17690 Red Eye

Overview

A red eye is when the white part of your eye looks pink, red or bloodshot. This happens when the tiny blood vessels on the surface of the eye get wider and more visible than usual. The white part of the eye is covered by a thin clear layer called the conjunctiva, and this layer is often where the redness shows. Red eye is very common. Most of the time it is caused by something mild, like an infection, an allergy or dryness, and it settles down on its own. But some causes of a red eye need to be checked quickly, because the eye is delicate and some problems can affect your sight if they are left alone.

Yes, red eye is one of the most common reasons people ask for eye advice. At any one time, many people have a red or gritty eye for a short while, and most cases are mild.

Red eye can affect anyone at any age. It is especially common in children who pick up coughs and colds at nursery or school, in people with hay fever or allergies, in contact lens wearers, in people whose eyes are dry, and in older adults whose eyes tend to become drier with age. People who work with chemicals, dust or bright lights may also be at higher risk.

Symptoms

Common symptoms

• Pink or red colour in the white part of one or both eyes
• A gritty, sandy or burning feeling in the eye
• Itching, which is often a sign that allergy is the cause
• Watery eyes or extra tears
• Sticky or pus-like discharge, sometimes making the lashes stick together after sleep
• Mild soreness rather than sharp pain
• A feeling that something is in the eye
• Slightly blurred vision caused by discharge or tears, which clears when you blink

Symptoms in children

• Sticky, crusty lashes on waking, which can make it hard for a young child to open the eye
• Rubbing the eye and being more clingy or unsettled than usual
• A recent cold or cough, since many eye infections in children follow a viral illness
• Redness in one eye that spreads to the other within a day or two
• A blocked tear duct in babies, which causes a watery, sticky eye without much redness
• Refusing to look at bright light or covering the eye with a hand

Symptoms in older adults

• Dryness and a gritty feeling, which becomes more common with age
• Crusting along the eyelid edges, which may be blepharitis (inflammation of the eyelid margins)
• Redness that comes with sudden blurred vision or halos around lights, which needs urgent checking
• Redness after a fall or bump to the face or eye
• Redness linked to shingles (a painful rash caused by the chickenpox virus) around the forehead or eye
• Less pain than expected even when the eye is damaged, so any change in vision matters

Causes

Main causes

• Viral conjunctivitis — the most common type, often caught from someone with a cough, cold or similar infection
• Bacterial conjunctivitis — an infection that tends to cause thicker, stickier discharge
• Allergic conjunctivitis — caused by pollen, dust, animal fur or makeup, and usually itchy
• Dry eye — when the eye does not make enough tears or the tears dry up too fast
• Blepharitis — inflammation along the edges of the eyelids
• A burst tiny blood vessel (subconjunctival haemorrhage), which looks bright red but is usually painless and harmless
• A scratch or sore on the clear front of the eye (the cornea), sometimes from a foreign body or a fingernail
• Contact lens problems, including overwearing, poor cleaning or sleeping in lenses
• Inflammation inside the eye, such as uveitis (inflammation of the inner eye), which is often painful and light sensitive
• A sudden rise in eye pressure, known as acute angle closure glaucoma, which is an emergency
• Irritants such as smoke, dust, chlorine, shampoo or cleaning products
• Injury, including sunburn of the eye from bright sunlight or arc welding

Risk factors

• Wearing contact lenses, especially if you sleep in them, swim in them or top up the cleaning solution instead of replacing it
• Close contact with someone who has a contagious eye infection
• Hay fever, eczema, asthma or other allergy-type conditions
• Dry eyes, which are more common with age and in air-conditioned or windy places
• Long stretches of screen work, which can make the eyes dry and sore
• Recent eye surgery or an eye injection
• A weakened immune system, which makes infection more likely
• Working with chemicals, dust or flying particles without eye protection
• Some medicines can dry the eyes or affect the surface of the eye — ask your doctor or pharmacist if you are unsure

When to see a doctor

See a doctor urgently if:

• Your eye is very painful, rather than just a bit sore
• Your sight has changed or become blurred and does not clear
• You are very sensitive to light
• You wear contact lenses and your eye is red and painful
• You have a chemical splash, a foreign body or an injury to the eye
• Redness around the coloured part of the eye, or one pupil looks different from the other
• A baby under one month old has a red, sticky eye
• You have a headache with sickness, halos around lights and a red eye

Book a routine appointment if:

• Redness that has not settled after about one to two weeks
• Red eyes that keep coming back
• Sticky discharge that keeps building up, or lashes that stay crusted
• A red eye with a lump or swelling on the eyelid
• Redness that you think is linked to a medicine you take

Diagnosis

A doctor, nurse or optometrist can usually work out the cause by talking to you about how it started and looking closely at your eyes and eyelids. They will check how well you can see, whether your eye is tender to touch, whether the redness is mostly in one area, and whether there is discharge, swelling or anything stuck in the eye. They will also ask about contact lens use, allergies, recent colds, injuries and the medicines you take.

Tests that may be done

• A vision check, often reading letters from a chart
• A close look at the eye using a bright light and a magnifier
• Special eye drops that make the surface of the eye easier to examine and show up scratches — these can briefly blur your vision and sting
• Checking the pressure inside the eye with a gentle puff of air or a small device
• A swab from the eyelid or eye if an infection needs to be identified
• Referral to an eye specialist (ophthalmologist) if the cause is unclear or the eye needs closer examination

What to expect at your appointment

The appointment is usually short and does not hurt, though the bright light can feel uncomfortable and drops may sting for a moment. If you have drops that widen your pupil, your vision may stay blurred for a few hours, so it helps to have someone with you or to avoid driving afterwards. You will usually be told what the likely cause is and what to do next before you leave.

Treatment

Treatment depends on the cause. Many red eyes get better on their own with simple care at home. Others need specific treatment — for example, drops prescribed by a clinician for an infection or an allergy, or treatment for a dry eye or eyelid problem. Because the causes are so different, getting the right diagnosis matters more than trying treatments at random.

Self-care at home

• Gently clean sticky lashes with cotton wool soaked in clean, cool water, using a fresh piece for each eye
• Use a cool compress for itching and swelling, or a warm compress for crusty eyelids
• Stop wearing contact lenses until the eye is fully better, and throw away the lenses and solution you were using when the redness started
• Wash your hands often, especially before and after touching your eye
• Do not share towels, flannels, pillows or eye makeup with anyone else, and use a clean towel each day
• Avoid rubbing your eye, even though it may itch
• Ask your pharmacist about lubricating eye drops or other simple options that suit your situation
• Take a break from screens, and blink often
• Stay away from smoke, dust and chlorinated pools while the eye heals

Medical treatments

If your red eye is caused by a bacterial infection, a clinician may prescribe antibiotic eye drops or ointment. For allergic redness, antihistamine or anti-inflammatory eye drops may be suggested. For dry eye, lubricating drops or gels can help, along with treating the underlying cause. Inflammation inside the eye needs drops prescribed by an eye specialist, and a sudden rise in eye pressure needs urgent treatment in hospital. Steroid eye drops should only ever be used when prescribed for you, because using them for the wrong reason can make some eye infections worse. Always check with your doctor or pharmacist before using any eye product, and mention any other medicines you take and whether you wear contact lenses.

When is surgery considered?

Surgery is rarely needed for a red eye. It may be considered when something is stuck in the eye and cannot be removed in the clinic, when a tear duct stays blocked and keeps causing infection, or for certain eye conditions such as a sudden rise in eye pressure. Your eye specialist would discuss this with you fully before any procedure.

Living with this condition

While your eye heals, keep things simple. Rest the eye, avoid makeup around the eyes until the redness has gone, and keep your hands clean. If the redness is in one eye, try to use separate towels and pillowcases so it does not spread to the other eye or to other people in the house. Most people can carry on with work, school or study, but it is sensible to stay home if you have a contagious infection and feel unwell.

Lifestyle tips

• Keep contact lens care strict: wash and dry your hands, use fresh solution, and follow the replacement schedule
• Take regular breaks from screens and blink deliberately
• Use a humidifier or place a bowl of water near a radiator if your home is very dry
• Wear sunglasses on bright, windy days to protect the eye surface
• Wear safety glasses for DIY, gardening or any work that sends dust or bits flying
• Try to keep good sleep habits, as tired eyes become dry and gritty more easily

Diet and exercise

There is no special diet that clears a red eye, but eating a balanced diet and staying well hydrated helps your eyes stay comfortable. Omega-3 rich foods, fruit and vegetables are all reasonable parts of a healthy diet. Regular exercise is fine with a red eye, though you may prefer to avoid swimming pools and contact sports until the eye settles, and to avoid swimming in contact lenses altogether.

Mental health and emotional wellbeing

A red eye can be worrying, especially if it is painful or your vision feels off, and it can affect your confidence in social or work situations. Most cases settle quickly. If you feel very anxious or low about your eye or your health in general, please talk to someone you trust or to your doctor. If you ever feel in crisis or unsafe, contact your local crisis service or emergency number straight away — you do not have to cope on your own.

Prevention

Not every red eye can be prevented, but many of the common causes can be reduced. Good hand hygiene, careful contact lens use, eye protection at work and at home, and managing allergies and dry eye all make a real difference.

Screening programmes

There is no routine screening test for red eye. Regular eye tests with an optometrist are still worthwhile, especially if you have diabetes, glaucoma in the family, or notice any change in your vision.

Complications

If left untreated

• A scratch or sore on the surface of the eye can become infected and leave a scar that affects sight
• Some infections spread and become more painful and harder to treat
• Inflammation inside the eye can damage sight if it is not treated
• A sudden rise in eye pressure can damage the optic nerve (the nerve that carries signals from the eye to the brain) within hours
• Untreated infection in a contact lens wearer can lead to a serious corneal infection
• A red eye that keeps returning can be a sign of an underlying condition that needs attention

Long-term outlook

The outlook is good for most people. Simple infections and allergies usually clear within one to two weeks, often without treatment. Even the more serious causes tend to do well when they are picked up and treated early — which is exactly why it is worth getting a painful or vision-changing red eye checked promptly. If your eye does not settle as expected, keep asking for advice.

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