Recently, I came across a post where a lady mentioned that her eyes are not as clear as before, the whites of her eyes are a bit yellowish, and sometimes there are red blood vessels.
Then many people in the comment section also said they have the same symptoms, including some who say it’s “liver fire and stomach fire, spleen deficiency and lung heat”, and some people say it’s the liver sending an alarm, or caused by staying up late.
As an ophthalmologist, I often encounter such issues in clinical practice, although most of the abnormalities that patients think are abnormal are actually normal according to the doctor’s diagnostic criteria, but indeed some patients’ concerns are not unreasonable.
So today let’s take a look at the causes of yellowish whites and red blood vessels in the eyes, and how to improve them?
Common Causes of Yellowish Eye Whites
What we call the “whites of the eyes” is actually the “sclera” next to the black part of the eye. The sclera is the outermost layer of the eye wall, a tough tissue that is milky white in color, enveloping the eyeball like a sturdy shell.
Caption: Sclera Sclera; IRIS IRIS; Pupil Pupil
On the surface of the sclera, there is a semi-transparent loose mucous membrane called the conjunctiva. The sclera itself has few blood vessels and nerves, containing rich collagen fibers and elastin proteins, while the conjunctiva is rich in nerves and blood vessels, and abnormalities such as red and congested eyes are usually due to conjunctival abnormalities, which is what we often hear as “conjunctivitis”, not abnormalities of the white sclera itself.
1. Jaundice
Among the complaints of “yellowish whites”, the most serious condition is jaundice. However, the scleral yellowing shown by jaundice is a uniform yellowing of the entire white part of the eye, while in ophthalmology, it is more common to see local yellowing of the whites.
The reason for jaundice is an imbalance in bilirubin metabolism (excessive production, processing disorders, or impaired excretion), leading to increased bilirubin levels in the blood. The sclera easily adsorbs bilirubin due to its rich elastin proteins, and because the milky white sclera is like a piece of white paper, abnormalities are more easily observed, so jaundice usually appears earliest in the eyes, then manifests as yellowing of the skin and oral mucosa.
If this phenomenon occurs, it is necessary to go to the hospital as soon as possible for examination and screening, it may be related to liver diseases, bile duct obstruction, or hemolytic diseases.
2. Age-related pigmentation or fat deposition under the conjunctiva
Age-related pigmentation or fat deposition under the conjunctiva is the most common cause of local yellowing of the whites.
Patients often complain, “My eyes used to be very white and bright, but now they seem a bit turbid and lifeless.” When I ask how long ago, the answer is usually “when I was a child” or “when I was in school.” This is probably the mark of time.
Just like our skin develops spots and blemishes as we age, the whites of the eyes also experience pigmentation, which usually does not need to be treated, or in other words, ophthalmologists really don’t have any good way to deal with these pigments.
Some patients have asked if they can have a “photorejuvenation” for the whites of their eyes, just like in dermatology. But those who have had photorejuvenation should remember that before the procedure, the doctor will cover the eyes with a protective device.
Regrettably, because the structure of the eyeball is special, photoelectric project that can be used on the skin cannot be used on the eyes, so as long as it does not affect daily life, learn to coexist with them.
3. Pinguecula
Pinguecula is a slightly raised nodule on the bulbar conjunctiva, usually found on the side near the inner corner of the eye, related to ultraviolet radiation-induced collagen degeneration.
People who work outdoors or in windy and sandy environments for a long time are more likely to develop pinguecula. Pinguecula usually has no discomfort and does not require treatment. If it affects appearance or the raised pinguecula affects the wearing of contact lenses, surgical removal can be considered.
Common Causes of Red Blood Vessels and Unclear Eyes
In addition to the above reasons for “yellowing”, long-term chronic inflammation leading to repeated congestion of the conjunctiva can also easily manifest as red blood vessels in the eyes and unclear eyes. Such as allergic conjunctivitis, dry eye, blepharitis, etc.
1. Allergic Conjunctivitis
During allergic attacks, antihistamine eye drops combined with artificial tears can be used, along with cold compresses to improve symptoms. If there are also allergic rhinitis or other systemic reactions, oral antihistamines, drops, or nasal sprays can also be used.
Children with long-term allergies are not only prone to red eyes and tearful expressions but also to having dark circles under their eyes, it is essential to take medication in full dosage and full course, and not to stop taking it on your own when there is a slight improvement.
If the allergy is very severe, it is also recommended to check the allergens in detail, avoid contact with allergens in daily life, and try desensitization treatment according to the situation to improve the quality of life.
2. Dry Eye
Dry eye is a very common “modern disease”, most people sitting in air-conditioned rooms, low air humidity, long-term use of electronic products, staying up late, and irregular life, all can easily lead to the occurrence of dry eye.
In addition, incomplete eye makeup removal, cosmetic blockage of meibomian gland openings can also easily lead to abnormal secretion of meibomian glands and cause meibomian gland dysfunction dry eye (MGD type dry eye).
It is recommended to use electronic products moderately, take breaks, thoroughly clean the eyelid margin, you can use a steam eye mask for hot compress to improve the state of the meibomian glands, and supplement with preservative-free artificial tears or tear secretion promoters. If the examination finds that the dry eye is severe and has caused damage to the corneal epithelium, you can also use eye drops that promote epithelial repair.
In addition, some patients’ dry eyes are related to ocular demodex infection, if the examination finds demodex infection, it is recommended to use tea tree oil-containing products for ocular surface cleaning to assist in dry eye treatment, and for meibomian gland dysfunction type dry eye, meibomian gland massage and IPL treatment can also be considered.
Caption: Blepharitis Demodex Infection
3. Blepharitis
Blepharitis is a subacute or chronic inflammation of the eyelid margin, hair follicles, and their associated glands.
Seborrheic blepharitis is more common and is a chronic inflammation caused by sebaceous gland overflow at the eyelid margin.
It is manifested as eyelid margin congestion, redness, attachment of epithelial squames and sebaceous crusts to the eyelid margin and eyelashes, often accompanied by eye itching, stabbing pain, and burning sensation.
Caption: Blepharitis
Patients may have oval-shaped skin Malassezia furfur at the local eyelid margin, which can break down lipids into irritating fatty acids. In addition, refractive errors, eye strain, malnutrition, and long-term use of inferior cosmetics may also induce.
Treatment should first remove the cause, improve nutritional status, strengthen physical exercise, clean the eyelid margin every day, and follow medical advice for medication.
How Should We Deal with Yellowish Eye Whites?
Like everyone else, I also like clear and distinct eyeballs that look spirited and particularly vivid. But
we need to accept that there will be some pigment, spots, and red blood vessels on the whites of the eyes. Under normal circumstances, these minor flaws are normal phenomena.
If you want to try to avoid them, you can do a good job of eye sun protection (choose lenses with sun protection index, wear sun hats or sunglasses), maintain good living habits, avoid staying up late and overusing your eyes. If there is indeed ocular inflammation, seek medical treatment in time and treat regularly.
But there are still some conjunctival changes related to age that cannot be completely avoided, just accept them, we don’t have to be perfect everywhere.
What about the online propaganda – “After using XX eye drops, my whites have changed from this to this,” with a picture of eyes without a single flaw, white to the point of shining – are these credible?
After reading a few shares (advertisements), I can say, all such post-use pictures are retouched, because it is impossible for a normal person’s eyes to have no red blood vessels, no blood vessels, what would supply oxygen? Tissue ischemia and hypoxia would lead to necrosis.
If there is an urgent need, such as going on camera, such as receiving important clients, but your eyes are red and listless from staying up all night the day before, it is indeed possible to consider using vasoconstrictor eye drops temporarily, which can make red blood vessels disappear immediately.
But considering that many people abuse these drugs, it must be emphasized here: these drugs are only recommended for temporary use when necessary, but after all, they only treat the symptoms, not the root cause, and long-term use of vasoconstrictors, after stopping the drug, it is easy to have a rebound effect, red blood vessels are more uncontrollable, falling into a vicious cycle. I also know that many people pursue the “refreshing feeling” after using eye drops, but truly practical artificial tears are very mild and have no special feeling.
A final tip, most eye drops, if not specifically stated, have a shelf life of only one month after opening, so don’t just look at the shelf life on the bottle, using a bottle of eye drops for a year also has a significant risk of infection.
References
