Red Bloodshot Eyes

“Red eye” is a non-specific term that describes the appearance of the eye. It can occur in one or both eyes. Red eye could be due to an illness, injury, eye infections, or other condition such as allergies. Doctors do not tend to take immediate action when a patient comes in with red eyes. It is a very common condition that is usually caused by something else such as fatigue, substance abuse, allergies, or cold/flu. Red eyes are also referred to as bloodshot eyes, pink eye, and allergy eyes.

Bloodshot Red Eyes

Red Eye Symptoms

Depending on the underlying cause, red eyes may be accompanied by additional symptoms such as:

  • Burning sensation
  • Watery eyes
  • Itchy eyes
  • Itchy eyelids
  • Swollen eyelid
  • Discharge; could be thick or watery
  • Foreign body sensation
  • Photophobia (light sensitivity)
  • Dermatitis (crusting or scaling of the eyelid skin)
  • Eyelashes falling out. This is typically associated with blepharitis.

What Causes Red Eyes?

Red eyes happen when the blood vessels on the surface of the eye (the conjunctiva) become irritated, which causes them to become enlarged and dilated. This can sometimes be a medical emergency. One of the most common causes of red eyes are allergens and environmental irritants such as pet dander, pollen, dust, wind, dry air, and sun. People who do not get enough sleep will also experience red eyes. Eye infections and inflammations can cause red eyes, as well as other symptoms such as itching, discharge, pain, and blurred vision. If a contact lens wearer does not keep their lenses clean and disinfected, or wears them for too long, they can experience red eyes. Excessive dryness can also cause eyes to become red and irritated.

Other times red eyes can be a red flag, indicating a more serious problem such as blepharitis, conjunctivitis, corneal ulcers, scleritis, or acute glaucoma. If you are experiencing other symptoms, such as discharge or pain associated with the redness, you should schedule an appointment with your eye-care professional or primary care doctor right away to see if one of these conditions is present.

A bright red patch on the sclera (the white part of the eye) is the sign of a subconjunctival hemorrhage. Subconjunctival hemorrhages occur when one of the tiny blood vessels under the conjunctiva bleeds. The cause of a subconjunctival hemorrhage is not always known, but some cases have been linked to coughing, straining, or using blood thinners. Occasionally subconjunctival hemorrhages have been linked to high blood pressure or a bleeding disorder. Because the hemorrhage is not dangerous, no treatment is needed and symptoms usually disappear within a week or two. If the cause is high blood pressure or a bleeding disorder, your eye-care provider may recommend you visit your family physician for treatment. If you use blood thinners, your doctor may recommend checking the dosage to ensure that your blood isn’t too thin.

Diagnosing Red Eyes

Typically an eye doctor can make a correct diagnosis after giving you an eye exam and asking you questions about your symptoms, medical history, diet, and lifestyle. In some cases additional tests will be ordered to determine the cause, but this is not common.

Solutions & Treatment for Red Eyes

In most cases, red, bloodshot eyes will clear up on their own. If you are experiencing bloodshot eyes due to allergies or environmental irritants, you can try using oral antihistamines or over-the-counter eye drops before seeking further medical attention. This solution often clears up red eyes quickly. Dry eyes usually become red eyes, and artificial tears (sold at any store) could be an easy fix to the problem. Rubbing your eyes will only make the situation worse, and can bring on additional symptoms. Avoid touching your eyes altogether, even if you have washed your hands thoroughly. Oil and debris can stick to your fingers or get under your fingernails and cause more redness, and may even scratch your eyeball. If the environment is bothering your eyes, change your location or minimize your time there, if at all possible.  Stay away from pets and pollen if possible.

You could also try putting an ice pack on your eyes. The coolness of the pack relieves symptoms like swelling and pain, and may alleviate the redness. You might also consider rinsing your eyes with warm and cool water. This can work to irrigate and cleanse your eyes without harming them. There are also eye-washing solutions that can be used to rinse out your eyes. Mild formulas exist that will not hurt your eyes or cause any more redness.

If you still feel like your red eyes are caused by a more serious condition, or if the red eyes will not go away, call your doctor and make an appointment. This would also be a great time to check for other conditions like blepharitis and conjunctivitis. Your doctor will be able to prescribe medicated eye drops, oral antihistamines, and pain relievers if necessary.

You can also make lifestyle changes to help eliminate red eyes. Getting plenty of sleep and eating a healthy diet keeps your eyes and other important organs healthy and resistant to infection. Try drinking more water and taking Vitamin A and E supplements. Fatty acids found in fish, nuts, and leafy vegetables can be very beneficial to dry, red eyes.

Prognosis of Red Eyes

Healing time depends on the cause of your red eyes. If they are allergy related, the redness may go away within hours once the allergen is removed. But if the redness is due to conjunctivitis, the red eyes may remain for up to two weeks. If you are unsure why your eyes are red, contact your eye-care provider for a proper diagnosis.

When to Contact Your Doctor

Contact your doctor immediately if:

  • Sudden changes in your vision occur
  • Severe pain accompanies redness
  • You have a fever over 101° F
  • Red eyes were caused by blunt or penetrating trauma
  • Facial swelling occurs (neck, lips, tongue, etc.)
  • Red eyes are persistent, recurrent, or cause you concern

Complications of Red Eyes

Red eyes are not usually due to a serious condition. In cases of conjunctivitis, complications may arise, such as not being able to work or go to school, or having to replace linens and cosmetics daily. If the red eyes are due to a serious condition such as glaucoma or trauma, treatment must be sought to avoid complications and permanent damage to the eye. For example:

  • Infection could spread to other parts of eye and body
  • Loss of vision may occur, possibly leading to blindness
  • Scarring of the eye
  • Loss of the eye
  • Passing the condition on to others (such as in cases of conjunctivitis)

Preventing Red Eyes

The best way to prevent red eyes depends on the cause, but there are some general steps you can take to ensure that your eyes and body remain healthy:

  • Always keep your hands clean; wash them thoroughly with soap and water.
  • Do not share linens, cosmetics, or washcloths (especially ones designated for your face).
  • Seek medical attention immediately if your eye gets injured or if it suddenly turns red without a known cause.
  • Never ignore red eyes, especially when they are accompanied by other symptoms.

To prevent red eyes due to allergies:

  • Do your best to stay away from allergens.
  • If you must be around allergens, take antihistamines prior to entering the environment.
  • If allergies develop, take a shower.
  • Talk with your health-care provider about medications, both prescription and over-the-counter. Talk with an allergist about diagnostic tests that may identify specific allergens.

To prevent red eyes due to conjunctivitis:

  • Stay away from anyone who may have conjunctivitis.
  • Never share towels, linens, washcloths, make-up, or eye drops with someone who has conjunctivitis.
  • If you have conjunctivitis, stay away from work, school, and other public places until you have been cured (this could take up to two weeks).
  • If someone in your household has conjunctivitis, disinfect objects around the house such as doorknobs, computer keyboards, and remote controls to prevent the spread of the infection.
  • Wash your hands frequently if you or someone you know has conjunctivitis.

Talking to Your Eye Doctor

Here are some questions to ask your eye doctor about red eyes:

  • What is causing my red eyes?
  • I do not have any known allergies; can you recommend an allergist?
  • How long will it take for the redness to go away?
  • What additional preventive measures can I take?
  • Which treatment options do I have?
  • Which over-the-counter medications can reduce my red eyes?
  • Which eye drops should I use? Do I need prescription-strength eye drops?

Did you know…frequently using eye drops to “get the red out” can cause your eyes to redden even more?

References:
  • J. Weizer, MD; J. Stein, MD, MS “Reader’s Digest Guide to Eye Care” (Quantum Publishing, 2009) 51-56; 155-156
  • J. DiGirolamo, MD “The Big Book of Family Eye Care” (Basic Health Publications, 2011) 229-234
  • MedlinePlus Medical Encyclopedia, Eye Redness, http://www.nlm.nih.gov/medlineplus/ency/article/003031.htm
This article was last updated on 07/2014