Eye Redness, Prominent Blood Vessels of the Eye, Pinguecula, Pterygium: Why Does It Happen and What Can You Do to Treat and Prevent It?

This blog post as well as this entire blog is meant to for educational purposes. Please always check with your eye doctor and or eye surgeon for treatment recommendations.

Eye redness is a common issue that can make your eyes look irritated, bloodshot, or inflamed. Whether it’s due to prominent blood vessels in the conjunctiva (the thin, transparent layer covering the white of the eye and inner eyelids) or the deeper sclera (the white part of the eye), redness can be bothersome and cosmetically concerning. 

But in some patients, it can represent the deeper issue of inflammation.

This blog post explores the causes of eye redness, with a focus on inflammation as the key driver, and outlines effective treatment and prevention strategies, including advanced procedures like argon laser photocoagulation and excision with amniotic membrane transplantation.

Why Do Eyes Get Red? The Role of Inflammation

The most common cause of inflamed or prominent blood vessels in the conjunctiva or sclera is inflammation. This can be triggered by various factors, including allergies, infections, dry eye syndrome, environmental irritants (e.g., dust, smoke), or chronic conditions. Inflammation causes blood vessels to dilate, leading to the characteristic red, bloodshot appearance.

Certain individuals may be more prone to eye redness:

• Rosacea: This is a genetic, systemic – – meaning internal within your body issue, inflammatory condition, which often affects the skin and face and can extend to the eyes structures (as in ocular rosacea), causing chronic conjunctival inflammation and redness and even affect the Meibomian Glands causing dry eye disease. Please listen to the podcast: https://podcasts.apple.com/us/podcast/the-eye-show/id1569268568?i=1000626450873
• Genetic predisposition: Some people naturally have more visible blood vessels or a tendency toward red eyes due to thinner conjunctival tissue or heightened vascular response.

While these factors increase risk, inflammation remains the key common denominator in eye redness, whether it affects the superficial conjunctival vessels or the deeper scleral vessels.

Conjunctival vs. Scleral Blood Vessels:

• Conjunctival vessels: Superficial, bright red, and movable with a cotton swab. Often linked to external irritants like allergies or dry eye.
• Scleral vessels: Deeper, with a more violaceous redness, often fixed and painful. Scleral inflammation (scleritis) may indicate systemic conditions like autoimmune diseases.

Other related conditions include:

• Pinguecula: A yellowish, benign growth on the conjunctiva near the cornea, caused by UV exposure, wind, or dust. It can become inflamed, worsening redness.
• Conjunctival Chalasis: Loose, redundant conjunctival tissue, often due to aging or chronic inflammation, leading to irritation and tearing.

Treatment Options for Eye Redness

Treating eye redness starts with addressing the root cause: inflammation. Below are the primary strategies, starting with ways to reduce inflammation, followed by advanced procedures for persistent cases.

1. Treat the Underlying Inflammation

Reducing inflammation is the cornerstone of managing eye redness. Here are evidence-based and practical approaches to decrease inflammation:

• Protect the eyes from UV light: Prolonged exposure to sunlight’s ultraviolet (UV) rays increases conjunctival inflammation and can worsen pinguecula. Wear UV-blocking sunglasses with 100% UVA/UVB protection to shield your eyes from harmful rays.
• Use blue-light-blocking glasses: While not definitively proven in randomized, double-blind, controlled studies, blue light from computer screens and devices may contribute to eye strain and inflammation. I recommend blue-light-blocking glasses for prolonged screen time as a precautionary measure to potentially reduce inflammation.
• Adopt an anti-inflammatory diet: Diet plays a significant role in systemic inflammation, which can affect the eyes. Reduce or eliminate gluten and refined sugars, and even dairy which are pro-inflammatory. Focus on whole foods like leafy greens, fatty fish (rich in omega-3s), and antioxidants (e.g., berries, nuts). A Mediterranean-style diet is ideal for reducing inflammation.
• Lifestyle practices:
• Exercise: Regular physical activity (e.g., 30 minutes of moderate exercise most days) reduces systemic inflammation.
• Prayer and meditation: Stress exacerbates inflammation. Mindfulness practices like prayer or meditation can calm the body and reduce stress-induced redness.
• Sleep well: Aim for 7–9 hours of quality sleep nightly to support overall eye health and reduce inflammation.
• FDA-approved nonsteroidal anti-inflammatory medications:
• Xiidra (lifitegrast): A prescription drop that targets inflammation in dry eye disease, reducing redness and discomfort.
• Restasis (cyclosporine A): Another drop for chronic dry eye, it reduces inflammation by modulating the immune response.
• Cequa (cyclosporine A, higher concentration): Similar to Restasis, it’s effective for severe dry eye-related inflammation.
• Vevye (cyclosporine, water-free formulation): A newer option for dry eye, it delivers anti-inflammatory benefits with enhanced comfort.
• Steroid eye drops: Short-term use of corticosteroid drops (e.g., prednisolone) can rapidly reduce severe inflammation. These are prescribed cautiously due to potential side effects like increased eye pressure and cataract formation refused for a longer period of time: for some people this can mean just a couple of weeks and for some people this can mean months. Genetics has a lot to do with how quickly steroid drops will cause a pressure increase which increases the risk of blindness from glaucoma, which is nerve damage; and cataract formation. I always recommend Patience to use the least amount of stairway as possible and when possible to choose to use their platelet rich plasma drops or plasma rich in growth factor drops or autologous serum because that does not increase the risk of high pressure/glaucoma or cataract.
• Advanced biologic therapies:
• Autologous serum drops: Made from a patient’s own blood, these drops contain natural anti-inflammatory factors and growth factors to heal the ocular surface.
• Platelet-rich plasma (PRP) drops: Similar to serum drops, PRP delivers concentrated anti-inflammatory and regenerative components.
• Amniotic membrane: Derived from donated placenta, amniotic membranes have potent anti-inflammatory and regenerative properties. They can be applied as a temporary “patch” or used in surgical procedures (see below).
• Cord blood serum: Rich in growth factors, it’s used in some cases to reduce inflammation and promote healing.
• Autologous stem cells: Emerging therapies using a patient’s stem cells may help regenerate damaged conjunctival tissue and reduce chronic inflammation, though these are still investigational.

2. Argon Laser Photocoagulation

What is it? Argon laser photocoagulation uses a focused laser to coagulate (clot) inflamed blood vessels or reduce pinguecula-related vascularity.

How does it work?

• For inflamed conjunctival vessels, the laser targets dilated vessels, causing them to shrink, reducing redness.
• For pinguecula, it decreases associated inflammation and vascular prominence, improving symptoms and appearance.

Procedure:

• Topical anesthetic drops numb the eye.
• A contact lens stabilizes the eye and focuses the laser.
• The laser delivers precise energy to target vessels or pinguecula tissue.
• The outpatient procedure takes minutes, with minimal downtime.

Benefits:

• Non-invasive, with quick recovery.
• Effective for mild to moderate redness or inflamed pingueculae.

Limitations:

• Not a permanent fix; new vessels may form.
• Less effective for large pingueculae or conjunctival chalasis.

Risks:

• Temporary discomfort or light sensitivity.
• Rare scarring or pigment changes.

3. Excision with Amniotic Membrane Transplantation

What is it? This surgical procedure removes inflamed vessels, pingueculae, or conjunctival chalasis, with an amniotic membrane graft applied to promote healing and prevent recurrence.

How does it work?

• Inflamed vessels: Chronically dilated vessels are excised, and the amniotic membrane reduces postoperative inflammation.
• Pinguecula: The growth is removed, and the graft covers the defect for smooth healing.
• Conjunctival chalasis: Excess tissue is trimmed, and the membrane stabilizes the conjunctiva.

Procedure:

• Performed under local or general anesthesia.
• Abnormal tissue is excised, and an amniotic membrane is sutured or glued over the site.
• A bandage contact lens may be used during healing.

Benefits:

• More permanent than laser treatment.
• Amniotic membrane minimizes scarring and inflammation.
• Effective for severe or recurrent cases.

Limitations:

• Invasive, with longer recovery (days to weeks).
• Higher cost due to surgery and graft.

Risks:

• Rare infection, bleeding, or graft failure.
• Temporary discomfort or foreign body sensation.

Prevention Strategies

Preventing eye redness involves minimizing inflammation and protecting the ocular surface:

• Wear UV-blocking sunglasses: Protect against UV-induced inflammation and pinguecula formation.
• Use blue-light-blocking glasses: Consider them for screen time to potentially reduce strain and inflammation.
• Follow an anti-inflammatory diet: Limit gluten and sugar; prioritize anti-inflammatory foods.
• Practice good eye hygiene: Avoid rubbing eyes, which can worsen chalasis or pinguecula.
• Use artificial tears: Lubricate eyes to reduce irritation and inflammation.
• Manage allergies: Antihistamine drops or avoiding allergens can prevent conjunctival inflammation.
• Regular eye exams: Monitor for underlying conditions like dry eye or scleritis, especially if redness persists.

When to Seek Treatment?

• Mild redness: Start with anti-inflammatory measures (e.g., lifestyle changes, artificial tears, or prescription drops like Xiidra or Restasis).
• Persistent or severe redness: Consider argon laser photocoagulation for conjunctival vessels or pinguecula.
• Chronic or cosmetically bothersome cases: Excision with amniotic membrane transplantation is ideal for inflamed vessels, large pingueculae, or conjunctival chalasis.
• Scleral redness or severe eye pain: Seek immediate evaluation, as this may indicate scleritis or an infection or tumor. Scleritis means inflamed deeper Scleral blood vessels, which are under the conjunctiva with pain, especially with eye movement. This is considered a medical emergency and needs to be treated right away.