What should I do if my eyes are bloodshot?

Eye redness is a common occurrence in daily life—for instance, after staying up late or crying for an extended period. While some cases of eye redness are merely conspicuous without other symptoms, others may be accompanied by pain or itching. Eye redness has numerous potential causes; therefore, identifying and addressing the underlying cause is essential to achieving optimal resolution and preventing recurrence. So, what should you do if your eyes become red? Below, we outline effective management strategies.

What to Do If Your Eyes Are Red

Acute Conjunctivitis

Cause: A highly contagious ocular infection commonly caused by bacterial or viral pathogens. Onset is typically abrupt, with either simultaneous or sequential involvement of both eyes. Symptoms include foreign-body sensation, pruritus, burning, photophobia, and ocular discomfort; visual acuity is usually unaffected.

Symptoms: Eyelid edema, conjunctival hyperemia, and copious discharge—purulent (bacterial), mucoid, or mucopurulent in nature. Crusting may seal the eyelids shut upon waking. In viral cases, discharge tends to be watery; corneal involvement (e.g., subepithelial infiltrates) may occur, along with preauricular or submandibular lymphadenopathy and tenderness.

Management Principles: Given its high transmissibility, strict isolation precautions are warranted. Avoid sharing towels, handkerchiefs, or washbasins; thoroughly clean and disinfect shared items after use. Maintain ocular hygiene—irrigate with saline or clean water if discharge is profuse. Topical antibiotics or antiviral agents may be prescribed. Systemic manifestations such as fever or headache necessitate concurrent internal medicine evaluation and management.

Acute Iridocyclitis

Cause: Etiology is complex and often idiopathic; however, associations exist with autoimmune disorders—including rheumatoid arthritis, tuberculosis, syphilis, and viral infections.

Symptoms: Ciliary or mixed conjunctival injection, keratic precipitates (KPs) on the posterior cornea, aqueous flare and cells, iris edema, miosis or irregular pupil shape, sluggish or absent pupillary light reflex, and posterior synechiae (adhesions between iris and lens). Intraocular pressure is typically normal but may fluctuate (elevated or reduced). Visual acuity declines, accompanied by marked photophobia, lacrimation, and ocular pain—often radiating to the brow, temple, or forehead.

Management Principles: Identify and treat the underlying etiology whenever possible. Local therapy includes topical 1% atropine to induce cycloplegia and mydriasis, warm compresses, and corticosteroid eye drops—or subconjunctival steroid injection in severe cases. Systemic corticosteroids (intravenous or oral) and nonsteroidal anti-inflammatory drugs (e.g., indomethacin) may be required for refractory or severe inflammation.

Corneal Keratitis

Cause: Most cases result from exogenous infection. Minor corneal trauma frequently serves as an entry point for pathogens—including bacteria, fungi, and viruses. Additionally, impaired corneal immunity or nutritional deficiencies may predispose individuals to keratitis. Symptoms include ocular pain, foreign-body sensation, blepharospasm, photophobia, epiphora, and sudden vision loss.

Symptoms: Clinical features vary depending on the causative agent, yet core signs include eyelid edema and spasm, prominent conjunctival injection, mixed conjunctival hyperemia with chemosis, corneal opacification or ulceration, keratic precipitates, and anterior chamber hypopyon (pus accumulation).

Management Principles: Etiologic diagnosis is paramount. Since most keratitis cases are infectious, prompt initiation of appropriate antimicrobial or antiviral therapy is critical.
Diagnostic workup includes slit-lamp examination, Gram and Giemsa staining of corneal scrapings, fungal potassium hydroxide (KOH) preparation, bacterial/fungal culture, and antimicrobial susceptibility testing. For bacterial keratitis, broad-spectrum antibiotics (e.g., fluoroquinolones) are first-line; Pseudomonas aeruginosa infections warrant adjunctive tobramycin, polymyxin B, or colistin. Fungal keratitis requires antifungals such as amphotericin B or natamycin. Viral keratitis (e.g., herpes simplex) is treated with topical or subconjunctival acyclovir or ganciclovir.Topical 1% atropine may be used to dilate the pupil, relieve ciliary spasm, and prevent posterior synechiae. Warm compresses and occlusive eye patching can alleviate pain, improve local circulation, and promote resolution of inflammation and ulcer healing. When the etiology remains uncertain, empiric broad-spectrum or combination antimicrobial therapy is recommended.

We hope this information proves helpful. Wishing you good health and happiness!