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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Waking up with red eyes. What could cause this?

Resolved Question:

Every morning I wake up with red eyes. They get better during the day, but more and more inflamed red blood vessels are now on the surface, creating a web like pattern. They come from all angles towards my iris. I know our eyes are filled with blood vessels but I have never looked so disgusting. I am doubly concerned. Because I make my living as an actor and this is an awful visual handicap in that profession. My wife's eyes are like this too but she is in denial. I think it is mold. I had the house searched for mold a couple months ago and they found nothing, but today I pulled the dryer out and there was a bunch of brown mold under there. I cleaned it up, but I worry because I have an infant. She seems fine but my wife and my eyes look gross. Will these raised red blood vessels ever go away? I have looked online and everywhere says no, and even my ophthalmologist was vague about it. I don't think he wanted to tell me they wouldn't go away. Also, is it possible for it to be from mold but my eyes are not bothered during the day. Only after I wake up are they red and there are a few new inflamed blood vessels that don't go away.

Submitted: 6 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 6 years ago.

Hello and thanks for your question. I can certainly understand the logic that this the red eyes may be from mold. It is definitely a disgusting thing, especially when it surrounds your little ones (I'm a parent, too). However, it is rare for an environmental mold to cause this type of conjunctivitis (and when I mean rare, I mean very rare). There is always a reason why an eye may be red and inflamed. For some, it is being around cigarette smoke--this definitely causes the eyes to be red and irritated. For other people, they are using a drop chronically (instead of sporadically) that gets-the-red-out, or is a redness reliever. The chronic use of these drops will actually make the eyes more red. For those people, I recommend getting off that kind of drop and staying off of it, letting the effect of that drop wash out of the eye, and then getting a good eye evaluation to determine the cause of any residual redness. But for these people, it can take a few weeks of being off the drop before significant improvement is seen.

There can be many other reasons for an eye to be red. This can range from a viral conjunctivitis (usually follows an upper respiratory infection or exposure to someone with a cold or red eye) and can cause irritation, mattering, tearing, burning or sensitivity to light and these symptoms usually then spread to the other eye. Allergic conjunctivitis is usually distinguished by significant itching. Sometimes a red eye without any other symptoms at all can be due to what is called episcleritis. This is a low-lying level of inflammation that can happen for reasons we do not understand. In addition, a red, irritated eye can be caused by a foreign-body in the eye which may have occurred if you were exposed to flying debris.

I suspect that you have dry eyes with inflammation. If there is tearing associated with this, it is difficult to understand why the eyes may be dry when they tear: the tearing is a reflex in response to dry eyes that is not sufficient to hydrate the eyes as they need to.

When there is inflammation in the eyes and/or eyelids, this is usually from what's called blepharitis, which is inflammation of the eyelids and glands in the eyelids. The eyelids are key players in making a layer of tears that coats the surface of your eyes called a tear film. The inflammation that is blepharitis keeps the eyelids from making that tear film as healthy as it needs to be and so the eyes dry out. Also because there is inflammation in the tears because of the blepharitis, there are bacteria pooling in your tear film. Often times an antibiotic +/- steroid drop or ointment is used to help kill the bacteria. This therapy is usually only used in a pulse fashion, to start out the treatment and then only used when there are flare-ups, not on a regular basis for most people. However, treating this with a steroid drop for a few days is not enough to treat this entire problem, it is usually just an adjunctive measure combined with the baseline treatment as I state below.

The baseline treatment for blepharitis and what I think you should start doing, is every day in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations (Sterilid or Ocusoft) or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water): you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done.

It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working; often times combining this with the topical steroid helps to bring relief sooner. Also the eyes are still significantly dry during these 3-4 weeks so use artificial tears one drop in each eye, 4x/day. After 4 weeks you should be able to start tapering off of the tears to as you need them.

Just doing the artificial tears, hot compresses and eyelid scrubs alone would likely start to help you after three or 4 weeks--but remember it could take this long of doing it every day before you see a significant effect, so don't stop it thinking it's not working. Also you may need an antibiotic/steroid combination medicine to help augment the therapy. If after 3 weeks of diligent treatment you are better, but not completely normal, you may need to see your eye doctor to assess for other causes of dry eyes, as blepharitis is only one cause of dry eye. Many times dry eye patients have more than one cause of dry eyes (Restasis is an excellent treatment for those people with dry eyes because they don't make enough of their own tears). Each cause of dry eyes needs to be appropriately treated for your symptoms to resolve.

If, after 2-3 weeks of doing this you see no improvement in your symptoms then I would suggest seeing your eye doctor as there may be inflammation that needs a steroid or antibiotic treatment to resolve.

Does this information help address your concerns? Does this make sense? Do you have any other concerns that I haven't addressed? I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need.

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Customer: replied 6 years ago.

Will the raised blood vessels ever go away or are they permanent? I went to an ophthalmologist and he said since they are so new they should go away. He might try steroid drops.

Expert:  Dr. Dan B. replied 6 years ago.

I agree. Their relatively new onset points to a good prognosis for them going away.

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