September 5, 2025 • 25 mins
In this episode of The Eye-Q Podcast, I’m joined by Dr. Michael Chua to decode the many causes of red eyes. We cover dry eye, allergies, subconjunctival hemorrhage, infections, and eyelid mites—plus simple strategies for relief like eyelid hygiene, artificial tears, and antihistamine drops. If you’ve ever wondered why your eyes are red and irritated, this conversation will give you clarity.
Dr. Michael Chua is a board-certified ophthalmologist practicing in Los Angeles, California. He attended medical school at the Perelman School of Medicine at the University of Pennsylvania. After medical school, he completed his ophthalmology residency at the New York Eye and Ear Infirmary, where he was elected Chief Resident.
Dr. Chua enjoys teaching others about vision and eye health. He has a YouTube channel with over 15,000,00 views and 150,000 subscribers.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
I would say probably the most common is dry eye.
Basically when the surface of the eye is dried out, then the
cornea gets exposed to kind of air and irritation.
And so all of that that that irritation cause inflammation in
the cornea and that can cause the release of cytokines and
little inflammatory chemicals. And so that can cause a red eye.
(00:21):
So that's probably the most common cause.
Other common causes of red eyes,things like allergy, allergic
conjunctivitis, so many people are allergic to things like pet
dander or mold or pollen. Or for us in LA, patients have
been exposed to irritants in theair from what recent wildfires?
Welcome to the IQ Podcast. I'm Doctor Ronnie Bannock, here
(00:44):
to help you boost your IQ with powerful insights that connect
your eyes, your brain, and your whole body Wellness.
This episode was recorded duringthe Eye Health Summit, where the
world's leading experts shared breakthrough insights in vision
and holistic eye care. Hello everyone and welcome back.
I'm Doctor Ronnie Bannock and today I'm thrilled to be joined
(01:08):
by Doctor Michael Chua and Ophthalmologist, who has a very
popular following online on YouTube and his YouTube channel.
Thank you so much, Doctor Chua, for joining us today.
Yeah, thank you for having me. I'm very happy to be here.
Absolutely. Now you are a wealth of
information. You cover so many topics on your
YouTube channel. So we could talk about a host of
(01:30):
different things, but what I thought we'd talk about today
specifically are conditions thathappen to, for many people,
various different types of red eye and inflammation on the
surface of the eye. I'm going to be talking about
all that. But before we do, I just want to
ask you, how did you get so involved in education,
particularly in making all your amazing videos online on
(01:52):
YouTube? Yeah, I always enjoy teaching
others, even through college andmedical school.
I was for a private tutor and I was ATA in college and basically
I supported myself through medical school by tutoring other
people. So I really enjoyed teaching
others. And so when I was finishing up
residency, I really, I found it interesting that you could use
(02:15):
video to teach so many people and help them with their
problems and eye conditions. I basically just started
recording videos of me talking about how to treat and how to
treat and manage different eye conditions and it took off.
So I kept doing it and melds with what I love to do, which is
I just love to help people with their vision and health problems
and putting it online and allowed me to help at this point
(02:38):
millions of people with their vision and health problems.
Yeah, you're doing such amazing work and the ability to reach,
like you said, millions of people from around the world and
a platform like YouTube is just phenomenal.
So now we have the technology togo along and support our
passions in educating people. So let's talk about the various
different types of things that can happen on the surface of the
(03:00):
eye because there are different types of inflammation that can
develop. First, let's just clarify some
terms here. We say in general the term
inflammation, but there are there specific types of
inflammation that tend to happento people when it comes to their
ocular surface. Yeah, absolutely.
A lot of it is dependent on the exact location.
So you can have inflammation of the eyelashes and the eyelid,
(03:23):
something we would call blepharitis.
And even blepharitis can get subtyped into anterior posterior
blepharitis. We have my Bomian glands or the
oil glands that secrete oil ontoour tear film to help prevent
tears from evaporating. So if my Bomian glands are
involved, that's one particular type of inflammation called my
Bomian gland dysfunction. Or you can have inflammation of
(03:43):
the surface of the eye, right, That's keratitis.
Or you could have inflammation inside the eye or uveitis.
So yeah, there's all different types of inflammation.
Oftentimes you get multiple types of some component of
blepharitis with keratitis or and also uveitis.
And it's up to us ophthalmologist and optometrist
to figure out where exactly thisinflammation is.
(04:03):
And trying to figure out what's triggering it.
But in addition to inflammation,you can also have other
conditions that could be causingred eyes or irritation or
inflammation to It is actually adiagnostic challenge for us
clinicians to figure out what's going on.
Oh, you're so right. Sometimes it's straightforward.
We can see exactly what's causing the inflammation, but
sometimes we need to dig a little deeper and sometimes
(04:25):
we're not sure and we just try to treat it the best way we can.
So now let's talk about you talkabout a couple of different
types of issues. What are the most common
reasons? Let's say the four most common
reasons people can develop a redeye.
Yeah, good question. So I would say probably the most
common is dry eye. Basically when the surface of
(04:45):
the eye is dried out, then the cornea gets exposed to kind of
air and irritation. And so all of that that that
irritation cause inflammation inthe cornea and that can cause
the release of cytokines and little inflammatory chemicals.
And so that can cause a red eye.So that's probably the most
common cause. Other common causes of red eyes,
(05:07):
things like allergy, allergic conjunctivitis.
So many people are allergic to things like pet dander or mold
or pollen, or for us in LA, patients have been exposed to
irritants in the air from what recent wildfires.
These things can cause an allergic reaction to.
So often times with allergic conjunctivitis, patients
(05:28):
mentioned that they have red eyes or sometimes a component of
tearing, and the most common symptom is itching.
Other common causes for Another common cause for red eye is a
subconjunctival hemorrhage are basically a when you have a
burst blood vessel in the surface of the eye that can
cause your eye to be red. And another common cause like we
(05:48):
talked about is some sort of inflammatory disease, something
like a uveitis or keratitis can cause a red eye as well.
Yeah. So that's pretty.
It's very broad. And you meant that certain types
of conditions can be associated with certain types of symptoms.
So let's talk about dry eye, which is what you mentioned
first. So you mentioned people can have
(06:09):
some burning. Are there other indications that
the redness may be coming from dry eye other than burning?
Yeah, it's a lot of it is based on symptoms and clinical
histories. Like you mentioned, burning,
foreign body sensation. Patients say they have a sandy,
gritty feeling in their eyes. Often times we can just see it
on exam. When patients have dry eyes,
(06:30):
they can have these things called punctate epithelial
erosions or little breakdown in the surface of the cornea of the
eye on the front of the eye. If you have really dry lips, you
can have a cracked lips, the surface of your lips may crack a
little. So we can see that on exam too.
So I would say those are probably the most common things
we're looking. Yeah, that gritty, sandy
sensation is often times so common.
(06:52):
People say I feel like there's an eyelash in my eye or I feel
like there's gravel inside my eye.
Another symptom I've also often cured from patients is tearing.
And can you explain this a little bit?
Like why do people, if they havedry eye, why may they have
tearing? Because you would think that's
Contra counterintuitive there. Yeah, definitely.
(07:12):
Yeah, it's a little bit confusing, contrintuitive.
So it depends on the quality of the tears that we're making.
And basically there's three different components of the
tears that we have. There's the aqueous layer, which
is like the water part. There's the oil layer, which is
the oil secreted from our mybomium glands and that helps
to prevent tears from evaporating.
(07:33):
And then there's also the mucus layer, which helps the the tears
just spread over the surface of the eye.
And so basically, if we're missing any of those components,
the quality of our tears are notthat good.
And so even though you may have some tears, if the tears aren't
staying on the surface of the eye or they're not, it's not
working properly, then yeah, you're lacrimal glands might be
(07:56):
getting triggered to make more tears when the surface of the
eye keeps drying out. Often times it's not just a
question of, oh, do you have enough tears?
It's also a question of what's the quality of the tears that
you're making. And so sometimes we need to
address the quality to help withthe dry eye symptoms.
So what I'm hearing from you is if the tear quality is not good
and the tears evaporate too quickly, is that correct to say?
(08:18):
And then other gland kicks in, lacrimal gland kicks in and
overproduces tears and compensation for that.
Yeah, exactly right. Yeah, OK.
Now let's talk a little bit about you mentioned allergies,
which are so common. Sometimes people have seasonal
allergies, Sometimes it's they're allergic to something
new in their environment, in their home even.
What are some of the the definitive or defining features
(08:42):
of allergy? Like how can you tell that apart
from dry eye? Yeah, that's a good question.
For me and my practice, a lot ofit is with clinical history.
So yeah, one of the most common complaints patients will mention
is itching. The itching is probably the
number one symptom patients willmention when it's related to
allergy and on exam too. So just trying to differentiate
(09:03):
between dry eye and allergic conjunctivitis.
With dry eye, like we mentioned,we're looking for those changes
in the surface of the cornea. If it's just allergic
conjunctivitis, you usually don't really see those kind of
the breakdown in the surface of the cornea as much unless a
patient, which is totally possible, a patient can have
both allergy and dry eye. But those things we look out for
(09:23):
on exam. What about like discharge?
Do you often times see dischargein some of these patients?
Yeah, that's, that can definitely be a component.
Often times 2 patients will mention tearing with allergy and
but you can also have tearing with dry eyes.
So it's sometimes it's not there's not very specific signs.
And then with discharge through that's one thing I forgot to
mention in terms of the most common causes for red eyes also
(09:45):
infection. So if you start seeing
discharge, you might want to at least think about infection
also, which could be contributing to the red eye.
I've also seen patients with allergies who have like really
puffiness of their eyelids. They wake up with puffiness and
then gradually make it better during the day.
Is that something you see often as well?
Yeah, you can definitely have eyelid involvement with allergic
(10:08):
conjunctivitis as well, Absolutely.
And what do you tell people in terms of how to manage that that
puffiness? Yeah, usually the the standard
of care for me is just anti a good antihistamine regimen.
Antihistamine drops do really well for treating allergic
conjunctivitis. The eye drops are really good
for that. When there's eyelid involvement.
Sometimes what we could do is some oral antihistamines as
(10:31):
well. I can help with the puffiness
and in some cases if there's refractory or they're still
having a lot of puffiness and the with drops and with pills
didn't really help. Sometimes we'll try an ointment.
They have some you could either use like a steroid ointment,
although we try not to use that long term, or even something
like tacrolimus which is a good ointment for eyelid puffiness as
(10:53):
well. Yeah, there's just some great,
great suggestions and that some of those things you can do on
your own, but some of them you need to work with your provider
and get a prescription for it, correct.
These are not available over thecounter for the most part, some
of these treatments. Now let's move on to the third
cause of red eye that you mentioned, which is a
subconjunctival hemorrhage. So, Doctor Chua, can you tell us
(11:13):
a little bit about what is it, why does it happen, and what can
people expect from a subconjunctival hemorrhage?
Yeah. So basically we all have these
tiny little blood vessels in thefront of our eye and the
conjunctiva. And so basically if something
causes one of those blood vessels to break, so if you
accidentally rub your eye too hard or maybe taking out a
(11:35):
contact lens, accidentally scratch one of those blood
vessels or maybe even while you're sleeping.
One common story I hear from patients is, Oh yeah, I just
woke up with it. So it's possible maybe when you
were sleeping, you accidentally rubbed your eye in the pillow
and cause one of those blood vessels to break.
Then you can have blood basically on the front surface
of your eye that conjunctiva, and instead of it being white,
(11:57):
it turns red. And those are a a little bit
easier. Those are definitely easier for
us to diagnose because once you see the blood on exam at the
microscope, we could pretty mucheasily say it's subconjunctival
hemorrhage. Although I will say in patients
who get recurrent subconjunctival hemorrhage,
sometimes that could be a sign of something else that's going
(12:17):
on, whether it be uncontrolled blood pressure or in my case, I
just literally yesterday I had apatient who had recurrent
subcontractival hemorrhages and it was related to a problem in
her brain. She had a Yeah, So you can.
And I learned that from you, Doctor Vanik.
Thank you very much. So I'm still using all the
things you taught me from residencies.
(12:38):
Yeah. It's subconjunctival hemorrhage,
luckily, is not dangerous in thevast majority of the cases.
But sometimes if it's recurrent,it can be a sign of something
else going on. Yeah, actually, I'll just share
a story. A few years ago, I had a
subconjunctival hemorrhage just out of the blue.
Maybe I was coughing or sneezing.
And then I noticed, oh, there's a little red spot.
(13:01):
And then over the next few hoursit grew and grew and grew and it
basically covered like more than1/3 of my, the white part of my
eye. And it honestly, it, it looks a
lot worse than it is, right? There's no pain, it's just it's
a cosmetic issue, right? People look at you, they see a
bright red eye and they get concerned.
But really it's pretty benign. And like you said, in most cases
(13:21):
it just goes away. It's only the the recurrent ones
you really have to worry about. I know some people when they
have it though, they try to put in eye drops and sometimes even
tinctures. Like for example, I've had a
patient who was putting Castor oil in his eye because of a
subconjunctival hemorrhage. What are your thoughts about
treatments like that? It's hard.
I think usually what I say for subcontractile hammer, which is
(13:44):
kind of like a bruise, it just goes away on its own.
There's there's not really much you just waiting for the
hemorrhage to resolve on its ownis usually fine.
Some patients I found that if they really want to try to speed
it up as much as possible, something like a lumify,
something like some sort of vasoconstricting type of eye
drop, but I don't you oftentimesyou don't really need to do
(14:06):
that. But in terms of Castor oil or
eye drops, usually that's not necessary.
It'll go away on its own. Yeah, I think patience is key.
A lot of people expect it to be gone within a day.
And honestly, it can take. For me, it took almost three
weeks for mine to go away, but it can take just like you said,
it's a bruise, right? It's a bruise on the surface of
the eye and it just give it sometime.
This has been such a fascinatingdiscussion with Doctor Chua
(14:29):
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(15:36):
Now, Doctor Chua, earlier you had mentioned that sometimes
there can be an infection as theunderlying cause for redness.
Can you explain a little bit more about that and the
different types of eye infections people can get?
Yeah, infection is definitely one of the more common causes
for red eye that we see The I guess the layman's from pink eye
is something that a lot of patients know about.
(15:57):
And so usually what that's referring to is something called
viral conjunctivitis or basically again, the
conjunctiva, that kind of that the pinkish clear tissue in the
front of the eye when you have aviral infection can cause
inflammation of the conjunctiva.And it's usually associated with
maybe sometimes you'll have a runny nose or a cough or some
(16:18):
type of cold symptoms. And when that virus can get into
the eye can cause red eye, can cause tearing discharge.
Often times it starts in one eyeand then it goes to the other
eye. Often times patients can point
out the person they got it from and whether it be from a Co
worker or someone at home who also had a recent cold or even
pink eye. So that's one of the most common
(16:39):
causes. Other types of infections that
we see, it could be not just caused by a virus, but bacterial
conjunctivitis. Usually when a bacteria is
involved, it's a little bit moreof a severe clinical picture.
You might have more discharge, more inflammation and other
causes. You can have infections of the
cornea or that transparent clearsurface from the front of the
eye. So when you have a corneal
(17:01):
infection that's usually associated, oftentimes it's
associated with contact lens wear.
And so that those are all different types of infections
that you can get and cause redness in the eye.
So when it comes to whether the conjunctivitis is viral or
bacterial or perhaps something else, what do you look for on
the exam? Or are there signs that people
(17:23):
can look for at home that may point them in One Direction or
another? Yeah, So it's a good question.
Sometimes it's actually not as straightforward.
Sometimes you have to give the the infection a little bit of
time for the signs and symptoms that pop up to help you
differentiate. In general, it's more commonly
viral. So sometimes that's just the
(17:43):
assumption. And then if it's not getting
better after a few weeks, maybe then your doctor might start
thinking, oh, maybe it might be bacterial.
But things we look out for in terms of viral conjunctivitis,
usually the discharge is a little bit more watery, little
bit more mucousy, whereas bacterial conjunctivitis, it can
look, the discharge can have look more more like pus, like
(18:04):
thicker, more purulent, Yeah, that that sort of picture.
Like more goopy and yeah, angry looking.
So I think this is a big misconception from many people.
They develop, quote UN quote, pink eye and they immediately
come and come to get checked outand they expect a prescription
and antibiotic prescription. What do you tell people?
(18:27):
Like we mentioned, in most casesit's viral.
And so with viral conjunctivitis, those kind of
improve on their own. And so if you have a cold and
you go to your primary care doctor and if it's viral,
antibiotics are to treat bacteria.
And so the antibiotics are really not going to do much for
a viral infection. And so oftentimes it's self
(18:51):
limited. It improves on its own with
time. Yes, it's uncomfortable.
Yes, you have pink eyes, Yes youhave watering and it's
uncomfortable blood, but usuallyit gets better on its own.
Antibiotics necessary. Doctor Chua.
Yeah, that's right. Usually you don't need
antibiotics to treat you. You definitely don't need
antibiotics to treat viral conjunctivitis.
Yeah. Yeah, OK.
(19:12):
Sometimes patients they do want something and I do recommend for
viral, I would recommend artificial tears for comfort.
That is something that recommendbut not a prescription drop.
Now, Doctor Chua, I wanted to ask you about this other
condition which is related to some of the other things you
mentioned. Sometimes people get crusting
along their lids and inflammation along their lids,
(19:33):
and it could be from something like a mite.
Can you talk to us a little bit about that?
What is that condition? How would people know and how do
we take care of it? That's a good question.
Lefaritis basically is when you have inflammation along the
eyelids and along the base of the eyelashes.
And so you can have these littleflakes, almost looks like
dandruff flakes at the base of your eyelashes.
(19:56):
And so the common trigger is we all have.
You know, bacteria and little microbes on our skin and our
hair, but in some patients they just happen to be a little bit
more sensitive to these microbes.
And so they develop this immune response and it manifests as
bufferitis, right? You can have pink puffy eyelids
(20:16):
with those little scales and along the base lashes and it's
one other cause of blepharitis was what's called demo dex
blepharitis and demo Dex is a little type of might that can
live and the base of your eyelashes.
It's not that common, although it usually is a trending topic
(20:37):
on social media because it's just it's it is good.
It gets a lot of clicks when yousee that there's a might that
could be living on the base of your eyelashes.
And for treaty for diagnosing demo decks that the, the typical
thing we look out for on exam isyou can have these little
cholerettes or it's like circular deposits at the base of
the eyelashes. And basically when we see those
(20:59):
cholerettes, we're at least thinking about Demodex.
And fortunately, I think anotherpart of why Demodex has been
taking off recently is because there's been a new prescription
medication that has been released for Demodex.
And so that company who releasedthe medication has made a big
marketing push to make sure thatall of the eye doctors are
looking out for Demodex. Yeah, I was looking at the
(21:20):
prevalence of Demodax in the general population and I saw
that it significantly increases with age.
Yes, some children have it, but as you get to be an adult and
especially older adult, I think I read somewhere if you live
into your like 90s, then almost 100% of people have Demodax.
So it's just something that is very common in the population,
(21:41):
not something to be alarmed about.
I know a lot of people, they hear this, like you said, like
it's it's you don't want to haveto have something living on you.
But many people have these eyelid mites and it's not really
not really too dangerous. I guess that's what I'm trying
to say. OK.
Doctor Chu, is there anything else you wanted to add that
people should be doing to take care of their eyes and their
eyelids? Like any preventative measures
(22:03):
for any of these conditions thatmay be helpful out, like for
example eyelid hygiene. Yeah, so eyelid hygiene is super
important. I think if someone is struggling
with chronic red eyes or if theyhave a component of blepharitis.
Blepharitis you can tell in the mirror if you look really
closely at the base of your eyelashes, if you notice there's
some flakes there, some white deposits or flakes, eyelid
(22:26):
hygiene is really good. So what you can use is kind of
some eyelid scrubs. There's a few different
companies that make different eyelid scrubs, but you basically
twice a day you want to just clean off the base of your
eyelashes. Good warm compress.
Warm compress helps to open up the oil glands, the mybomium
glands, and helps them to drain properly so that you have that
oil layer on in your tear film to help prevent dry eye.
(22:49):
A good artificial tear. A lot of patients have dry eye
and so having a good quality artificial tear to use, handy to
use whenever you're feeling dry or irritated.
That's definitely helpful. OK, those are excellent tips and
so simple to do. Now, is there any kind of major
myth or misconception people have about red eye that you want
(23:09):
to dispel? Anything that patients
oftentimes ask you and you say no, that's just not right.
The tough thing, actually, I think the tough thing with red
eye is you can never really assume what's causing the red
eye. Like we mentioned, we talked
about I think four or five reasons, but there are so many
reasons that why someone might have a red eye.
I made a few videos. I've actually, I think I've had
(23:30):
to make multiple videos because there's so many possible
different reasons of why someonemight have a red eye.
So I think the one thing to try to avoid is just assuming that,
Oh yeah, I have a red eye. It must be an infection or it
must be this or it must be that.Just seeing your local eye
doctor and trying to make sure you diagnose it correctly
because like we mentioned, there's so many different causes
and the treatments are so different.
(23:51):
Whether it be an infection or like a uveitis or an
inflammation, the treatments areso different that the first step
is you really got to diagnose itcorrectly so you could get down
to the bottom of it. So that's what I'd recommend.
Yeah, those words are goal Doctor Chua, so important.
Yes, you can try to self diagnose, but it's really best
if, especially if you have a chronic issue, get it checked
out. Don't just sit on it and try to
(24:12):
do DIY at home. Well, Doctor Chua, thank you so
much for sharing all of your expertise.
You've been a wealth of information and you've shared so
much on this short interview andyou share so much on your videos
on your channel. So I highly encourage people to
reach out and and follow you. And if anyone else wanted to
contact you, perhaps even becomea patient if they live in the in
(24:33):
your area, how could they find you?
Yeah, I practice at practice. It's called Puente Hills Eye
Care. But if you just look up my name,
Michael Chua, our website will come up.
You could give our office a callor you could just look for me on
YouTube. All of our information is there.
And again, if you don't yet follow Doctor Chua, please do so
on his YouTube channel. Thank you all for joining us.
(24:54):
Thank you Doctor Chua for spending some time with us and I
will see you all during the nextsession.
Thanks for having me. Thank you for tuning in to the
IQ Podcast. I hope you enjoyed today's
episode and learn something new.To help.
You boost your IQ. Leave us a review and share the
podcast with your family and friends.
Stay connected with me for more eye opening insights on ihealth,
(25:18):
nutrition and lifestyle. Until next time, keep your
vision clear and your IQ sharp.
I would say probably the most common is dry eye.
Basically when the surface of the eye is dried out, then the
cornea gets exposed to kind of air and irritation.
And so all of that that that irritation cause inflammation in
the cornea and that can cause the release of cytokines and
little inflammatory chemicals. And so that can cause a red eye.
(00:21):
So that's probably the most common cause.
Other common causes of red eyes,things like allergy, allergic
conjunctivitis, so many people are allergic to things like pet
dander or mold or pollen. Or for us in LA, patients have
been exposed to irritants in theair from what recent wildfires?
Welcome to the IQ Podcast. I'm Doctor Ronnie Bannock, here
(00:44):
to help you boost your IQ with powerful insights that connect
your eyes, your brain, and your whole body Wellness.
This episode was recorded duringthe Eye Health Summit, where the
world's leading experts shared breakthrough insights in vision
and holistic eye care. Hello everyone and welcome back.
I'm Doctor Ronnie Bannock and today I'm thrilled to be joined
(01:08):
by Doctor Michael Chua and Ophthalmologist, who has a very
popular following online on YouTube and his YouTube channel.
Thank you so much, Doctor Chua, for joining us today.
Yeah, thank you for having me. I'm very happy to be here.
Absolutely. Now you are a wealth of
information. You cover so many topics on your
YouTube channel. So we could talk about a host of
(01:30):
different things, but what I thought we'd talk about today
specifically are conditions thathappen to, for many people,
various different types of red eye and inflammation on the
surface of the eye. I'm going to be talking about
all that. But before we do, I just want to
ask you, how did you get so involved in education,
particularly in making all your amazing videos online on
(01:52):
YouTube? Yeah, I always enjoy teaching
others, even through college andmedical school.
I was for a private tutor and I was ATA in college and basically
I supported myself through medical school by tutoring other
people. So I really enjoyed teaching
others. And so when I was finishing up
residency, I really, I found it interesting that you could use
(02:15):
video to teach so many people and help them with their
problems and eye conditions. I basically just started
recording videos of me talking about how to treat and how to
treat and manage different eye conditions and it took off.
So I kept doing it and melds with what I love to do, which is
I just love to help people with their vision and health problems
and putting it online and allowed me to help at this point
(02:38):
millions of people with their vision and health problems.
Yeah, you're doing such amazing work and the ability to reach,
like you said, millions of people from around the world and
a platform like YouTube is just phenomenal.
So now we have the technology togo along and support our
passions in educating people. So let's talk about the various
different types of things that can happen on the surface of the
(03:00):
eye because there are different types of inflammation that can
develop. First, let's just clarify some
terms here. We say in general the term
inflammation, but there are there specific types of
inflammation that tend to happento people when it comes to their
ocular surface. Yeah, absolutely.
A lot of it is dependent on the exact location.
So you can have inflammation of the eyelashes and the eyelid,
(03:23):
something we would call blepharitis.
And even blepharitis can get subtyped into anterior posterior
blepharitis. We have my Bomian glands or the
oil glands that secrete oil ontoour tear film to help prevent
tears from evaporating. So if my Bomian glands are
involved, that's one particular type of inflammation called my
Bomian gland dysfunction. Or you can have inflammation of
(03:43):
the surface of the eye, right, That's keratitis.
Or you could have inflammation inside the eye or uveitis.
So yeah, there's all different types of inflammation.
Oftentimes you get multiple types of some component of
blepharitis with keratitis or and also uveitis.
And it's up to us ophthalmologist and optometrist
to figure out where exactly thisinflammation is.
(04:03):
And trying to figure out what's triggering it.
But in addition to inflammation,you can also have other
conditions that could be causingred eyes or irritation or
inflammation to It is actually adiagnostic challenge for us
clinicians to figure out what's going on.
Oh, you're so right. Sometimes it's straightforward.
We can see exactly what's causing the inflammation, but
sometimes we need to dig a little deeper and sometimes
(04:25):
we're not sure and we just try to treat it the best way we can.
So now let's talk about you talkabout a couple of different
types of issues. What are the most common
reasons? Let's say the four most common
reasons people can develop a redeye.
Yeah, good question. So I would say probably the most
common is dry eye. Basically when the surface of
(04:45):
the eye is dried out, then the cornea gets exposed to kind of
air and irritation. And so all of that that that
irritation cause inflammation inthe cornea and that can cause
the release of cytokines and little inflammatory chemicals.
And so that can cause a red eye.So that's probably the most
common cause. Other common causes of red eyes,
(05:07):
things like allergy, allergic conjunctivitis.
So many people are allergic to things like pet dander or mold
or pollen, or for us in LA, patients have been exposed to
irritants in the air from what recent wildfires.
These things can cause an allergic reaction to.
So often times with allergic conjunctivitis, patients
(05:28):
mentioned that they have red eyes or sometimes a component of
tearing, and the most common symptom is itching.
Other common causes for Another common cause for red eye is a
subconjunctival hemorrhage are basically a when you have a
burst blood vessel in the surface of the eye that can
cause your eye to be red. And another common cause like we
(05:48):
talked about is some sort of inflammatory disease, something
like a uveitis or keratitis can cause a red eye as well.
Yeah. So that's pretty.
It's very broad. And you meant that certain types
of conditions can be associated with certain types of symptoms.
So let's talk about dry eye, which is what you mentioned
first. So you mentioned people can have
(06:09):
some burning. Are there other indications that
the redness may be coming from dry eye other than burning?
Yeah, it's a lot of it is based on symptoms and clinical
histories. Like you mentioned, burning,
foreign body sensation. Patients say they have a sandy,
gritty feeling in their eyes. Often times we can just see it
on exam. When patients have dry eyes,
(06:30):
they can have these things called punctate epithelial
erosions or little breakdown in the surface of the cornea of the
eye on the front of the eye. If you have really dry lips, you
can have a cracked lips, the surface of your lips may crack a
little. So we can see that on exam too.
So I would say those are probably the most common things
we're looking. Yeah, that gritty, sandy
sensation is often times so common.
(06:52):
People say I feel like there's an eyelash in my eye or I feel
like there's gravel inside my eye.
Another symptom I've also often cured from patients is tearing.
And can you explain this a little bit?
Like why do people, if they havedry eye, why may they have
tearing? Because you would think that's
Contra counterintuitive there. Yeah, definitely.
(07:12):
Yeah, it's a little bit confusing, contrintuitive.
So it depends on the quality of the tears that we're making.
And basically there's three different components of the
tears that we have. There's the aqueous layer, which
is like the water part. There's the oil layer, which is
the oil secreted from our mybomium glands and that helps
to prevent tears from evaporating.
(07:33):
And then there's also the mucus layer, which helps the the tears
just spread over the surface of the eye.
And so basically, if we're missing any of those components,
the quality of our tears are notthat good.
And so even though you may have some tears, if the tears aren't
staying on the surface of the eye or they're not, it's not
working properly, then yeah, you're lacrimal glands might be
(07:56):
getting triggered to make more tears when the surface of the
eye keeps drying out. Often times it's not just a
question of, oh, do you have enough tears?
It's also a question of what's the quality of the tears that
you're making. And so sometimes we need to
address the quality to help withthe dry eye symptoms.
So what I'm hearing from you is if the tear quality is not good
and the tears evaporate too quickly, is that correct to say?
(08:18):
And then other gland kicks in, lacrimal gland kicks in and
overproduces tears and compensation for that.
Yeah, exactly right. Yeah, OK.
Now let's talk a little bit about you mentioned allergies,
which are so common. Sometimes people have seasonal
allergies, Sometimes it's they're allergic to something
new in their environment, in their home even.
What are some of the the definitive or defining features
(08:42):
of allergy? Like how can you tell that apart
from dry eye? Yeah, that's a good question.
For me and my practice, a lot ofit is with clinical history.
So yeah, one of the most common complaints patients will mention
is itching. The itching is probably the
number one symptom patients willmention when it's related to
allergy and on exam too. So just trying to differentiate
(09:03):
between dry eye and allergic conjunctivitis.
With dry eye, like we mentioned,we're looking for those changes
in the surface of the cornea. If it's just allergic
conjunctivitis, you usually don't really see those kind of
the breakdown in the surface of the cornea as much unless a
patient, which is totally possible, a patient can have
both allergy and dry eye. But those things we look out for
(09:23):
on exam. What about like discharge?
Do you often times see dischargein some of these patients?
Yeah, that's, that can definitely be a component.
Often times 2 patients will mention tearing with allergy and
but you can also have tearing with dry eyes.
So it's sometimes it's not there's not very specific signs.
And then with discharge through that's one thing I forgot to
mention in terms of the most common causes for red eyes also
(09:45):
infection. So if you start seeing
discharge, you might want to at least think about infection
also, which could be contributing to the red eye.
I've also seen patients with allergies who have like really
puffiness of their eyelids. They wake up with puffiness and
then gradually make it better during the day.
Is that something you see often as well?
Yeah, you can definitely have eyelid involvement with allergic
(10:08):
conjunctivitis as well, Absolutely.
And what do you tell people in terms of how to manage that that
puffiness? Yeah, usually the the standard
of care for me is just anti a good antihistamine regimen.
Antihistamine drops do really well for treating allergic
conjunctivitis. The eye drops are really good
for that. When there's eyelid involvement.
Sometimes what we could do is some oral antihistamines as
(10:31):
well. I can help with the puffiness
and in some cases if there's refractory or they're still
having a lot of puffiness and the with drops and with pills
didn't really help. Sometimes we'll try an ointment.
They have some you could either use like a steroid ointment,
although we try not to use that long term, or even something
like tacrolimus which is a good ointment for eyelid puffiness as
(10:53):
well. Yeah, there's just some great,
great suggestions and that some of those things you can do on
your own, but some of them you need to work with your provider
and get a prescription for it, correct.
These are not available over thecounter for the most part, some
of these treatments. Now let's move on to the third
cause of red eye that you mentioned, which is a
subconjunctival hemorrhage. So, Doctor Chua, can you tell us
(11:13):
a little bit about what is it, why does it happen, and what can
people expect from a subconjunctival hemorrhage?
Yeah. So basically we all have these
tiny little blood vessels in thefront of our eye and the
conjunctiva. And so basically if something
causes one of those blood vessels to break, so if you
accidentally rub your eye too hard or maybe taking out a
(11:35):
contact lens, accidentally scratch one of those blood
vessels or maybe even while you're sleeping.
One common story I hear from patients is, Oh yeah, I just
woke up with it. So it's possible maybe when you
were sleeping, you accidentally rubbed your eye in the pillow
and cause one of those blood vessels to break.
Then you can have blood basically on the front surface
of your eye that conjunctiva, and instead of it being white,
(11:57):
it turns red. And those are a a little bit
easier. Those are definitely easier for
us to diagnose because once you see the blood on exam at the
microscope, we could pretty mucheasily say it's subconjunctival
hemorrhage. Although I will say in patients
who get recurrent subconjunctival hemorrhage,
sometimes that could be a sign of something else that's going
(12:17):
on, whether it be uncontrolled blood pressure or in my case, I
just literally yesterday I had apatient who had recurrent
subcontractival hemorrhages and it was related to a problem in
her brain. She had a Yeah, So you can.
And I learned that from you, Doctor Vanik.
Thank you very much. So I'm still using all the
things you taught me from residencies.
(12:38):
Yeah. It's subconjunctival hemorrhage,
luckily, is not dangerous in thevast majority of the cases.
But sometimes if it's recurrent,it can be a sign of something
else going on. Yeah, actually, I'll just share
a story. A few years ago, I had a
subconjunctival hemorrhage just out of the blue.
Maybe I was coughing or sneezing.
And then I noticed, oh, there's a little red spot.
(13:01):
And then over the next few hoursit grew and grew and grew and it
basically covered like more than1/3 of my, the white part of my
eye. And it honestly, it, it looks a
lot worse than it is, right? There's no pain, it's just it's
a cosmetic issue, right? People look at you, they see a
bright red eye and they get concerned.
But really it's pretty benign. And like you said, in most cases
(13:21):
it just goes away. It's only the the recurrent ones
you really have to worry about. I know some people when they
have it though, they try to put in eye drops and sometimes even
tinctures. Like for example, I've had a
patient who was putting Castor oil in his eye because of a
subconjunctival hemorrhage. What are your thoughts about
treatments like that? It's hard.
I think usually what I say for subcontractile hammer, which is
(13:44):
kind of like a bruise, it just goes away on its own.
There's there's not really much you just waiting for the
hemorrhage to resolve on its ownis usually fine.
Some patients I found that if they really want to try to speed
it up as much as possible, something like a lumify,
something like some sort of vasoconstricting type of eye
drop, but I don't you oftentimesyou don't really need to do
(14:06):
that. But in terms of Castor oil or
eye drops, usually that's not necessary.
It'll go away on its own. Yeah, I think patience is key.
A lot of people expect it to be gone within a day.
And honestly, it can take. For me, it took almost three
weeks for mine to go away, but it can take just like you said,
it's a bruise, right? It's a bruise on the surface of
the eye and it just give it sometime.
This has been such a fascinatingdiscussion with Doctor Chua
(14:29):
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(15:36):
Now, Doctor Chua, earlier you had mentioned that sometimes
there can be an infection as theunderlying cause for redness.
Can you explain a little bit more about that and the
different types of eye infections people can get?
Yeah, infection is definitely one of the more common causes
for red eye that we see The I guess the layman's from pink eye
is something that a lot of patients know about.
(15:57):
And so usually what that's referring to is something called
viral conjunctivitis or basically again, the
conjunctiva, that kind of that the pinkish clear tissue in the
front of the eye when you have aviral infection can cause
inflammation of the conjunctiva.And it's usually associated with
maybe sometimes you'll have a runny nose or a cough or some
(16:18):
type of cold symptoms. And when that virus can get into
the eye can cause red eye, can cause tearing discharge.
Often times it starts in one eyeand then it goes to the other
eye. Often times patients can point
out the person they got it from and whether it be from a Co
worker or someone at home who also had a recent cold or even
pink eye. So that's one of the most common
(16:39):
causes. Other types of infections that
we see, it could be not just caused by a virus, but bacterial
conjunctivitis. Usually when a bacteria is
involved, it's a little bit moreof a severe clinical picture.
You might have more discharge, more inflammation and other
causes. You can have infections of the
cornea or that transparent clearsurface from the front of the
eye. So when you have a corneal
(17:01):
infection that's usually associated, oftentimes it's
associated with contact lens wear.
And so that those are all different types of infections
that you can get and cause redness in the eye.
So when it comes to whether the conjunctivitis is viral or
bacterial or perhaps something else, what do you look for on
the exam? Or are there signs that people
(17:23):
can look for at home that may point them in One Direction or
another? Yeah, So it's a good question.
Sometimes it's actually not as straightforward.
Sometimes you have to give the the infection a little bit of
time for the signs and symptoms that pop up to help you
differentiate. In general, it's more commonly
viral. So sometimes that's just the
(17:43):
assumption. And then if it's not getting
better after a few weeks, maybe then your doctor might start
thinking, oh, maybe it might be bacterial.
But things we look out for in terms of viral conjunctivitis,
usually the discharge is a little bit more watery, little
bit more mucousy, whereas bacterial conjunctivitis, it can
look, the discharge can have look more more like pus, like
(18:04):
thicker, more purulent, Yeah, that that sort of picture.
Like more goopy and yeah, angry looking.
So I think this is a big misconception from many people.
They develop, quote UN quote, pink eye and they immediately
come and come to get checked outand they expect a prescription
and antibiotic prescription. What do you tell people?
(18:27):
Like we mentioned, in most casesit's viral.
And so with viral conjunctivitis, those kind of
improve on their own. And so if you have a cold and
you go to your primary care doctor and if it's viral,
antibiotics are to treat bacteria.
And so the antibiotics are really not going to do much for
a viral infection. And so oftentimes it's self
(18:51):
limited. It improves on its own with
time. Yes, it's uncomfortable.
Yes, you have pink eyes, Yes youhave watering and it's
uncomfortable blood, but usuallyit gets better on its own.
Antibiotics necessary. Doctor Chua.
Yeah, that's right. Usually you don't need
antibiotics to treat you. You definitely don't need
antibiotics to treat viral conjunctivitis.
Yeah. Yeah, OK.
(19:12):
Sometimes patients they do want something and I do recommend for
viral, I would recommend artificial tears for comfort.
That is something that recommendbut not a prescription drop.
Now, Doctor Chua, I wanted to ask you about this other
condition which is related to some of the other things you
mentioned. Sometimes people get crusting
along their lids and inflammation along their lids,
(19:33):
and it could be from something like a mite.
Can you talk to us a little bit about that?
What is that condition? How would people know and how do
we take care of it? That's a good question.
Lefaritis basically is when you have inflammation along the
eyelids and along the base of the eyelashes.
And so you can have these littleflakes, almost looks like
dandruff flakes at the base of your eyelashes.
(19:56):
And so the common trigger is we all have.
You know, bacteria and little microbes on our skin and our
hair, but in some patients they just happen to be a little bit
more sensitive to these microbes.
And so they develop this immune response and it manifests as
bufferitis, right? You can have pink puffy eyelids
(20:16):
with those little scales and along the base lashes and it's
one other cause of blepharitis was what's called demo dex
blepharitis and demo Dex is a little type of might that can
live and the base of your eyelashes.
It's not that common, although it usually is a trending topic
(20:37):
on social media because it's just it's it is good.
It gets a lot of clicks when yousee that there's a might that
could be living on the base of your eyelashes.
And for treaty for diagnosing demo decks that the, the typical
thing we look out for on exam isyou can have these little
cholerettes or it's like circular deposits at the base of
the eyelashes. And basically when we see those
(20:59):
cholerettes, we're at least thinking about Demodex.
And fortunately, I think anotherpart of why Demodex has been
taking off recently is because there's been a new prescription
medication that has been released for Demodex.
And so that company who releasedthe medication has made a big
marketing push to make sure thatall of the eye doctors are
looking out for Demodex. Yeah, I was looking at the
(21:20):
prevalence of Demodax in the general population and I saw
that it significantly increases with age.
Yes, some children have it, but as you get to be an adult and
especially older adult, I think I read somewhere if you live
into your like 90s, then almost 100% of people have Demodax.
So it's just something that is very common in the population,
(21:41):
not something to be alarmed about.
I know a lot of people, they hear this, like you said, like
it's it's you don't want to haveto have something living on you.
But many people have these eyelid mites and it's not really
not really too dangerous. I guess that's what I'm trying
to say. OK.
Doctor Chu, is there anything else you wanted to add that
people should be doing to take care of their eyes and their
eyelids? Like any preventative measures
(22:03):
for any of these conditions thatmay be helpful out, like for
example eyelid hygiene. Yeah, so eyelid hygiene is super
important. I think if someone is struggling
with chronic red eyes or if theyhave a component of blepharitis.
Blepharitis you can tell in the mirror if you look really
closely at the base of your eyelashes, if you notice there's
some flakes there, some white deposits or flakes, eyelid
(22:26):
hygiene is really good. So what you can use is kind of
some eyelid scrubs. There's a few different
companies that make different eyelid scrubs, but you basically
twice a day you want to just clean off the base of your
eyelashes. Good warm compress.
Warm compress helps to open up the oil glands, the mybomium
glands, and helps them to drain properly so that you have that
oil layer on in your tear film to help prevent dry eye.
(22:49):
A good artificial tear. A lot of patients have dry eye
and so having a good quality artificial tear to use, handy to
use whenever you're feeling dry or irritated.
That's definitely helpful. OK, those are excellent tips and
so simple to do. Now, is there any kind of major
myth or misconception people have about red eye that you want
(23:09):
to dispel? Anything that patients
oftentimes ask you and you say no, that's just not right.
The tough thing, actually, I think the tough thing with red
eye is you can never really assume what's causing the red
eye. Like we mentioned, we talked
about I think four or five reasons, but there are so many
reasons that why someone might have a red eye.
I made a few videos. I've actually, I think I've had
(23:30):
to make multiple videos because there's so many possible
different reasons of why someonemight have a red eye.
So I think the one thing to try to avoid is just assuming that,
Oh yeah, I have a red eye. It must be an infection or it
must be this or it must be that.Just seeing your local eye
doctor and trying to make sure you diagnose it correctly
because like we mentioned, there's so many different causes
and the treatments are so different.
(23:51):
Whether it be an infection or like a uveitis or an
inflammation, the treatments areso different that the first step
is you really got to diagnose itcorrectly so you could get down
to the bottom of it. So that's what I'd recommend.
Yeah, those words are goal Doctor Chua, so important.
Yes, you can try to self diagnose, but it's really best
if, especially if you have a chronic issue, get it checked
out. Don't just sit on it and try to
(24:12):
do DIY at home. Well, Doctor Chua, thank you so
much for sharing all of your expertise.
You've been a wealth of information and you've shared so
much on this short interview andyou share so much on your videos
on your channel. So I highly encourage people to
reach out and and follow you. And if anyone else wanted to
contact you, perhaps even becomea patient if they live in the in
(24:33):
your area, how could they find you?
Yeah, I practice at practice. It's called Puente Hills Eye
Care. But if you just look up my name,
Michael Chua, our website will come up.
You could give our office a callor you could just look for me on
YouTube. All of our information is there.
And again, if you don't yet follow Doctor Chua, please do so
on his YouTube channel. Thank you all for joining us.
(24:54):
Thank you Doctor Chua for spending some time with us and I
will see you all during the nextsession.
Thanks for having me. Thank you for tuning in to the
IQ Podcast. I hope you enjoyed today's
episode and learn something new.To help.
You boost your IQ. Leave us a review and share the
podcast with your family and friends.
Stay connected with me for more eye opening insights on ihealth,
(25:18):
nutrition and lifestyle. Until next time, keep your
vision clear and your IQ sharp.
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