Red eye is a symptom that develops with inflammatory lesions of the eyelids, tear ducts, conjunctiva or cornea. Clinically, the disease is manifested by hyperemia, increased tear, edema, pain, visual dysfunction. To determine the causes of development, biomicroscopy, visometry, perimetry, ultrasound, gonioscopy, tonometry, ophthalmoscopy are performed. Conservative therapy includes the use of antibacterial drugs, NSAIDs, glucocorticosteroids, antihistamines, mydriatics and antiseptics.
Red eye is a common pathology in practical ophthalmology. There are no accurate statistical data on the epidemiology of the disease, which is due to the large number of background diseases that lead to its development. It was found that more than 75% of the population had symptoms of this pathology of physiological or pathological genesis. When the anterior part of the eyeball is affected, this indicator reaches 95-98%. The disease can develop at any age. Men and women suffer with the same frequency. Pathology is widespread everywhere.
Causes of red eye
This ophthalmopathology is considered as a symptom complex that characterizes the course of the pathological process in the anterior segment of the eye. Risk factors for the development of the disease are prolonged use of contact lenses, autoimmune and metabolic disorders, arterial hypertension, a burdened allergic history. The main causes of development include:
- Inflammation of the structures of the eyeball. Red eye is a common manifestation of blepharitis, eyelid abscess, dacryoadenitis, dacryocystitis, conjunctivitis, keratitis.
- Exposure to chemicals. Injection of conjunctival vessels is a frequent reaction to decorative cosmetics, eye care products, increased chlorine content in water, chemical reagents.
- The ingress of a foreign body into the orbital cavity. Pathology occurs when the conjunctiva is irritated by foreign bodies – dust particles, cosmetics or smoke.
- Visual fatigue. Overstrain of the eye muscles leads to a violation of blood supply and the appearance of hyperemia. This is a physiological phenomenon that passes on its own.
- Allergic reactions. The development of clinical manifestations is provoked by allergies to pollen, pet hair, and flowering plants.
- Infectious diseases of the eyes. Injection of conjunctival vessels is a characteristic symptom of toxoplasmosis, syphilis, chlamydia.
- Blood diseases. Clinical manifestations may indicate hemophilia, thrombocytopenic purpura, idiopathic thrombocytopenia, Willebrand’s disease, desyminated intravascular coagulation syndrome (DIC).
- Dry eye syndrome. The development of pathology is caused by a violation of the process of lacrimation, which is the basis of xerophthalmia.
The key importance in the mechanism of the occurrence of red eye is assigned to an increase in the permeability of the vascular wall. This is caused by the release of vasoactive substances into the bloodstream: histamine, bradykinin, interleukins 1, 2, 6, 8, thromboxane A2. Less often, hyperemia is a consequence of an anomaly in the development of blood vessels, manifested by thinning of the wall or a change in the rheological properties of blood. As a result, the vascular network is clearly visualized on the surface of the eyeball. If the integrity of the capillary walls is violated, bleeding develops with the formation of extensive hemorrhage zones.
Symptoms of red eye
The first manifestation of pathology is hyperemia of the conjunctival surface, which is later joined by small areas of hemorrhage located on the periphery of the limb. The onset is usually rapid, prodromal phenomena are present only with the infectious genesis of the disease. With a unilateral form, there may be a narrowing of the pupil on the side of the lesion. Patients complain about the appearance of “flies” or “floating opacities” in front of their eyes. There is a feeling of “sand in the eyes”, the development of which is due to the expansion of the vessels of the conjunctiva. The intensity of the pain syndrome varies from a feeling of mild discomfort to severe pain, accompanied by the inability to open the eyelids, irradiation into the brow arches, temporal region.
Patients note the appearance of itching, swelling, increased lacrimation. A characteristic sign of the disease is photophobia. With a complicated course, whitish, yellow or green masses intensively stand out from the medial corner of the eye. Visual dysfunction is manifested by the appearance of “fog” or “shroud” in front of the eyes, a decrease in visual acuity. There is a pronounced cosmetic defect. The recurrent course of the syndrome in children disrupts the process of social adaptation. With allergic genesis, symptoms increase at the time of exposure to allergens, autumn-spring seasonality is noted.
With the development of the disease against the background of conjunctivitis, changes in the cornea are not visually determined, but its increased sensitivity is noted. With dacryocystitis, along with all the symptoms described above, pathological masses of a cheese-like consistency are released from the lower lacrimal point when pressing on the lacrimal sac. In addition to the general symptoms in patients with iridocyclitis, the color of the iris changes, the pupil is deformed. Soreness is most pronounced in the projection area of the ciliary body. When the disease occurs against the background of blepharitis, symptoms are represented by redness of the eyelids, the presence of scales between the eyelashes and on the skin, ulcerative defects on the skin of the eyelids, loss of eyelashes.
With low effectiveness of therapeutic measures on the part of the cornea, complications such as bacterial keratitis, degenerative-dystrophic changes or turbidity may occur. The acute course of inflammatory processes of the conjunctiva, tear ducts, eyelids or cornea is often replaced by chronic. Dacryocystitis is often complicated by phlegmon of the lacrimal sac. With a prolonged course of iridocyclitis, the pupillary opening may grow, which leads to a violation of the circulation of intraocular fluid and the development of secondary glaucoma. Visual acuity decreases due to opacity of optical media, spasm of accommodation. The rarest complications of pathology are orbital cellulitis, the formation of connective tissue mooring. The development of the inflammatory process with the appearance of pan- and endophthalmitis is more often noted.
To make a diagnosis, a visual examination is carried out, a special complex of ophthalmological examinations is used. Hyperemia of the anterior surface of the eyes is detected with the naked eye. The main diagnostic methods include:
- Biomicroscopy of the eye. The technique makes it possible to visualize the expansion of the conjunctival vascular network, hemorrhage zones, clouding of the lens.
- Visometry. A decrease in visual acuity is determined. If a spasm of the accommodation apparatus is suspected, an additional test with mydriatics is recommended.
- Perimetry. An auxiliary method that allows you to identify a concentric narrowing of the field of vision.
- Ultrasound of the eyes. Ultrasound is used to visualize organic changes (foreign body) that can lead to the development of pathology. The technique is also used to detect objective signs of complications (clouding of the lens, anterior and posterior synechiae).
- Ophthalmoscopy. Examination of the fundus is carried out in order to study the condition of the optic nerve disc and retina to assess the reversibility of visual dysfunction.
- Gonioscopy. A small amount of turbid fluid in the anterior chamber may be detected.
- Tonometry. Intraocular pressure increases a second time in people with a history of uveal tract damage.
Treatment of red eye
The leading role in the treatment of pathology is occupied by etiotropic therapy, carried out to eliminate the clinical manifestations of the underlying disease. Surgical interventions are effective for traumatic injuries of the eyeball and dacryocystitis (dacryocystorinostomy). In early childhood, probing of the lacrimal-nasal canal is recommended. Conservative therapy is based on the use of:
- Antibacterial drugs. The appointment of a course of antibiotic therapy should be preceded by a study of the sensitivity of the pathogen to the drug used (antibioticogram). Frequent instillations of drugs are shown (at least 6-8 times a day). In severe cases, systemic antibacterial therapy is used.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). They are used to stop signs of inflammation, reduce the manifestations of edema and pain syndrome.
- Glucocorticosteroids. Instillations of hormonal drugs are prescribed when NSAIDs are ineffective. In the idiopathic variant of the disease, glucocorticosteroids are strictly contraindicated.
- Mydriatics. They are used in patients with iridocyclitis to dilate the pupil and normalize intraocular hydrodynamics. The expediency of using this group of drugs to prevent the fusion of the pupillary orifice has been proved.
- Antihistamines. They are prescribed for the allergic nature of the disease in the form of drops. In case of systemic manifestations of allergy, oral administration or intramuscular administration is indicated.
- Antiseptic solutions. Antiseptic solutions are used to wash the conjunctival cavity in order to remove pathological masses.
- Vitamin therapy. Vitamins A, C and P are used in addition to the main treatment.
Prognosis and prevention
The prognosis for life and working capacity is favorable. Specific preventive measures have not been developed. Non-specific prevention is reduced to compliance with the rules of eye hygiene, prevention of contact of dust and toxic substances with the conjunctiva. Patients with a burdened ophthalmological history should be examined twice a year by an ophthalmologist with mandatory biomicroscopy of the eyes. When working in production, it is recommended to use personal protective equipment (glasses, masks). For preventive purposes, instillations of moisturizers, artificial tear preparations are prescribed.