What causes seemingly random very red areas in eyes?

[tiff]

Today my son came home from school with a patch in each of his eyes that was very red. One eye's red area is much larger than the other and these are not his usual red veins that are obvious. He was only at school for a half day and insisted nothing got in his eyes and he was unaware of the redness. Should I assume it was an irritant, he rubbed his eyes with dirty hands, an allergy, what could have done this and how do I take care of it? It's almost like conjunctivities, but only in two areas, not the whole white of his eye. Thanks.

[No tears in ATL]

Only thing I can think of is an allergy. Does it shrink or fade when applying a cold pack?

[littlemermaid]

Does he have photophobia? can he see normal distance (ask him if he can see aeroplanes or distant posters etc if he's not recognising letters) Does he get chalazia or styes?

Can you ask a nurse, pharmacist, optometrist, or emergency doc to have a look? Someone who knows signs of what they're looking for needs to examine with an ophthalmoscope.

I know you've all got persistent allergies, but if it hasn't cleared after No Tears in ATL's gentle sterile water compress and some rest, then an eye doc looks for signs of keratitis or infection.

My d was noticed and diagnosed by a pharmacist, and I will always be grateful to her. She said 'I know this isn't allergy or conjunctivitis because even without a lens I can see tiny red veins growing from the whites of the eye across the cornea. There's something else going on here because that is neovascularisation.' A pharmacist, with first line assessment training. Now at this point her red eyes, overtearing and photophobia had been seen several times by GPs, without ophthalmoscope exam, and been given large doses of eyedrops for allergy and conjunctivitis with preservatives in. I genuinely thought at the time that the docs knew what they were doing and the drops would heal her.

It took a year for me to realise even the county cornea ophthalmologist had misdiagnosed this because I trusted medics would do the right thing by a child and we tried to get on with our lives. LM had undiagnosed meibomian gland dysfunction but they didn't even observe it and treat as chronic blepharitis. The signs of virus infection they thought they saw were the corneas starting to break down from dry eye - surface damage, subepithelial dot lesions.

So five years later and much better informed, I wish I could go back in time and tell myself to trust my doubts and instinct.

Can you find someone good to have a look with an ophthalmoscope? We've got eyedocs in the emergency rooms but, as I say, they don't necessarily pick up more difficult conditions but they should be able to observe the signs for you. Do you think an optometrist would do this the best?

[littlemermaid]

In answer to 'what causes seemingly random very red areas in eyes' as well as allergy, and taking into account your eye doc has observed meibomian gland dysfunction that he hasn't treated except with lubricant and 'hopes will go away on puberty' (what?), Google 'child blepharokeratoconjunctivitis' and 'child blepharitis':

http://www.sciencedirect.com/science...91853112004120 Articles in JAAPOS with current refs.

Blepharokeratoconjunctivitis (BKC) can lead to significant ocular discomfort, recurring chalazia, conjunctival/corneal phlyctenules with secondary neovascularization, and scarring. These changes in children may compromise visual acuity and lead to amblyopia.

Just to clarify, LM is not using oral antibiotics because she got intracranial hypertension, but these are standard treatment protocols. If it's this.

If you want to see KKN faster, phone up, and knowing him, he will see him eg end of clinic - children's hospitals are friendly places, there is no need to hesitate except $. I've just realised it's only a 2 hour drive from you. What to worry about is chronic uncontrolled keratitis, as the articles.

[tiff]

The eye doctors are closed on Saturdays. I can take him to the pediatrician today, will they have the scope you mentioned to check out his red patches? The one in his left eye is gone this morning, but the right eye is worse.

[littlemermaid]

I would phone round and ask. They can't do the job without a hand-held ophthalmoscope, doesn't have to be the sit-down one. Saturday is a nightmare here too. I'd have to go to high street optometrist or emergency room with a red eye. It's good the other eye's resolving but long-term I would get a paediatric cornea ophthalmologist assessment x

[tiff]

Thanks, little mermaid. Dr. xxx will be traveling and so he can't see our son before his April 1 appointment.

I am not aware of phototobia with our son since he has not complained about it. April can't come soon enough!

I'll take him to the pediatrician today in case they can help in any way with the eye that still is very red.
Aren't red veins somewhat normal?
By the way, you mentioned your daughters red veins creeping across her cornea.

[littlemermaid]

Yes, I guess it's normal with allergy and dry eyes, and that I'm not familiar with it because LM is dealing with chronic MGD. Neovascularisation across the limbus is a sign of distressed cornea, in our case chronic inflammation from the MGD.

Just to share our experience in case it helps you with these difficult decisions. We mothers are not eye docs and it all drives me crazy.

It's good Pittsburgh are honest when he's away and what the service actually is, because then you can decide what's best for you. Certainly, regular local backup is essential.

[tiff]

Ped said his conjunctiva is bumpy and it looks like allergies. She suggested Zaditor drops to control the symptoms for a few days. Should I get him some?

[tiff]

Sorry to be so neurotic. I'm really concerned for my son and am nervous about this new pink bump near the iris of his eye. The pink bump was not there this morning and it's making me really scared. Do those bumps go away? Have any of you heard of this before? Will Zaditor help?

[littlemermaid]

Is the pink bump in the white of his eye? Is he rubbing his eye because it's itchy? Is he asking for more lubricant drops?

One way I've been shown to tell allergy, which includes reaction to eyedrops, is to look under the inside lower eyelid. When LM has a reaction, underneath the eyelid is brick red and the redness goes right down to the bottom. When she has grumbling MGD, there is more of a white stripe right at the bottom of the eyelid underneath.

We use normal saline vials 0.9% to flush the eye if we want to, as well as the thick lubricant drops. Rebecca was saying Theratears may not be thick enough for comfort and suggesting something like Oasis Tears Plus.

Does he have other signs of allergy like runny nose? Sorry I don't have experience of environmental allergy, just eyedrop sensitivity. Hope someone can post up and tell us what an allergic eye looks like?

If it was me, I'd be at the eye doc on Monday for a check and reassurance on what the pink blob actually is, talk to him again about chronic blepharitis and keratitis. You were saying the red eye was getting better with care and cool compress so maybe the anti-allergy drop could wait till a decision from the ophth on Monday. Why can't they prescribe an anti-allergy drop without preservatives?

It's a nightmare, trying to deal with this. I'm so sorry and sympathetic. It's about finding an assessment you're happy with and a paediatric ophthalmologist - Rebecca was offering to help with this and talk on the phone about the history and symptoms x

[tiff]

The blob is gone and the redness is less intense, but remains visible. I did the allergy drops twice yesterday and will
Administer them just once today. Poor guy has a stomach virus so that doesn't help. I'm calling the optho tomorrow. I've not heard back from Rebecca yet, but will try again.

How is your daughter doing? I hope you are both well.

[littlemermaid]

Hello Tiff, Very well done getting rid of the plob and reducing the redness. Hope you get an easier time now.

My d's eyes flareup when she has a virus too. Doesn't help that she licks her finger like your little fella and rubs her eyes, which I think might cross-infect her eyes sometimes. It's a different scenario for us with rosacea and she uses various topical antibacterials every day. She really has chronic keratitis and unresolved MGD still, and the eyedocs are supportive but there's no progress.

The tear film was better with lower punctal plugs, which she got Sept 2011, but they had infected by summer 2012, so she is frequent dropping but spends huge amounts of time studying and using the computer. LM lives a very busy and packed teenage life - A* student, plays musical instruments in county orchestras, sings to cathedral choir standard.

My personal problem is guilt about not having fixed this for her, and trying to plan for the future, including financially. So my goals have had to change to that now she's old enough to look after herself more.

We have used loads of steroid eyedrops for past flareups. I'm very interested to know the US view on this and I'll be looking out for it. When do adult cataracts start? I guess the paediatric ophthalmologists never see the result of chronic steroid use so don't want to think about it, but data would be good.

The anxiety is appalling, isn't it.

[tiff]

Great news! Dr. xxx's assistant got us an appointment with him next Wednesday! Thank God. He cried for an hour about his right eye today. I cannot wait to see what on earth is bothering my little guy and learn how to properly help.

[littlemermaid]

Wow, very well done. Let's hope it's a good move for you.

To save time in the consultation and get the best out of him, I would type up the symptoms history now with all past prescriptions, the allergy meds included. Maybe see if you can get the past records from your local eye doc if there's been vision changes since he was first assessed there.

Also a list of questions - don't hesitate to ask anything because he will help you any way he can. That's what he likes to do. I would tell him about your eye history too, see what he thinks.

KKN will know how much of this is allergy and what's happening to the corneas. Also it will be a relief for someone that experienced to rule out any other causes. Here's a draft joint paper on distinguishing different types of allergy http://www.privateeyeclinic.com/publ...kids_aapos.pdf. The final paper is Wong and Nischal 'Managing a child with an external ocular disease', JAAPOS 2010, Elsevier, and it's not open access, but I can send you .pdf if you want it.

I'm finding a good place to keep up to date on diagnosis and treatments is Medscape Reference (need to register), try different searches like 'child eye blepharitis' and 'allergy eye'. And the American Academy of Ophthalmology (AAO) Preferred Practice guidelines http://one.aao.org/CE/PracticeGuidelines/default.aspx, particularly the PPP and differential diagnosis for conjunctivitis http://one.aao.org/CE/PracticeGuidel...3-585e7c3852c7. And the DEWS Report.

Long term it's about designing a successful routine, I guess. Rebecca was suggesting thicker drops, and Pinklady has had more success using thicker drops and gels at night although she can tell you more about that.

Is he crying because he's in pain? The poor little chap. Can you get the eye pressures checked with a non-contact tonometer meanwhile? And check that his irises are dilating normally. Also signs of allergy like lumps and bumps underneath the upper eyelids. Rebecca was suggesting sunglasses if that helps.

I would be asking KN who to speak to when he's away. Surgeons don't hang about, especially not this one, and he will have a team. Also, our problem has always been not being able to find local regular checks but he might be able to suggest someone.

I'd still be talking to Rebecca about $ and options. Hope the journey's OK, without snow