Michael Cole, OD, Child and Family Eye Care Center

“I THINK I’VE got pink eye; I need some drops,” is a common phrase heard in our clinic. While red eyes are common occurrences, it is important to determine the cause of the redness before treatment. “Pink eye” isn’t really a diagnosis, but rather a description of the situation — that the eyes are red. There are many reasons why one’s eyes could be red, some of which are caused by infections, but many are not.

By far, the most common cause of red eyes that come into our clinic is due to improper contact lens wear. When contact lenses are not discarded as designed or are worn repeatedly overnight, the cornea becomes inflamed, causing the body to mount an immune response. This immune response often causes sores on the cornea, leading to light sensitivity, extreme pain, and (you guessed it!) a very red eye. Frequently, these episodes are incorrectly explained as “infections” due to not being evaluated properly. Unless treated appropriately, these small sores will fester and leave scars that will affect long-term vision.

An allergic reaction can also lead to very red eyes. Allergies can also cause significant swelling of the white part
of the eye, which is often alarming to those affected. Frequently there are recurrent episodes of allergic responses, and it is important to resolve acute episodes as well as formulate an effective long-term treatment plan.

Often, a foreign body or mild injury is the cause of redness. One may not recall getting something lodged in
the eye, but only a very tiny object can create considerable irritation. Without a biomicroscope for careful inspection, it is near impossible to find a small object tucked in a corner of the eye.

Acute, painful red eyes need to be evaluated by an eye care professional for proper diagnosis. Recently, a man came into our office with a red eye and severe enough pain to keep him home from work and cause a few sleepless nights. He had been treated with two different antibiotic eyedrops with no improvement and was desperate for help. This man did not have an infection, but rather a condition called uveitis, a severe inflammatory reaction. Because he had not gotten proper treatment, his iris had adhered to the lens that sits behind it, preventing the normal flow of fluid out of the eye. His eye pressure had risen to dangerously high levels causing his pain and irreparable damage. With appropriate treatment, he was back to normal in no time.

When an infection is present, it is important to know what type of pathogen the culprit is. In almost all cases, there is a virus causing the problem. Because the vast majority of ocular infections are viral in nature, antibiotic eye drops are ineffective. Some viral infections are rather benign and will run their course in a week or two, while others are more concerning. For example, the two viruses that cause cold sores and shingles can attack the eye, and, if left untreated, will cause damage that results in permanent vision impairment. An eye care provider can tell you what type of infection is present and treat it appropriately. Most viral ocular infections are no more contagious than a common cold, and the best way to protect yourself or others is to wash hands often.

In some rare cases, an actual bacterial infection can occur on the ocular surface. When this does happen, there is normally an excessive amount of thick, goopy discharge. While ocular inflammation and viral infections normally cause some discharge as well, bacterial conditions have incredible amounts of discharge — more than you would
imagine possible. Although this amounts to a gross, goopy situation, in most cases these are cleared up quickly with treatment.

Other organisms such as fungi and amoebas can invade the tissues of the eye as well. While these types of events are thankfully rare, they are very serious and difficult to treat. When they occur, there is almost always permanent damage as a result. Early diagnosis and treatment is critical for the best outcomes in these cases.

In order to properly treat red eyes, it is important that patients are evaluated by an eye care provider. Without proper diagnosis and treatment, otherwise mild conditions can become worse and cause very poor outcomes, including permanent vision loss.

If your family encounters a red eye, please give our office a call and we would be happy to see you for same day treatment