Hesperian Health Guides

Red Eyes and Painful Eyes

 woman with one eye swollen and closed

Various problems cause red, painful eyes. When trying to determine the problem and what to do about it, ask the person if there was an injury to the eye or if she felt something go into the eyes.

Type of redness and pain Possible cause
Usually both eyes but may start in one eye
Mild burning pain
Usually reddest at outer edges
If there is also thick white or yellow discharge, probably a bacterial infection called conjunctivitis
One or both eyes
Redness and pain may be severe
An injury to the eye from something sharp or from a blow
Chemical burns or harmful liquids in the eye
Usually one eye only
Bleeding inside the eye, affecting the iris (colored part)
Bleeding in the colored part of the eye, often because of an injury
This is an emergency
Usually one eye only
Redness and pain—not severe at first but can get worse
A bit of dirt in the eye
Scratch on the eye surface
Usually one eye only
Pain often severe
Reddest close to the iris
Ulcer on the cornea
Acute glaucoma
All are emergencies
Usually one eye only
Redness with a bump or swelling on the eyelid (with or without pain)
Infection around the eyelash or under the eyelid
Usually one eye only
Bright red patch on the white part of the eye
Probably a tiny blood vessel has burst, not an emergency
Usually both eyes
Discomfort but not pain
Redness and itchy, watery eyes and sneezing, worse at certain seasons during the year
Hay fever, also called allergic conjunctivitis
Usually both eyes
Redness but no discharge and no pain
Rash or fever
Conjunctivitis caused by a virus.
If your region has Zika virus, red eyes could be one of the signs.

If there is redness, check if eyes are watery or have discharge (pus or secretions):

  • Thick secretions or discharge can be conjunctivitis (‘pink eye’ or ‘red eye’), a bacterial infection, especially if the eye is also very red.
  • Watery eyes, with mild redness, that feel itchy in the corner of the eyes near the nose, are usually allergies.
  • Watery eyes, with mild redness after a cold or flu, may be caused by a virus. This needs no special treatment and medicines will not help.
  • Watery eyes, with redness and fever, cough and a runny nose, could be a sign of measles, even before a rash appears.

Conjunctivitis (‘pink eye’, ‘red eye’)

Conjunctivitis can occur at any age, but is especially common in children.

 eye that is red and oozes pus from the corners
  • Eye looks pink or red
  • Eye may itch or burn
  • Starts in one eye, may spread to both
  • Thick discharge may cause the eyelids to stick together overnight

Most conjunctivitis is caused by a virus that goes away in a few days without any special treatment.

If the yellow or white discharge is thick, the cause is likely a bacteria that can be treated with antibiotic eye ointment or drops. Even if the eye seems better, use the treatment for all 7 days so the infection does not come back.

Before applying antibiotic eye treatment, gently clean each eye with separate, wet cloths. Change cloths and wash your hands between cleaning and treating each eye to avoid spreading the infection from one eye to the other, or to yourself or other people.


Conjunctivitis spreads very easily from one person to another. Wash hands often and after touching the eyes of another person or your own. Do not let a child with conjunctivitis use towels or bedding that others will use. Separate the child from other children until her eyes are better.

Conjunctivitis in newborn babies

An infection in a baby’s eyes needs prompt treatment.

  • Red, swollen eyes
  • Pus in eyes
  • Eyelids stuck together, especially upon waking
 baby with swollen oozing eyes

A newborn baby with red, swollen eyelids and pus may have an infection of gonorrhea or chlamydia that passed during birth. If eyes are swollen when the baby is between 2 and 4 days old, it is more likely to be gonorrhea. Treat immediately to prevent harm to the baby’s eyes. If they are swollen when the baby is between 5 and 12 days old, it is more likely to be chlamydia. These infections, which spread during sex, affect many men and women but often give no signs of sickness. It is best to test and treat all pregnant women for these infections to prevent the baby from getting them at birth.

To protect the eyes from permanent damage and blindness, use antibiotic eye ointment. Test the baby and mother to know what kind of infection they have. Both will need further treatment with antibiotics, not just eye ointment.

Care for a newborn baby’s eyes to prevent problems
Immediately at birth, gently clean the baby’s eyes with a new cotton swab. Then put antibiotic eye ointment on the eyes of a newborn baby to prevent eye infections. Use 1% tetracycline OR 0.5% to 1% erythromycin ointment. Put a thin line of ointment in each eye, 1 time only. Do this right away, within 2 hours after birth.

If a baby has watery eyes all the time, especially if tears fill the eye and run down the face even when the baby is not crying, it could be that the tiny tubes that drain tears away from the eye are blocked. This problem often goes away by itself, but a health worker can show you how to gently massage the baby’s face on the side of the nose (Crigler or lacrimal sac massage), to help open the tubes.

Hay fever (allergic conjunctivitis) and allergies bothering the eyes

Dust, pollen, or other particles in the air cause sneezing along with red, itchy, and watery eyes in some people. When the body reacts with the same signs to the same thing every time, it is called an allergy. If this happens only certain times of the year, the person may have an allergy to pollen released by trees and plants (also called hay fever). If it happens all the time, the cause could be dust, mold, chemical products, or animals. Allergies irritate both eyes.


If you know what is causing the eyes to react, the best treatment is to avoid or remove the source of the problem. For example:

  • Try to keep sleeping areas and bedding free from dust. If an animal is causing the allergy, avoid the animal and the area where it sleeps.
  • Close or cover windows at night.
  • Use a dust mask or cloth to over your mouth and nose to protect yourself from breathing pollen and dust when working or walking outside.

Anything that is very close to your eye, like eye makeup, or something you can smell, such as clothing washed with a perfumed soap, can also cause allergies that that affect the eyes. If you stop using the product that is irritating the eyes, the allergy should bother you less.

Soothe itching eyes with a wet folded cloth over your eyes (cool water feels best). If antihistamine eye drops are available, they may help eyes feel better when hay fever is severe.

Ulcer on the cornea (damage to eye surface)

eye with a white spot covering part of the  pupil

When the very delicate surface of the eye is damaged by infection or scratched, a painful corneal ulcer can result. Do not rub your eye, it only makes it worse.

The person’s vision is often reduced and they have severe pain. They may have thick or watery discharge.

The eye is red and if you look at the cornea in strong or bright light, you may see a gray-white patch. It may look less shiny than the rest of the eye.


This is an emergency. If the ulcer on the cornea is not well cared for, it can cause blindness. Get medical help. Apply antibiotic eye ointment or drops in the affected eye every hour on the way to see an eye specialist.

Iritis (inflammation of the iris)

one normal eye and
another eye that is irritated with the iris smaller and of irregular shape instead of round
pupil small, often irregular
redness around iris

Inflammation of the iris is called iritis. Its cause is usually not known.

  • Usually in one eye only
  • Deep aching pain in the eye
  • The pupil (the black center of the eye) may have an irregular shape instead of round
  • Redness on the white part of the eye closest to the iris
  • The eye hurts more in bright light
  • Vision is usually blurred


Iritis is a serious eye problem and is painful. Get medical help within 1 to 2 days.

Antibiotics are not useful.

An experienced health worker may use eye drops to increase the size of the pupil, and other eye drops to decrease inflammation.

Trachoma — a chronic conjunctivitis

Trachoma is an eye infection that spreads from one person to another by hands, flies, and cloths that touched an infected eye. Trachoma is most common in children and their mothers. If a person is infected many times, after several years this can make the eyelashes turn in and scratch the eye’s surface, which causes pain and loss of vision. Because it feels scratchy, it is sometimes called “hair in the eye.”

Trachoma has become less common in the world but is still a serious problem in some countries, especially in Sub-Saharan Africa. It mostly affects people who live in poverty, in crowded conditions, and where there are many flies and little water. Improving water and sanitation is important in preventing trachoma.

 inside of eyelid covered with bumps
scarred inner eyelid with eyelashes turned inward
  • Trachoma often begins in young children like a mild conjunctivitis that is not very noticeable at first.
  • Repeated infections in young children cause small white-gray swellings to form inside the upper eyelids. To see these, fold the eyelid back.
  • After years of repeated infections, these swellings or bumps become white scars under the eyelid. Scars pull the eyelashes inward and these scratch the clear part of the eye, causing pain to the eye and loss of vision.

The best treatment for trachoma is a single dose of azithromycin by mouth. If azithromycin is not available, 1% tetracycline eye ointment inside the eye 2 times a day for 6 weeks also works.

For people with advanced trachoma, a simple surgery can make the turned-in eyelashes turn outward again. If surgery is not available, a trained eye-health worker may be able to remove the irritating eyelashes.


Early and complete treatment of trachoma prevents its spread to other people. Wash children’s faces every day and wash your hands after touching anyone’s eyes. Wash towels, clothes, and bedding often to be sure that 2 people never share a pillow or the same cloth to dry their faces.

Keep flies away by covering food, keeping latrines covered, and composting away from the house. See Water and Sanitation: Keys to Staying Healthy.

If there are many cases in your community, health authorities may treat everyone in the community with azithromycin to stop trachoma from spreading.

NWTND eye Page 18-3.png

Trachoma is spread by flies, fingers, and fabric.

This page was updated:10 Jan 2020