Senior Living: What your red eyes are telling you

By Dr. Thomas LaGrelius

Contributing writer

This month at the office I’ve seen several red eyes. Also, my daughter had a red eye, my granddaughter had a red eye, and I had a red eye. The cause and treatment of each red eye was different.

A red eye can be an emergency and I want patients seen quickly. There are dozens of causes of red eyes I don’t have space here to discuss. Key is the idea that a red eye associated with pain or any vision change is of greatest concern.

You have all heard the term “pink eye” and may think it means something. It doesn’t. It’s a description not a diagnosis. You have to know much more to understand why the eye is pink.

Whatever the cause of your red eye, a couple of things can be done before you see your doctor. First, if you wear contacts, take them out! Red eyes can be caused by erosions of the surface of the eye by contact lenses that will heal faster if you leave the contact out.

Second, it is always safe to use plain artificial tears, called “methyl cellulose” eye drops. They have no other drugs or chemicals in them.

Sometime red eyes are just due to dry eyes, allergies, dust or smoke irritation and get better with just artificial tear therapy put in every hour or two. But do not let that delay calling your doctor!

My personal senior citizen red eye was caused by a blocked oil duct in the upper lid called a “chalazion”. Treatment is simply warm soaks and cleansing till it clears, and resisting the temptation to do more. Persistent cases can respond to tetracyclines or even cortisone, which stop inflammation rather than treat infection. A chalazion is usually not infected. Recurrent cases need to be seen by an eye surgeon.

The commonest cause of a red eye looks quite scary, but it is the most harmless.

It’s called a “subconjunctival hemorrhage.” It can occur at any age, but is more common in seniors. A tiny, invisible blood vessel under the white part of the eye bursts.  Sometimes there is a minor trauma history or it’s preceded by heavy coughing or sneezing.

The bleeding is trivial and stops quickly, but there is nothing to stop the tiny drop of blood from spreading in the space under the eye membrane all over the rest of the white part of the eye. The blood stops spreading at the edge of the colored part of the eye, the limbus. There is a barrier there it can’t cross, but part or all of the white of the eye becomes a bright, fiery red. It is painless and vision is unaffected.

The victim is often surprised to see it in the mirror, or finds out when somebody else says, “What happened to your eye?”

Like any bruise, it eventually yellows and fades away in a couple of weeks. There is no need for treatment, just reassurance. I like to make sure the patient’s blood pressure is not high, that they do not have anything wrong with their blood clotting system and are not diabetic, all three of which can be associated with the problem.

In children and adults, “pink eye” can be caused by “epidemic adenovirus” causing conjunctivitis.

That diagnosis can sometimes be made quickly from a swab of the fluid in the eye or nose. There is no treatment needed, though we use soothing eye drops.  It can look nasty but it will go away on its own. This and other viruses can cause “pink eyes,” and must be distinguished from more serious bacterial conjunctivitis. Viruses often affect both eyes and other parts of the respiratory system too.

Bacterial conjunctivitis tends to look more goopy and inflamed. The lids are also often involved, red and swollen. More often, only one eye is involved. A culture of the fluid can be useful to identify the type of bacterial infection. It is treated with topical antibiotic eye drops.

For more information on the many other types of conjunctivitis see: visionaware.org

Herpes simplex (cold sore virus) and Herpes zoster (shingles virus) in the eye are very serious causes of red eye.

To make that diagnosis, it is necessary to anesthetize the eye with drops and stain the eye with a fluorescent stain. Eye pressure should also be measured during this process. Vision should be checked and compared to previous tests when available.

A classic branching pattern of the fluorescent stain viewed under ultraviolet light makes the diagnosis. At the same time, one can also see simple corneal abrasions, which are common and less serious causes of red eyes. Zoster patients also have skin blisters in the area. These infections are treated vigorously with topical and oral antiviral drugs to prevent vision loss.

Corneal abrasions often occur from trauma or when the patient accidentally scratches the eye while asleep and wakes up with a red eye. There is pain and a sensation like something scratchy is under the upper lid while blinking. Abrasions can be easily seen with fluorescent stain and do not look at all like Herpes simplex or zoster.

Acute glaucoma is one the of most dangerous causes of a red and painful eye. It results from a sudden and severe increase in eye pressure and is a serious vision-threatening emergency. The pressure in the eye has to be measured to make this diagnosis.

Not every red eye is due to problems in the eye itself.

Case Study:

A woman presented with a red and swollen left eye.

The exam did not reveal an obvious diagnosis and her vision was normal.  She had recently had an airline flight with pressure changes affecting her sinuses and ears. She had congestion of her left nostril and some pain over the forehead.

The maxillary sinus and frontal sinus on that side were opaque to light transmission, using a tiny flashlight, but clear on the right. I concluded she had a left sided sinusitis causing her eye to swell and become red.  She was successfully treated with oral antibiotics, nasal and oral decongestants. However, I never proved this diagnosis with a sinus X-ray as I would have liked to. It was a diagnosis made on clinical grounds when we were in San Francisco visiting family.

I think it was correct, but a doctor without his tools is at a real disadvantage.

Live long, be well (and call if you get a red eye),

Dr. Thomas W. LaGrelius, M.D., F.A.A.F.P., is a certified specialist in family medicine and geriatric medicine. He is the founder and president of Skypark Preferred Family Care, a concierge primary care/geriatrics practice based in Torrance www.skyparkpfc.com. He is a staff member at Torrance Memorial Medical Center and Providence Little Company of Mary Torrance Hospital.  Email questions and topic suggestions to office@skyparkpfc.com