The question, “Doc, why are my eyes always red?” is commonly asked of me by patients.
Red eyes are screaming for attention and rarely improve on their own without proper treatment. There are several reasons your eyes can be red, many of which can be serious and should be assessed and treated by an eye doctor. Though over-the-counter eye drops exist to “get the red out,” they are only a quick fix and only mask the true eye problem.
Your doctor may ask you questions about your red eyes at your visit.
- How long have you had red eyes?
- Which symptoms are you experiencing? Severity? Pain?
- How many hours do you spend on the computer?
- Do you take any medications?
- Do your eyes appear red all day or do they seem worse in the morning/evening?
- What type of contacts do you wear and how long do you wear them?
- Have you tried any medications or drops for treatment?
Top 10 reasons for red eyes
Dry eye
Dry eye is a multi-symptom disease with many causes and the most common reason for red eyes. You may have dry eye and have some or all the symptoms. Common symptoms of dry eye include redness, watering, stinging, burning, and a gritty sensation like something is in the eye.
Computer users, allergy sufferers, women, contact lens wearers, and those taking certain medications are more likely to suffer from dry eye. Your doctor will evaluate your eyes and determine if you aren’t producing enough tears and/or if the ones you do produce are functioning appropriately. Treatment is recommended depending on the appearance of your eyes and the results of specific dry eye tests. If you wear contact lenses, sometimes changing the brand of contacts or length of wear time can improve your eye redness.
Allergic conjunctivitis
Allergic conjunctivitis presents as red, itchy, watery eyes typically occurring during the spring or fall. Allergy eyes can occur throughout the year if your eyes are exposed to allergens like pets, grasses, or mold. While taking allergy medications like Zyrtec can improve your symptoms, you can experience quick relief with prescription allergy drops or pharmacy solutions like Pataday. Cold compresses can improve the look and feel of your eyes.
Viral conjunctivitis
Viral conjunctivitis is a red, painless eye with a watery discharge. A viral infection of the eye can accompany a cold or another virus your body may be fighting. Viral conjunctivitis is extremely contagious, and care should be taken to avoid transfer to the other eye or to another member of the family. Viral infections can be contagious and present for 7-14 days. All pillows should be washed, eye makeup thrown out, and door handles cleaned to prevent transfer. The appearance of your eyes can be improved with a doctor’s treatment, but the virus can still be present for up to 2 weeks.
Bacteria conjunctivitis
Bacteria conjunctivitis is a bacterial infection of the white part of the eye and is a rare condition in adults. The most common signs are a painless, red-eye with a yellow-green discharge which makes it difficult to open your eyes. Eyes and eyelashes feel sticky and gooey. Bacterial conjunctivitis is more common in children, and treatment is typically an anti-bacteria eye drop.
Pinguecula
A pinguecula is a scar-tissue-like growth on the eye caused by UV exposure to the eye over one’s life. If you grew up in the south or nearer to the equator, you are more likely to have a pinguecula. Pingueculas are located on the white part of the eye and can be near your nose or your ears. They can appear yellowish in color or red if they are inflamed due to wind or outside elements.
If you have a pinguecula, you should protect your eyes from outside elements by wearing UV-protecting sunglasses. If the pinguecula is inflamed, a steroid can eliminate the redness.
Corneal ulcers/infiltrates
A corneal ulcer or infiltrate is the most common reason for a red eye if you sleep in your contact lenses. An ulcer can be caused by bacteria, a virus, fungus, or parasite. An eye with an ulcer is red, watery, painful, and light-sensitive. Your eye may be very difficult to open, and your vision may also be blurry.
Corneal ulcers and infiltrates are serious conditions and may leave a permeant scar on your cornea and permanently blurry vision. If you sleep in your contacts, you should immediately take them out and not wear them again until you are cleared by a doctor. Treatment for the condition depends on the cause of the ulcer.
Superficial punctate keratitis (SPK)
Superficial punctate keratitis, also called SPK, is inflammation of your cornea. The cornea is one of the most sensitive organs of the body with 70 to 80 larger nerves and SPK makes the eye feel sandy, gritty, or even as if something is in your eye. SPK is a condition of the cornea often due to chronic dry eye or contact lens overwear. Both contact lens wearers and non-contact lens wearers can suffer from SPK. Treatment for SPK can vary and depends on the cause. Changing your contact lens brand and treating the dry eye are common solutions.
Corneal abrasion
A corneal abrasion is a scratch on the cornea. Corneal abrasions can be very painful and may take several days or up to a week for your eye to completely heal. Corneal abrasions rarely occur from soft contact lenses, but typically result from a pet’s nail, paper cuts, tree branches, or mascara wands.
A corneal abrasion should be watched carefully by your doctor to make sure it is healing properly. Treatment can vary but your doctor can improve your pain by applying a bandage contact lens and temporarily dilating your injured eye.
Uveitis
Uveitis is inner eye inflammation causing red, painful, and light-sensitive eyes. This condition can be of unknown cause, but if it occurs multiple times, it may be a condition of an inflammatory condition in your body like rheumatoid arthritis, sarcoidosis or lupus. You will be given specific drops for treatment and pain, and your doctor may recommend bloodwork to find the root cause.
Blepharitis
Blepharitis is inflammation of the lid margins that can result in red eyes. The lids and eyelashes become red, itchy, and sticky debris builds at the base of the eyelashes. This condition contributes to dry eye. Lid scrubs, a heat mask, and oral antibiotics in combination may be used to improve the look and feel of your eyes. If you have a condition like rosacea, you are more at risk for blepharitis.
Over-the-counter solutions for red eyes
To best treat your red eye, it is imperative to find the reason for the redness. The best temporary quick fixes include:
- Systane brand non-preservative tears
- Blink brand for contact lens wearers
- Retaine brand tears for use 2x per day
- Lumify, an over-the-counter glaucoma medication that can be used to immediately whiten your eyes.
In conclusion, normal, healthy eyes are not red. If those around you are constantly commenting on your red eyes, it is time to address the problem and find a solution!
