Q The whites of my eyes are never quite white. I have had all my bloods come back normal – cholesterol, kidney etc – and I don’t drink or smoke and I get plenty of sleep. I also use hypoallergenic mascara and don’t have any allergies that I know of. What can I do to make the whites of my eyes white? I am a woman in my 40s.
A Much like the colour of your skin or your teeth, the whites of your eye may be within the range of normal. That being the case, there are plenty of Over-The-Counter (OTC) eyedrops that temporarily treat mild red eye for up to eight hours. Firstly, you should be certain that you are not suffering with an eye infection – generally there is associated a green/yellow discharge from the eye during an infection and even some mild eye pain. Secondly, you must make sure the pressure in your eyeball is normal before using some of these eyedrops. Having high pressure in the eyeball is called glaucoma. Glaucoma is the known as ‘the silent stealer of sight.’ Everyone over 40 years of age should get regular eye examinations (with an optician) every three to five years depending on their family history of eye disease. Some of these OTC remedies contain medication to constrict the blood vessels in the whites of the eye to reduce redness and can make glaucoma worse. The best way to get the pressure in your eyeball tested is to attend an optician for a glaucoma (puff) test.
Excessive air pollution, dry humid climates and excessive sun exposure or rubbing of the eyes may cause temporary eye irritation and redness. Always wear sunglasses with appropriate UV filter category when outdoors or driving. Other eye symptoms that might indicate a different diagnosis or something more serious include eye itchiness or seasonal eye allergies, visual disturbance (eg loss of vision, blurred vision or double vision), sensitivity to bright light (photophobia), eye pain on blinking or pain on eye movements.
Conjunctivitis (inflammation in the conjunctiva) can be viral, bacterial or triggered by allergies and is one of the most common causes of red eye. There is another lining between the sclera, the white of the eye, and the conjunctiva called the episclera and sometimes this can become inflamed to cause episcleritis. Symptoms of episcleritis include red eye, producing lots of tears, sensitivity to bright light and a hot gritty sensation in the eye. One last inflammation in the outer layers of the eye to mention is scleritis which is very serious and tends to cause severe eye pain and a more bluish-purple discolouration of the eye. Typically, scleritis is linked to a chronic inflammatory or connective tissue disease. Dry eye disease can cause the whites of the eye to turn red and sometimes the eyelids develop a clear crust. Some of the common causes of dry eye include damage to the tear glands, a side-effect of certain medication post laser eye surgery to sharpen visual acuity, vitamin A deficiency, or some medical conditions like diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren’s syndrome and thyroid disorders. If left untreated, chronic dry eye disease can result in a grittiness or foreign body sensation, blurred vision, and potentially vision-threatening corneal erosions and corneal infections. An optician can diagnose dry eye disease with a litmus paper test and a fluorescein eye stain test to assess for corneal erosions.
Yellowing of the whites of the eye is called jaundice. This occurs due to elevated bilirubin levels in the blood stream that deposit in the conjunctiva of the whites of the eye. It can be a sign of liver or gallbladder (hepato-biliary) disease but can also occur in healthy people with slight variation in their liver metabolism. You should at least attend an optician for an exam.
⬤ Dr Jennifer Grant is a GP with Beacon HealthCheck