Squiggly veins in eyes

Eye redness

Bloodshot eyes appear red because the vessels at the surface of the white portion of the eye (sclera) become swollen. Vessels may swell due to:

  • Eye dryness
  • Too much sun exposure
  • Dust or other particles in the eye
  • Allergies
  • Infection
  • Injury

Eye infections or inflammation can cause redness as well as possible itching, discharge, pain, or vision problems. These may be due to:

  • Blepharitis: Swelling along the edge of the eyelid.
  • Conjunctivitis: Swelling or infection of the clear tissue that lines the eyelids and covers the surface of the eye (the conjunctiva). This is often referred to as “pink eye.”
  • Corneal ulcers: Sores on the cornea most often caused by a serious bacterial or viral infection.
  • Uveitis: Inflammation of the uvea, which includes the iris, ciliary body, and choroid. The cause is most often not known. It may be related to an autoimmune disorder, infection, or exposure to toxins. The type of uveitis that causes the worst red eye is called iritis, in which only the iris is inflamed.

Other potential causes of eye redness include:

  • Colds or allergies.
  • Acute glaucoma: A sudden increase in eye pressure that is extremely painful and causes serious visual problems. This is a medical emergency. The more common form of glaucoma is long-term (chronic) and gradual.
  • Corneal scratches: Injuries caused by sand, dust, or overuse of contact lenses.

Sometimes, a bright red spot, called a subconjunctival hemorrhage, will appear on the white of the eye. This often happens after straining or coughing, which causes a broken blood vessel on the surface of the eye. Most often, there is no pain and your vision is normal. It is almost never a serious problem. Because the blood leaks into the conjunctiva, which is clear, you cannot wipe or rinse the blood away. Like a bruise, the red spot will go away within a week or two.

Red Veins in Your Eyes

Red-eye is a common term to describe red, bloodshot eyes. Usually, if the whites of the eyes have red veins in them, it is due to fatigue, lack of sleep, viral infection or irritation. If obvious red blood vessels persist it could point to an underlying medical condition or infection. Before trying to get rid of them you should first try to figure out why they might be there.

Bloodshot eyes

Bloodshot or red eyes occur when small blood vessels that are present on the surface of the eye become enlarged and congested with blood. This happens due to a reduced amount of oxygen being supplied to the cornea or the tissues covering the eye. The appearance of red-eye ranges in severity from a bright red that completely covers the sclera to a few enlarged blood vessels that look like wiggly red lines across the white of the eye.

Symptoms of red eye

Red eyes can occur in one or both eyes and may be accompanied by:

  • eye pain
  • itching
  • eye discharge
  • swollen eyes
  • visual disturbances such as blurry vision

Or have no irritation at all.

Common causes of red veins in the eyes

Red blood vessels that are obvious in the sclera can be due to many different causes—here are some of the most common causes.

Contact lenses

One of the main causes of eye irritation and redness is over-wearing or not properly caring for your contact lenses. This can cause a build-up of irritating surface deposits and microbes on your eye.

If your eyes become bloodshot while wearing contact lenses, remove your contacts immediately and visit your eye doctor.

Allergies

An allergic reaction to dust, pollen, animal hair or mould can lead to red blood vessels in the eyes. If you have hay fever the eyes are usually itchy and irritated and you might have other symptoms such as sneezing and nasal congestion.

Dry eyes

If you don’t have enough lubrication in the eye this can lead to irritation, redness and a gritty sensation. If dry eyes are a chronic problem, this could indicate Sjogren’s syndrome which is an autoimmune condition that affects the tear ducts.
For Article on Dry Eye

Conjunctivitis

Conjunctivitis is one of the most common and contagious eye infections, particularly among school children. It occurs when the conjunctiva becomes infected. The conjunctiva is the thin, normally transparent membrane that covers the sclera and lines the eyelids. When the conjunctiva is infected, the blood vessels within it become irritated and swell, giving the eye a red or pink appearance. In fact, a reddish-pink eye is a tell-tale symptom of conjunctivitis.
For Article on Conjunctivitis

Eye injuries

Trauma or injury to the eye can result in red, bloodshot eyes. As an inflammatory response to injury, blood vessels in your eye dilate to allow more blood flow to the site of the injury for quicker healing. This dilation (and sometimes breakage) of blood vessels on the eye is what causes the redness.

Eye injuries can range from minor eye scratches (corneal abrasions) to deep puncture wounds and chemical burns. Whatever the source, always treat an eye injury as a medical emergency and see an eye doctor immediately.

Treatment suggestions

You can minimize your risk of contact lens-induced red eye by keeping your lenses clean and disinfected and replacing them according to your eye doctor’s directions. Your doctor also may advise you to try daily disposable lenses or a different type of contact lens material, such as gas permeable lenses.

Allergy support

In this instance, most people would reach for an antihistamine medication or eye drop to provide relief. Other alternatives include taking a natural anti-allergy product that contains zinc, vitamin D, quercetin, perilla or albizzia.
For Product Suggestions

Eye drops

Looking for eyedrops to relieve and clear redness from irritated eyes?

Fish oil

Supplementing with fish oil has in a meta-analysis of randomised controlled studies to be an effective treatment for dry eye syndrome. Fish oil is rich in omega-3 which reduces inflammation and helps support natural tear production.

Blood vessel support

The blood vessels in our eyes are delicate and prone to breakages. To support healthy capillaries in the eyes consider taking:

  • bilberry
  • vitamin C
  • bioflavonoids
  • vitamin E

All these nutrients are antioxidants which prevent eye inflammation, support healthy circulation and boost immunity to provide protection against infection.

Oligomeric Proanthocyanidins (OPCs) are the active ingredient found in grape seed extract. Thiese can help strengthening the capillaries and preventing blood vessel leakage.
For Product Suggestions

Eye bath

If there is infection or irritation in the eye which is causing visible redness you could try an eye bath with drops of calendula and eyebright. Make sure you make up a different solution for each eye and that the water and equipment used is sterilized correctly.

Warm compress

Placing a heat pack or warm washer over the eyes can bring relief to dry, irritated eyes. The heat promotes circulation and stimulates natural oil production to lubricate the eyes. Repeat as often as needed throughout the day. In contrast to a warm compress apply a cold tea bag or cloth over the eyes to reduce inflammation and itchiness.

Conclusion

If you experience red veins in the eyes, there’s no need to panic. Reflect on what things in your daily routine and lifestyle could be impacting your eyes and take this information to your health practitioner. There are many different causes of multiple blood vessels in the eyes and resolving the issue can only be obtained if a cause is identified.

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Ariano R. Efficacy of a novel food supplement in the relief of the signs and symptoms of seasonal allergic rhinitis and in the reduction of the consumption of anti-allergic drugs. Acta Biomed. 2015 Apr 27;86(1):53-8

Liu A, Ji J. Omega-3 essential fatty acids therapy for dry eye syndrome: a meta-analysis of randomized controlled studies. Med Sci Monit. 2014 Sep 6;20:1583-9

Monograph. Vaccinium myrtillus (bilberry). Altern Med Rev. 2001 Oct;6(5):500-4.

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Tortuous Retinal Arteries

The significance of tortuous retinal arterioles has been hotly debated in the literature for decades. While some studies suggest that tortuosity may be strongly associated with systemic vascular conditions, others have disproved this theory and have found no apparent correlation.13 One study concluded that older age, higher blood pressure, alcohol consumption, greater BMI, diabetes and higher HbA1c level are significantly associated with less tortuous arterioles.13 A smaller study of 218 healthy young Caucasians associates straighter retinal arterioles with higher blood pressure and BMI.13 Conversely, two small clinic-based studies associate elevated blood pressure with increased retinal arteriolar tortuosity. Therefore, additional larger population-based studies are needed to further evaluate the relationship between arteriolar tortuosity and vascular diseases.

Narrowed, attenuated retinal arterioles in retinal artery occlusion. Click images to enlarge.

Narrowed Retinal Arteries

Narrowed retinal arteries can occur secondary to atherosclerosis, hypertension or both.14 Chronic hypertension has the potential to cause many types of ocular findings, including: arteriolar attenuation, arteriole-venule nicking, cotton wool spots, hemorrhage, maculopathy, and optic nerve edema if severe.14 Retinal arteriolar attenuation is a defining sign of hypertensive retinopathy.14 The finding is considered an autoregulatory, physiological response to retinal artery vasospasm.14

Chronically elevated blood pressure can cause irreversible arteriolar narrowing and hardening of the arteriolar wall, with an apparent broadening of the arterial light reflex.14 “Copper” and “silver wiring” are exaggerated forms occurring secondary to increased optical density of the vessel.

The major anatomical difference between retinal arterioles and venules are that arterioles have thicker vessel walls capable of compressing and reducing blood flow through the underlying venule. The sclerotic changes in vessel wall structure from chronic hypertension may have the potential to indent the underlying venule when crossing over it in the retina.14 This crossing change, known as arteriovenous nicking, can change the hemodynamics within the venule. This condition should be watched closely and managed cautiously, as patients are at increased risk for thrombus formation and secondary branch retinal occlusion. Managing them with periodic evaluation as well as comanaging systemic risk factors with a primary care provider or cardiologist is crucial to prevent future manifestations of the disease.

Retinal artery occlusion is an important consideration when a patient presents with narrowed retinal arteries. These occlusions are commonly caused by emboli, thrombi, trauma or inflammation causing a blockage within the retinal arteriole. Recognizing arteriolar attenuation, in conjunction with other signs of a retinal artery occlusion (pallid edema of the retina, correlating visual field or visual acuity loss, presence of an afferent pupil defect) supports the diagnosis. Fundus photography can aid in side-by-side retinal comparison and identification of reduced retinal perfusion and arteriole attenuation. OCT-A can image the abnormal blood flow through the arteriole system.

Retinal artery occlusion is a significant indicator of systemic disease.15 All acute cases of retinal artery occlusion warrant immediate referral to a stroke unit for evaluation. It is essential to suspect certain cases of retinal artery occlusions may be caused by giant cell arteritis. Should suspicion be high, immediate evaluation with erythrocyte sedimentation rate and c-reactive protein is required as 5% to 10% of all central retinal artery occlusions are caused by giant cell arteritis.15

Atherosclerosis is caused by the hardening of the vessel wall due to the build-up of fatty plaque, causing a reduced arteriole lumen size. The Blue Mountains Eye Study and the Beaver Dam Eye Study revealed smaller arterioles and larger venules were associated with a 20% to 30% increased risk of coronary heart disease (CHD) mortality independent of cardiovascular risk factors.16 Another study showed that women with larger retinal venules or narrower arterioles each had a 30% higher risk of CHD, even after adjusting for other known cardiovascular risk factors.16

Understanding the various conditions that may change the appearance of the retinal vasculature will allow for early management and possible prevention of sight-threatening sequelae. Aside from direct clinical examination, the newly developed OCT-A may prove to be a useful, noninvasive imaging technique of the retinal microvasculature. OCT-A is capable of direct, high resolution imaging of blood flow using the motion from red blood cells within the vessel. Using advanced imaging modalities such as fundus photography and OCT-A will allow for monitoring and detection of vascular changes over time. The status of the retinal vessels can provide much information about our patients’ systemic health. The retinal vascular system has a story to tell if you are willing to listen.

Dr. Rousso is a faculty member at Nova Southeastern University’s College of Optometry.

Dr. Sowka is chief of advanced care and director of the glaucoma service at Nova Southeastern University College of Optometry.

Red Eyes

Why is my eye red?

Red eye is a condition in which the white part of your eye (the sclera) becomes red. Sometimes you can see squiggly lines, like veins, on the surface of your eye, making one or both eyes appear bloodshot. The redness comes from blood vessels that are dilated as a result of some type of irritation or infection.

The numerous causes of red eye include:

  • Allergies
  • Dry eyes
  • Glaucoma
  • Eye injury
  • Blepharitis (eyelid inflammation)
  • Pink eye (conjunctivitis)
  • A sty (bump) in your eye
  • Foreign object in your eye
  • Keratitis (inflammation)
  • Smoke and air pollution
  • Digital eye strain
  • Corneal ulcer
  • Alcohol consumption
  • Lack of sleep
  • Subconjunctival hemorrhage

In many cases, the redness goes away on its own, but if it doesn’t, or one eye appears severely red and veiny, it could be a sign of an underlying, serious eye condition. It’s a good idea to seek treatment as soon as possible, as some untreated eye diseases can lead to permanent vision loss.

When should I see a doctor for red eyes?

If redness accompanies sudden vision changes along with eye redness, or you have a severe headache or eye pain, seek emergency medical care. If, however, you have one red eye and symptoms spread to the other eye, it could be a sign of conjunctivitis, which is highly contagious. Additionally, if you have a red eye that doesn’t get better after a few days, or your eye continually feels irritated, it’s time to make an appointment with Dr. Ghobrial.

Dr. Ghobrial provides expert diagnosis and treatment for the underlying causes of red eye so you can get prompt relief from discomfort. And, if you need further evaluation and testing for more serious conditions such as glaucoma or dry eye syndrome, Dr. Ghobrial has many years of experience as an ophthalmologist treating these conditions as well.

Can I continue wearing my contacts if my eye is red?

It’s best to discontinue wearing contact lenses if you have a red eye that won’t go away. In many cases, wearing your contact makes your eye feel worse and become even more irritated. Sometimes your contact lens could be the cause of your red eye as well. Dr. Ghobrial recommends that you wear your glasses and bring your contacts with you to your eye exam so he can determine if your contact is a contributing factor to your red eyes.

Call to schedule an exam or book online to get treatment for your red eyes, today.

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