preferable behind the screen).
• The correct distance between the eyes and a computer monitor is 40-50 cm.
• use of a protective filter that absorbs part of the electromagnetic waves that are harmful to human vision.
• do not rub your eyes with your hands.

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

• When touching the area around the eyes, wash your hands thoroughly.
• Do not share towels (it is better to use paper napkins) or bedding.
• Do not share dishes 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.

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Forecast

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

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