Generality
Conjunctival hyperemia is a frequent disorder characterized by redness of one or both eyes.
In some cases, the redness of the eye can represent the only appreciable alteration; at other times, conjunctival hyperaemia is accompanied by a rather variegated symptomatology ranging from blurred vision to increased tearing, from photophobia (sensitivity to light) to the sensation of a foreign body. When the redness is persistent or manifests itself in a recurrent way it is advisable to consult an ophthalmologist.
The simultaneous presence or absence of pain represents the element that most directs the doctor in the choice of diagnostic investigations and different therapeutic strategies.
The conjunctiva in brief
- The conjunctiva is the thin mucous membrane that lines the anterior surface of the eyeball (with the exception of the cornea) and the inner surface of the eyelids.
- Its main function is to protect the eye from foreign bodies and infectious agents. This structure also helps maintain the tear film and facilitates the sliding of the two opposing conjunctival surfaces, thus avoiding friction in the blinking phases.
- The conjunctiva can be affected by numerous pathological processes: inflammation, allergic reactions, neoplasms, dystrophic changes and degenerative diseases. On the conjunctiva, moreover, general affections of the organism of various types, such as infectious diseases, dermatoses and metabolism disorders, are reflected.
What's this
"Conjunctival hyperemia" is the medical term used to indicate ocular redness . This manifestation is extremely frequent, so much so as to represent one of the main reasons for visiting the doctor.
Hyperemia: what it is
In general, hyperaemia is the increase in the amount of blood circulating in a given organ or district of the body, caused mainly by capillary vasodilation.
Mild conjunctival hyperemia is often caused by benign pathologies, which have no relevant consequences on vision. When the redness of the eye is sudden, persistent or recurrent, however, it could indicate the presence of pathologies that are dangerous to the eye.
Causes
Conjunctival hyperemia reflects a dilation of superficial ocular vessels .
One of the most frequent causes of this manifestation is dry eyes: when the eye is not very lubricated, the continuous friction generated by the movement of the eyelid ends up irritating the conjunctiva.
Another reason for the redness of the eye is conjunctivitis, that is the inflammation of the conjunctiva. This condition can manifest itself in acute or chronic form. The causes of conjunctivitis can be various, but the most frequent are the following:
- Eye infections (due to bacteria, viruses, fungi or parasites);
- Seasonal or perennial allergies (hypersensitivity to pollens, dust mites, molds or pet hair);
- Intense irritation from foreign bodies and chemical-physical agents (eg dust, sand, atmospheric pollutants, soap, radiation, etc.).
Other frequent causes of conjunctival hyperemia include:
- Corneal abrasions;
- Penetration of foreign bodies;
- Incorrect use of contact lenses (eg wear them for prolonged periods, do not remove them at night and do not change them regularly).
If the symptom is associated with persistent pain, it may indicate the presence of:
- Uveitis (inflammation that affects part or all of the uveal tract, between the retina and the sclera);
- Iritis (inflammation of the iris);
- Blepharitis (inflammation of the eyelids);
- Keratitis (inflammation of the cornea);
- Sclerite (inflammation of the sclera);
- Acute angle-closure glaucoma.
Ocular redness can also be caused by traumas that cause bleeding in the conjunctival blood vessels.
The most trivial cause of conjunctival hyperemia is crying of emotional or irritative origin. This latter event can occur, in particular, due to various conditions, including:
- Exposure to intense sunlight (without protective glasses);
- Smoke, dust, wind and other irritants (eg ammonia and chlorine);
- Presence of foreign bodies.
Conjunctival hyperemia may also depend on excessive alcohol consumption ; this substance contributes, in fact, to dilate the ocular and cutaneous capillaries, causing the characteristic redness.
Transient eye redness can also be experienced when shampoo, soap or skin care cosmetics accidentally come into contact with the eyes.
Conjunctival hyperemia may also depend on:
- Excessive use of computer monitors or televisions (eye strain);
- Absence of eye protection in hazardous work environments (example: welding processes);
- Side effect of some drugs (eg oral anticoagulants);
- Age (alteration of the tear film linked to aging);
- Sjögren syndrome;
- Acne rosacea;
- Wegener's granulomatosis.
Other situations in which red eyes can occur are "cooling" diseases, such as the flu or the common cold. Often, a febrile state causes a mild conjunctival hyperemia, as well as a cough, especially when intense, can determine the rupture of the small capillaries that supply the sclerae.
Possible causes of conjunctival hyperaemia | |
Conjunctival hyperemia without pain | Eyes red and sore |
Mild conjunctivitis Dry eye syndrome Allergy Irritating external agents Subconjunctival hemorrhage Feverish state Kawasaki syndrome Sclerite / Episcleritis (rare diagnosis) Meningitis (less common) | Severe conjunctivitis Acute keratitis Acute Irite Glaucoma (less common) |
Symptoms and complications
At the ocular level, conjunctival hyperemia manifests as an isolated symptom or occurs in association with other disorders. These vary according to the basic medical condition and may include:
- Blurred view;
- photophobia;
- Excessive tearing;
- Foreign body sensation;
- Mild or intense pain.
Generally speaking, a transient conjunctival hyperemia (lasting about 1-2 days) can be distinguished, which generally has no relevant consequences, from persistent, sudden or recurrent redness. In these cases, conjunctival hyperaemia may be a symptom of a serious illness that should be assessed in an emergency setting.
Alarm signals
Conjunctival hyperemia requires immediate medical attention if the following signs also arise:
- Bleeding from the eye;
- Secretions of dense material of yellow or greenish color;
- Reduction of visual acuity;
- Blurred or double vision;
- Intense eye pain;
- Flashes of light (photopsia);
- Mythesopsia (appearance of moving bodies, black spots, dark spots or streaks, in the visual field).
Conjunctivitis
Inflammation of the conjunctiva causes the rapid appearance of redness, caused by the dilation of numerous blood vessels. Hyperemia is less pronounced near the iris, while it is greater on the sides of the eyeball. Often, this manifestation can arise along with itching, burning, blurred vision and sensitivity to light. Conjunctivitis can also be associated with catarrhal or mucopurulent secretion (the eyes tend to "stick") and the appearance of crust along the eyelids. Therefore, in the presence of severe eye irritation and abundant or yellowish secretions, it is advisable to consult your doctor; in this case, in fact, conjunctivitis probably has an infectious origin and as such can spread to the other eye or be easily transmitted to other people. In the meantime, care must be taken to wash the hands thoroughly and avoid contact between them with the other eye.
Allergy
Seasonal or perennial allergic reactions can occur with recurrent conjunctival hyperemia following exposure to airborne allergens (such as pollen, dust mites, mold or animal hair) or that come into direct contact with the conjunctival mucosa ( hypersensitivity from local contact). During this condition, the eyes appear moderately red and are itchy. The possible excretions tend to appear light in color (unlike conjunctivitis, in which they are yellowish). In addition to conjunctival hyperaemia, allergy causes a characteristic sensation that something (similar to sand) is present along the inner surface of the eyelids.
Subconjunctival hemorrhage
Subconjunctival hemorrhage appears as a bright red spot, not associated with other signs of inflammation. These extravasations of blood below the conjunctiva derive from the rupture of the wall of a capillary and usually appear as a result of minor trauma, coughing and sneezing (for example, in the course of diseases of the upper respiratory tract). In some cases, subconjunctival bleeding may be accompanied by systemic arterial hypertension, blood dyscrasias and viral conjunctivitis.
Glacucoma
If accompanied by very severe pain, conjunctival hyperemia can be caused by a rapid and elevated increase in intraocular pressure, as in the case of acute glaucoma. This pathology is a real medical emergency, which, in the absence of adequate treatment, can compromise vision up to blindness. For this reason, it will be important to go to an emergency room as soon as possible to start treatment quickly.
Foreign body
The presence of a foreign body at the conjunctival level causes a unilateral symptomatology, characterized by conjunctival hyperemia, pain, difficulty in keeping the eye open, tearing and photophobia. If considered to be tarsal, foreign bodies can cause corneal lesions due to the continuous rubbing of the eyelid during blinking. For this reason, they must be removed as soon as possible.
Diagnosis
If conjunctival hyperemia begins suddenly or tends to persist, it is always advisable to undergo a check-up, not using eye drops without an exact diagnosis. In patients with conjunctival hyperemia associated with pain, the slit-lamp examination with fluorescein staining and tonometry is essential.
Once the underlying cause is diagnosed, it is important to follow the therapeutic protocol that the doctor indicates to manage the disorder correctly. This reduces the risk of potential complications such as impaired visual function or the spread of infection.
Therapy
Treatment for conjunctival hyperemia depends on the underlying cause and the severity of the concomitant manifestations. After a thorough eye examination, drug therapy may be indicated, which helps alleviate symptoms. This may include antibiotic drops, eye ointments, saline rinses, artificial tears or antihistamines.
Often, once the exposure to an irritant has been eliminated, conjunctival hyperemia resolves spontaneously within a short time. In other cases, the use of artificial tears or antihistamines (orally, eye drops or ointments) can alleviate symptoms and support the therapy indicated for the underlying condition. If the cause is a bacterial infection, the doctor may prescribe eye drops or ointments containing an antibiotic. In the case of an allergic reaction, however, topical antihistamine and cortisone drops are used (to reduce hyperemia and conjunctival edema), which can be associated with the use of artificial tears and systemic drugs.
To avoid conjunctival hyperemia it is very important to take precautionary measures: avoid environmental pollutants, use a humidifier if the environment is very dry (for example, for heating in closed rooms) and make sure to wash your hands frequently when handling contact lenses.
