Red eyes, pink eyes – are they tired eyes?

Red eyes are as a result of dilated blood vessels in the conjunctiva of the eye ball. The conjunctiva is the clear mucous membrane that covers the white part of the eye and the inside of the eyelids. When the eyes are tired they can go red but this is not the main cause of red eyes.  Most commonly allergy or dry eyes will result in red eyes.  Tired eyes are often associated with extended periods of reading or computer use or being in a smoky or air conditioned environment, all of which could result in dry eyes.  These can be treated with OTC medicines.

‘Pink eyes’ is another  term for red eyes caused by an infection, most commonly a viral infection  although  it can be allergic or bacterial in origin. Viral and bacterial conjunctivitis or pink eye  is especially contagious and should be treated quickly and with care.

Occasionally the condition causing red eyes  is a serious disorder which needs to be diagnosed and treated promptly and may require referral to an eye specialist.

Causes of red eyes:

The conjunctiva is exposed to bacteria and other irritants. Tears help to protect the conjunctiva by washing away bacteria. Tears also contain enzymes and antibodies that kill bacteria. Sometimes infections overcome these protective mechanisms, resulting in conjunctivitis.  There are many causes of red eyes which are summarised in table 1

There are some questions that need to be asked to establish the correct diagnosis of red eyes

When did it start?

If the red eyes started suddenly it could be as a result of allergy, conjunctivitis, a foreign body in the eye, minor trauma or acute glaucoma.

If the eyes have been red for a while, the patient could have a pterygium, blepharitis (eyelid infection or inflammation), dry eye syndrome or a conjunctival tumour.

Is the eye itchy?

Allergic conjunctivitis is typically itchy, Dry eye syndrome in the elderly can also present with itchy eyes.

Is there any discharge from the eye?

Mucous discharge would suggest an allergy.

Watery discharge indicates a viral conjunctivitis.

Purulent discharge would indicate a bacterial conjunctivitis.

Is it painful?

Severe pain could be as a result of arc eyes (welder’s eyes), acute glaucoma, sinusitis or infection in the eye ball. Moderate pain  is common in deep inflammation or infection of the eye. These patients need to be referred to a doctor or specialist.

Is the vision is affected?

Most cases where the vision is affected, patients need to be referred to an optometrist, doctor or specialist to correctly diagnose and treat the problem.

Symptoms of conjunctivitis

Red eyes are the most obvious symptom that there is an infection or irritation in the eye. The patients complain of blurred vision. There may be eye pain. With bacterial conjunctivitis, crusts form on the eye lids overnight. There is a gritty feeling in the eye with increased tearing and sensitivity to light. If the eye is very itchy, the cause could be allergic in origin. Pink eyes starts in one eye and spreads to involve both eyes.

Treatment of red eyes

It is important to have the correct diagnosis of red eye so that the treatment can be aimed at the cause.

Treatment of simple causes of red eyes:

• Blepharitis is treated by cleaning the eyelids and lashes daily  with a moist cotton tip eye bud and applying antibiotic eye drops or ointment e.g. chloramphenicol four times a day until improvement is noticed.
• Allergic conjunctivitis is treated with antihistamines e.g. Zaditen®, Patanol® or Spersallerg®and  may disappear on its own onve the causative the allergen has been removed.
• Viral conjunctivitis does not have any specific treatment, artificial tears can relieve the scratchiness and antihistamine eye drops will clear the redness.
• Bacterial conjunctivitis and keratitis needs to be treated with antibiotic eye drops or ointment.
• Viral or bacterial conjunctivitis can be soothed by applying a warm compress (clean cloths soaked in warm water) to the closed eyes.
• Dry eye syndrome is treated with artificial tears e.g. Teargel®, Optive® or Cellufresh® on a permanent basis.
• Irritants such as smoke and air conditioners are best treated by avoiding the irritant or using artificial tears if the irritant is unavoidable.
• Loose foreign material in the eye e.g.an eyelash or dirt in the eye can cause discomfort, burning, stinging, smarting, tearing, itching, irritation, inflammation, redness, and uncontrollable blinking. Foreign material may cause ocular infection and should be removed. Sterile eyewash can be used to gently irrigate the eye, with the hope that the inrushing fluid will dislodge the object and flood it from the eye.
• Contact lens related red eyes normally require the attention of an ophthalmologist. The patients should be advised to remove the contact lenses and put them in the contact lens container to show the ophthalmologist. If the cornea has an ulcer they should be referred urgently.
• Subconjunctival haemorrhage normally resolves by itself and does not require treatment.

Decongestant drops e.g. Safyr Bleu®, EyeGene® or Oxylin®, cause the blood vessels in the eye to constrict and in that way relieve the redness. These types of eye drops should not be used for longer than 3 days. Using them beyond 72 hours can actually cause a condition of increased redness. Instead of continuing to use them, patients should be advised to stop the use completely so the eyes can recover.

Prevention of  pink eyes

Good hygiene can help prevent the spread of conjunctivitis. Advise patients to :

• change their pillow cases frequently
• eye cosmetics should not be shared
• towels and handkerchiefs should not be shared
• contact lenses should be handled and cleaned properly
• hands to be kept away from the eyes
• replace eye cosmetics regularly
• wash hands regularly

Conclusion

Eye problems can be some of the most disabling conditions, since vision is needed to perform life’s daily tasks. Red eyes are uncomfortable and can be embarrassing for patients. Although tiredness can contribute to red eyes there is usually another underlying cause for red eyes.  Some issues can be treated effectively with OTC products, but others require a prescription. Generally, if the patient experiences eye pain, changes in vision or the redness and irritation continues, they should stop the OTC medication and be referred to an optometrist, doctor or ophthalmologist.

Marjolein Bench BPharm