People with brown eyes might wish they had green eyes, while those with green may yearn for blue—but nobody wants red eyes. Even pink eyes are enough to send people to the doctor. In fact, conjunctivitis—the clinical term for both red eye and pinkeye—is one of the most common problems an eye doctor sees.

Conjunctivitis can be caused by irritants, trauma, infections, medications, even the common cold. Rubbing the eyes or swimming in chlorinated pools may cause a mild and temporary case of the condition, as can wind, sand, and dust. Often the cure for a mild case of conjunctivitis is time. Once the irritant is removed, the condition clears.

Other causes and cases can be much more serious and may even lead to blindness. Often the only one who can tell you which type you have is a doctor, because the initial symptoms are very similar.

In each case the underlying source of the redness is the same. The conjunctiva, an almost transparent, thin membrane that covers the white of the eye, is filled with tiny blood vessels that bring nutrients, protective antibodies, and other substances to the surface of the eye. Whenever the conjunctiva is irritated, these blood vessels become dilated—they fill up with blood. These widened blood vessels are what makes the eye look pink or red.

Now let's take a closer look at some of the causes of the red eye and other irritating eye problems.

Drops for Bloodshot Eyes

Most nonprescription eyedrops are vasoconstrictors. They "get the red out" by constricting, or shrinking, the blood vessels in your eyes. Some of these drops also contain an antihistamine that relieves the itchiness that often accompanies eye irritations.

The effect of these drops usually lasts for a few hours. When they wear off, sometimes the redness comes back worse than ever (the "rebound" phenomenon). If your eyes continue to be bloodshot or there is an excessive amount of discharge, you may have an eye infection or some other problem that requires a doctor's attention.

Over-the-counter eyedrops also carry warnings about avoiding excessive use. Heed them. Using them too frequently can cause more eye problems than they can cure.

Blepharitis

Quite often, a red eye doesn't indicate a problem in the eye itself but rather in the eyelid. Blepharitis is an inflammation of the eyelid margins and the eyelids and meibomian glands, the oil-producing glands in the lids.

One of the most common eye problems, blepharitis causes discharge from the eyes that can make your eyelids stick shut when you wake up in the morning. Your eyelashes may be crusty, turn white, and even fall out. Occasionally the cornea can be damaged by the bacteria or toxins that come in contact with the eye from the inflamed eyelid.

Blepharitis is a chronic problem for many people, and while it may not always be curable, it can be kept under control.

There are numerous causes, including infections, seborrhea, excessive rubbing of the eyes, and allergies to drugs or cosmetics. Blepharitis can even be a side effect of measles, scarlet fever, and other diseases.

The most common cause is a low-grade Staphylococcus infection of the rims of the eyelids. The staph bacteria like the oily, scaly environment of the lid margins, and they thrive there. It may be the toxin produced by the bacteria that gets into the eyes and makes them red.

No matter what causes blepharitis, the treatment usually consists of cleansing the eyelid margins and lashes margins and lashes a baby shampoo solution, applied with a cotton-tipped swab or washcloth.

Next, the oily secretions in the glands have to be removed. To get them out first apply a hot compress over your closed eyes for 10 minutes or so. Then massage the eyelids, using a gentle rubbing action. Massage the upper eyelid downward to work the oil secretion out of the glands in much the same way you squeeze toothpaste out of a tube. Then massage the lower lid upward.

As a rule, this eyelid treatment must performed every night for at least a week or two until the problem is under control. But since blepharitis can be a chronic condition that will come back once treatment is halted, you might have to do it once or twice a week—for the rest of your life. While this is not a pleasant prospect, most people who have the condition make it a part of their daily ritual, like brushing their teeth.

It is a good idea for the doctor to take a culture of the secretion before the treatment starts. If he can identify a specific type of bacteria, he can prescribe either an antibiotic you can take orally or an antibiotic ointment to be rubbed into the eyelids. But this ointment won't work very well unless you keep the eyelids clean.

Lid Twitches, Tics, and Spasms

Eyelids can present other annoying problems besides inflammation. Involuntary movements or spasms, for example, come in three basic varieties.

Tics and twitches. No one really knows what causes minor eyelid tics and twitches. They are usually associated with being tired or under a great deal of stress, or needing glasses.

Essential blepharospasm. This is a rare condition in which both eyes close involuntarily. In advanced cases, the neck and mouth might also twitch when the spasms strike. No one knows what causes the spasms, which can be troublesome and incapacitating. Although biofeedback and drugs are occasionally successful, surgery may be required to cure the problem. Recently, botulinum toxin, derived from the bacteria that cause botulism food poisoning, has been injected into the muscles undergoing spasm with good results.

Hemifacial spasm. This is a spasm that affects the eyelid muscles—and sometimes the muscles around the mouth—on one side of the face. It is caused by an artery pressing against the nerve of the facial muscles. Surgery is usually required to relieve the pressure, but sometimes medication will do the job.

Sties and Similar Problems

Even though each of these three different types of eyelid infection has a specific definition and produces a different type of lump, the words hordeolum, sty, and chalazion are frequently used somewhat interchangeably. We often lump these lumps together and call them chalazia.

If you have a hordeolum, a red, swollen, and tender area develops in one of the lids because of a boil or abscess in the affected gland. When the meibomian gland is the one affected, it is known as an internal hordeolum. When one of the smaller glands is infected, it is known as a sty.

A chalazion is a similar type of inflammation affecting the meibomian glands. The eyelid becomes swollen and tender, and a nodule develops inside the lid. While the condition often goes away as mysteriously and quickly as it develops, it can become a cosmetic problem or even distort your vision. It should be treated with hot compresses as soon as it is detected.

Apply a hot compress for 15 minutes four times a day. If the swelling has not been reduced after a week or two, the abscess might have to be drained by your doctor.

The draining is a simple, in-office procedure. The doctor will anesthetize the eyelid and make a small cut in the back side of the lid so the pus can drain. Then he will apply an antibiotic ointment, and he may even place a patch on the eye after the procedure.

For reasons still unknown, some people are plagued with these problems over and over again. There is no way to prevent them, but scrubbing the eyelid margins with baby shampoo on a regular basis does seem to reduce their frequency.

Adenovirus

Once called shipyard eye because it was first isolated and identified in a California shipyard during World War II, adenovirus is a common but relatively harmless eye infection that can hit with epidemic proportions and sweep through schools, hospitals, doctors' offices, factories, and even entire communities. Summertime epidemics of the malady are often referred to as swimming pool conjunctivitis or pinkeye.

With adenovirus infections, the eye becomes very red and swollen. There may be some discharge and sensitivity to light. You can usually find a swollen gland on the side of the head, just in front of the ear.

Fortunately, adenovirus does not usually require any medication, nor does any medication knock out the virus. Like the common cold, it will cure itself. But as with a cold, even though you cannot cure it, you can make yourself more comfortable while you have it. Warm compresses not only feel good, they give you a chance to close your eyes, relax, and lie down.

Like a cold, adenovirus is very contagious, but following a few simple safety steps will help limit its spread. You should wash your hands after touching the infected eye, and towels and washcloths used by the infected person should be kept separate from the rest of the family's linens—at least until they've been washed.

Even newspapers, silverware, or a handshake could be a way of transmitting the virus to another person, if that person touches the infected material and then touches his eye. Remember also, that if one eye is infected and the other is not, don't touch one eye and then the other. Most cases do ultimately affect both eyes, but a little caution could help keep the infection rate down.

A similar type of infection, known as acute hemorrhagic conjunctivitis, spread throughout the entire world in 1969, at the same time as the Apollo 11 mission to the moon. Because some people were convinced that the virus was brought back by the spacecraft, the malady was dubbed Apollo 11 conjunctivitis.

There are two principal differences between it and adenovirus. First, acute hemorrhagic conjunctivitis is even more contagious than adenovirus. Second, the eyes become even redder because of tiny hemorrhages from blood vessels within the conjunctiva itself. Like adenovirus, "space conjunctivitis"—as some people still call it, cures itself and often does so much more quickly than adenovirus.

Gonorrheal Conjunctivitis

Bacteria can also frequently cause conjunctivitis. One of the most serious is the bacterium that causes gonorrhea. If this bacterium gets in the eye, it produces a type of conjunctivitis that features a great deal of redness, swelling, and pus. Gonorrheal conjunctivitis is a medical emergency and requires immediate treatment, usually with penicillin.

Trachoma

Caused by a bacteria-like agent called Chlamydia, trachoma is the leading cause of blindness in the world today. In fact, it's been one of the leading causes of blindness since history began. One of the oldest diseases known to humanity, it was first recognized in the twenty-seventh century B.C.

Although it is now quite rare in the United States, trachoma used to be common among American Indians. Currently it is quite common in Africa, South America, and Asia, affecting more than 400 million people worldwide. The disease is found primarily in less-developed countries, where it may be transferred by flies. It can also be transmitted by community towels or other items shared by large numbers of people. But the disease does tend to disappear as economic and hygienic conditions improve.

As the infection develops, the conjunctiva becomes inflamed, leading to scarring. This causes the eyelashes to turn in and irritate the cornea, which in turn can lead to a blinding corneal infection.

Trachoma is a major health problem and the target of some of the most concentrated efforts in dye research. Fortunately, the disease responds well to antibiotic treatment. The problem in the field, however, is often a lack of cooperation and transportation. Sometimes available medicine never reaches the people who need it. Another problem, especially in some of the more remote parts of the world, is educating people about how to avoid reinfection.

There is, by the way, a slightly different strain of chlamydia that causes nonspecific urethritis, the most common type of venereal disease. This infection can occasionally be transferred to the eye.

Eye Infections in Newborns

Ophthalmia neonatorum is a form of conjunctivitis that can hit newborn infants when the mother has a genital infection such as herpes, gonorrhea, or chlamydia. The infection reaches the baby as it passes through the birth canal.

To protect the baby's eyes, a 1 percent silver nitrate solution or an antibiotic ointment is put into the baby's eyes at birth.

This preventive treatment is required by law in 47 states and the District of Columbia. In the remaining three states, it is required only in births attended by midwives or in cases in which the presence of disease is suspected.

In ten states, the requirement may be waived if the parents object—and lots of parents object. (After all, they reason, neither of them is the sort of person who would have that sort of disease.) If the parents object, and there is a genital infection, the baby can develop a serious eye infection.

Herpes

A serious case of the red eye or conjunctivitis can also stem from the herpes simplex virus. This is the same virus that produces cold sores or fever blisters, and a close relative of the virus that causes genital herpes.

If you have had one herpes-related eye infection, you may get another one, and another one. They tend to recur because the virus resides in the nerves around the eye and periodically travels down those nerves to cause trouble. More than half the population of the United States has the virus, but for reasons still unknown, it causes problems for only a small percentage of us.

One thing that we do know for sure is that the active infection can be triggered by stress, fever, or intense sunlight. Sometimes, avoiding these triggers can help prevent another attack.

When herpes does strike the eye, it can cause more than just conjunctivitis. It can also hit the cornea and cause major problems. When the virus is multiplying, it produces tiny clusters of ulcers—called dendrites—that branch out over the surface of the eye. Like the corneal infections that accompany adenovirus, dendrites will usually disappear on their own as the immune system mounts an attack on the virus. Treating them with antiviral eye drops will often speed their disappearance.

The real problems begin when the virus gets into the deeper corneal tissues and causes the sort of severe inflammation that can lead to blurred vision, pain, and corneal scarring—permanent scarring. If permanent damage happens, a corneal transplant may be required. Sometimes, too, the virus can go even deeper and infect the iris or the retina.

Steroid or cortisone-type eyedrops can be used to treat this deeper form of corneal herpes, but sometimes the medication can make it even worse. While steroids do suppress inflammation, they also suppress the immune system's ability to get rid of the virus that started the trouble in the first place. As a rule, it's usually better to avoid steroid eyedrops whenever possible.

Still another herpes virus, the varicella-zoster virus, causes chicken pox and shingles. If the shingles are around an eye, they can cause a red eye and serious inflammation inside the eye itself. This type of infection usually is accompanied by skin vesicles—small fluid-filled bumps—around the eye and intense pain in the forehead and scalp.

The virus travels along nerve fibers. But while these fibers have pathways throughout the skin, only one side of the body is affected. The nerves on the right side of the body do not connect with those on the left side. As a result, a shingles infection on one side of the face—as a rule—will not usually spread to the other.

The varicella-zoster virus can be devastating and requires prompt treatment. But even with prompt treatment, permanent eye damage cannot always be avoided.

We are now in an era when medications are being developed against viral infections in the same way that antibiotics have been developed against bacterial infections. An oral antiviral drug known as acyclovir (Zovirax), when taken early, will usually lead to a milder case of shingles than one would expect. But all herpes infections of the eye require careful monitoring by an ophthalmologist. One or more medications may be required, and it is important to be able to determine just when to increase or decrease the dosage of one or the other.

There is a great deal of time and effort being invested in developing a vaccine and drugs that work against the herpes virus. If you are at risk of developing a herpes virus eye infection, there are two things you can do until that vaccine is developed and perfected: Learn how to spot the early warning signs of a viral infection and avoid the triggers that can kick off a viral eye infection—too much sunlight, stress, or a fever.

Subconjunctival Hemorrhage

Did you ever wake up to find out that someone had apparently painted your eyeball bright red while you slept? Either the entire eye or just a spot on it? Don't bother looking for the paintbrush. The real cause was probably a subconjunctival hemorrhage.

Subconjunctival hemorrhages are caused by the rupture of tiny blood vessels within the conjunctiva. Sometimes you can actually pinpoint the trigger: a coughing or sneezing fit, vomiting, or straining during a bowel movement. Quite often, however, all you'll have is a red eye and not even a clue as to what caused the spontaneous breaking of a small blood vessel.

Whether you know the cause or not makes little difference. There is nothing you can do about it except wait for it to clear up on its own. That usually takes a week or two.

Dacryocystitis

Dacryocystitis is an infection of the lacrimal sac, more commonly called the tear duct.

When it occurs in infants, it is usually because the nasolacrimal duct in the nasal passage—which allows tears to drain from the inner corner of the eye to the inside of the nose—failed to open before birth. Eye infections can then easily develop in the closed duct, causing a noticeable swelling between the baby's eye and the bridge of the nose. Warm compresses, vigorous massage, and antibiotics are usually necessary to open the closed duct. If that fails, an ophthalmologist must use a thin probe to open it.

When dacryocystitis occurs in an adult, the cause is not always as clear-cut. It may be the aftereffect of an injury such as a broken nose, or a sinus infection may have closed off the nasal opening of the duct.

As with infants, the treatment for adults consists of warm compresses, massaging, and antibiotics. While an infant's nasolacrimal duct may be probed to open it when all else fails, an adult with the same problem may have to undergo a surgical procedure called a dacryocystorhinostomy. The operation forms a connection between the lacrimal sac and the nose.

Eric Rost

Copyrighted material; do not reprint without permission.

 

View all articles by Eric Rost