Why are my eyes red, watery, itchy and sore?

When visiting ophthalmologists, many patients complain that their eyes are red and watery, or that their eyelids are red and their eyes are watery.

When do these symptoms occur and what to do if your eyes are watery and red?

Why is the eye red and watery?

It should be noted that there are various external risk factors for hyperemia of the eyes and increased secretion of tear fluid. This includes dust or smoke getting into the eyes, contact with detergents or other household chemicals (containing phosphates, which cause an allergic reaction of the skin and mucous membranes), and in women - decorative cosmetics. Red eye syndrome occurs from eye strain due to prolonged stress. And in old age and in children, eyes often water and are red from cold wind, very bright light or water.

Experts associate the pathological causes of these symptoms with a number of infectious ophthalmological diseases.

If the eyelid is swollen, it seems that something got into the eye, the eye itself is red, hurts and waters, then most often this is the first sign of inflammation of its mucous membrane - conjunctivitis. Redness is noted on the tarsal conjunctiva (on the inside of the eyelids). After a couple of days, the discharge becomes thicker due to the addition of pus, that is, the eye is red, swollen, waters and fester. By the way, similar symptoms are also noted with inflammation of the lacrimal gland (dacryoadenitis).

Depending on the pathogen, conjunctivitis is defined as bacterial (pneumococci, Staphylococcus aureus, Haemophilus influenzae, Moraxella, Pseudomonas may be involved in its development) or viral (including those caused by the herpes virus). And when red eyes are watery and there is a runny nose, then these are most likely symptoms of damage to the mucous membranes of the nasal cavity, nasopharynx and conjunctiva of the eyes by one of the serotypes of the Adenoviridae virus - adenoviral conjunctivitis. And complaints that in the morning the eyes are red and watery may indicate the presence of epidemic hemorrhagic conjunctivitis, which is spread exclusively by contact and at first affects one eye (causing itching and increased reaction to light).

However, the conjunctiva can also become inflamed as a result of a systemic allergic reaction, which causes the pathogenesis of seasonal allergic conjunctivitis. In such cases, the nose becomes stuffy, the eyes are red, watery and itchy, and swelling of the eyelids is noted.

Eyes also become very watery and red with keratoconjunctivitis: when the infection affects not only the conjunctiva, but also the corneal epithelium that passes into it. In addition, the cornea can be infected with the water-dwelling amoeba of the genus Acanthamoeba, causing acanthamoeba keratitis. According to experts, the risk factors for this disease are damage to the cornea, particularly in those who wear contact lenses.

In addition to conjunctivitis, keratitis or dacryoadenitis, red eyelids and watery eyes (often with purulent discharge) occur with the development of an inflammatory process in the hair follicles of the eyelashes - blepharitis (or with combined inflammation - blepharoconjunctivitis), as well as with infection of the meibomian glands located along the edge of the eyelids (meibomian blepharitis or meibomitis).

In case of hyperemia, ophthalmalgia and hypersecretion of lacrimal fluid – in other words, if the eye is red, hurts and waters – there is a suspicion of either glaucoma, the pathogenesis of which is associated with increased intraocular pressure, or episcleritis or anterior diffuse scleritis. Scleritis is an inflammation of the outer shell of the eye (sclera); it can be of bacterial or autoimmune etiology (that is, it can develop in people with rheumatoid arthritis and other autoimmune diseases).

Pericorneal injection of the eye vessels (i.e. their redness), lacrimation, photophobia, blepharospasm and decreased visual acuity are manifestations of inflammation of the vascular membrane of the eye - uveitis, which has various etiologies (infectious, endocrine, autoimmune).

If a child has a red eye and waters, then the reasons for these symptoms, as well as the pathogenesis of the diseases that cause them, are the same as in adults. Read also - Why does a child have red eyes and what to do?

Pathogenesis

The pathogenesis of reddening of the eyes, which occurs in the diseases mentioned above, is largely explained by the branching of intertwined blood vessels located in the vascular membrane of the eye (choroid) and having different lumens. It is believed that this reduces the rate of blood outflow from the capillaries into the venous sinus. In addition, red blood cells can exit the vessels through the gaps in the endothelium of the capillary walls, contributing to hyperemia.

At the same time, the presence of a large number of immune (mast) cells that release inflammatory mediators and have Ig (immunoglobulin) receptors on their membranes plays an important role in the reaction of eye tissues during inflammation.

In keratitis, in the inflamed cornea, the multilayered epithelium of which is adapted to rapid regeneration, the process of formation of new blood vessels begins, the filling of which increases hyperemia at the onset of the disease.

And hypersecretion of tear fluid has a protective nature - due to the presence in its composition of the hydrolase enzyme lysozyme, which destroys bacteria, that is, it has bactericidal properties. For more information on the pathogenesis of lacrimation, see the material - Eyes are watery in adults and children

Diagnostics

Diagnosis – taking into account the patient’s complaints of redness of the eye, pain and increased lacrimation – should reveal the etiology of these symptoms.

This may require tests such as a complete blood count, blood chemistry, antibody testing, microbiological examination of a smear of discharge from the eye, or cytological examination of cells from a corneal scraping.

Ophthalmological instrumental diagnostics – examination using a slit lamp and ophthalmoscom; (as indicated) intraocular pressure measurement, ultrasound of the eyes, retinography, keratotopography, perimetric testing are performed. For more details, see – Eye examination

Based on the examination results, differential diagnostics are carried out to determine the exact diagnosis and prescribe therapy.

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Treatment

Ophthalmologists know what to do if your eyes are watery and red. Depending on the cause – conjunctivitis, blepharitis, keratitis or scleritis – appropriate medications are prescribed, usually locally applied drops or ointments.

Inflammations of bacterial etiology require the use of antibiotics. For example, use drops Albucid (with sodium sulfacyl); Brulamycin (with the aminoglycoside antibiotic tobramycin); Okomistin (contraindicated for pregnant women and children under three years of age); Gatifloxacin (Zimar); Oftadek and Conjunctin (with decamethoxin); Vigamox (with moxifloxacin); Fucithalmic (with fusidic acid). Dosage, contraindications, possible side effects - in the material Eye drops for conjunctivitis

It is possible to use antibacterial eye ointments such as tetracycline, chloramphenicol, Colbiocin (with chloramphenicol, tetracycline and sodium colistimethate), Maxitrol (with neomycin and dexamethasone).

Also read: What is conjunctivitis and how to deal with it?

In case of viral origin of inflammation, Okoferon and Oftalmoferon drops are used; in cases of conjunctivitis or keratitis caused by the herpes virus, Oftan Ida (drops with idoxuridine) are instilled.

For allergic conjunctivitis, antihistamine eye drops are needed: Alelastin or Allergodil (containing azelastine hydrochloride), Cromoghexal or Cromopharm (with cromoglycic acid).

For conjunctival keratitis, the regenerating ointment Betamecyl and the gel with dexpanthenol Korneregel are used.

When treating scleritis, both local corticosteroids are prescribed - Oftan-Dexamethasone or Maxides eye drops, hydrocortisone ointment, and systemic ones (taken orally).

Surgical treatment

Hyperemia of the eyes and lacrimation are symptoms, and surgical treatment may be required if pathologies are detected that require surgical intervention.

For example, this could be a problem with the lacrimal canal, in case of obstruction of which (dacryocystitis) it is necessary to surgically ensure normal outflow of lacrimal fluid.

In glaucoma, in order to remove excess intraocular fluid, iridectomy is used, during which a microscopic hole is made with a laser, which allows the pressure inside the eye to be reduced.

Folk remedies

In ophthalmology, it is not recommended to use folk remedies: perhaps in the form of compresses of raw grated potatoes or lotions with black tea to relieve itching and swelling of the eyelids.

Herbal treatment allows for rinsing the eyes with decoctions of chamomile flowers, mallow, yarrow, fireweed, snakeweed, thyme, cinquefoil, deadnettle, or plantain leaves.

Consequences and complications

Each pathology, during the development of which the eyes become very watery and red, can have certain consequences and give complications.

Thus, conjunctivitis of pseudomonas and adenovirus origin is most often complicated by keratitis. In turn, inflammation of the cornea is fraught with deterioration of vision, and damage to its integrity - partial and complete loss of vision.

Infectious conjunctivitis can also result in vascular pannus of the cornea – the formation of a cloudy area with ingrown blood vessels in its surface layer.

Among the complications of keratitis, the transformation of the inflammatory process into a purulent form is noted, with the occurrence of a corneal ulcer, the perforation of which causes disturbances in the iris (in the form of pigment dispersion syndrome).

Glaucoma, scleritis and uveitis can lead to blindness.

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Prevention

The main prevention of hyperemia of the eyes and increased lacrimation is hygiene, which will help to avoid infection in the eyes. It is especially important to monitor the cleanliness of children's hands, because - by rubbing the eye with dirty hands - the child transfers a huge number of bacteria into it, which can cause inflammation.

And, no matter how trivial it may seem, strengthen your immune system and take vitamins in the winter.

Forecast

Inflammation of the conjunctiva, lacrimal gland and even cornea can be cured; the progression of glaucoma can be slowed. It is more difficult to make a prognosis regarding diseases of autoimmune etiology, as well as allergic conjunctivitis. In any case, when the eye is red and watery, treatment is necessary. With increased intraocular pressure, it should be urgent to prevent blindness.