From the Guidelines
To treat morning conjunctival hyperemia, start with artificial tears or lubricating eye drops applied 3-4 times daily, including right before bedtime and upon waking, as this approach is supported by the most recent conjunctivitis preferred practice pattern 1. The use of artificial tears can help alleviate dryness, which is a common cause of morning red eyes. Over-the-counter options like Refresh, Systane, or TheraTears can provide immediate relief. For allergy-related redness, try antihistamine eye drops such as Zaditor or Alaway, as they are effective in reducing allergic symptoms 1. Applying a cool compress for 5-10 minutes can reduce inflammation and constrict blood vessels. If your eyes are crusty upon waking, gently clean your eyelids with baby shampoo diluted in warm water using a clean washcloth. Red morning eyes often result from dryness during sleep, allergies to bedding, or environmental irritants. Some key considerations for managing conjunctivitis, as outlined in the preferred practice pattern, include establishing the diagnosis, identifying the cause, and establishing appropriate therapy to relieve discomfort and prevent complications 1. Avoid rubbing your eyes, use a humidifier in your bedroom, and consider replacing your pillow regularly to reduce allergen exposure. If symptoms persist beyond a week, worsen, or are accompanied by pain, discharge, or vision changes, consult an eye doctor as these could indicate a more serious condition requiring prescription treatment. It's also important to differentiate between primary conjunctival disease and conditions in which conjunctival inflammation is secondary to systemic or ocular diseases, as the treatment should be directed at correcting the underlying problems 1. Key points to consider in the management of conjunctivitis include:
- Establishing the diagnosis and identifying the cause
- Relieving discomfort and pain
- Preventing complications
- Preventing the spread of communicable diseases
- Educating and engaging both the patient and the referring healthcare providers on conjunctivitis management 1.
From the Research
Morning Conjunctival Hyperemia Treatment
The treatment for morning conjunctival hyperemia, or red eyes upon waking, depends on the underlying cause.
- If the cause is bacterial conjunctivitis, treatment options include:
- If the cause is allergic conjunctivitis, treatment options include:
- Topical antihistamines with mast cell-stabilizing activity, which are the treatment of choice for allergic conjunctivitis 4
- Artificial tears and cold compresses to help relieve symptoms
- If the cause is viral conjunctivitis, treatment options include:
- Supportive care such as artificial tears, cold compresses, and antihistamine eye drops 4
- Strict personal hygiene, including frequent handwashing, to decrease the risk of transmission
Important Considerations
It's essential to note that the treatment for morning conjunctival hyperemia should be guided by a comprehensive history and physical examination to determine the underlying cause 4. Additionally, ophthalmology referral is indicated for conjunctivitis in certain cases, such as in neonates or patients with severe pain, decreased vision, or recent ocular surgery 4.
Treatment Approach
In some cases, delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing, and treatment without antibiotics using artificial tears and eye bathings may be considered 3. However, the development of resistance of typical germs to all antibiotic groups is alarming and should influence therapeutic behavior 3.