A new narrative review published in Ophthalmology and Therapy highlights the growing global burden of noninfectious conjunctival hyperemia and calls for clearer diagnostic pathways, safer long-term treatment options, and formal management guidelines.
Conjunctival hyperemia remains one of the most common ophthalmic presentations worldwide, increasingly driven by lifestyle and environmental factors, including digital eye strain (also known as “computer vision syndrome”), contact lens wear, cosmetics, smoking, and pollution. The review authors note that dry eye disease (DED) and ocular allergy are now among the leading causes of chronic or recurrent redness, with DED prevalence estimates ranging from 5–50% and ocular allergy affecting up to 40 percent of patients.
While many cases are self-treated with over-the-counter drops, management is often suboptimal. Traditional α1- or mixed α1/α2-adrenergic decongestants provide short-term vasoconstriction but are limited by tachyphylaxis and rebound redness. By contrast, the review highlights evidence for low-dose brimonidine 0.025%, a highly selective α2-adrenergic agonist, which demonstrated significant redness reduction without tachyphylaxis over 29 days and minimal rebound on discontinuation; however, long-term real-world data remains lacking, warranting further investigation.
Beyond pharmacology, the paper underscores the aesthetic dimension of ocular redness. Patients increasingly seek redness relief for cosmetic reasons, amplified by video conferencing and social media trends. The review authors caution against surgical “eye-whitening” procedures, which have been associated with serious complications including scleral thinning, necrotizing scleritis and diplopia requiring strabismus surgery.
Globally, treatment patterns vary widely and are not always aligned with guidelines, with concerning reports of steroid self-medication in some regions (e.g. Saudi Arabia and India), which further delay management and diagnosis of conjunctival hyperemia. The review identifies a lack of dedicated management guidelines for noninfectious conjunctival hyperemia and calls for consensus recommendations, improved patient education, and better screening tools to differentiate benign redness from sight-threatening emergencies.
As screen use and contact lens uptake continue to rise worldwide, the review authors conclude that demand for safe, durable redness control will only increase – placing pressure on clinicians to balance medical necessity, aesthetic expectations, and long-term ocular surface health. “The development of diagnosis and management guidelines specific to noninfectious conjunctival hyperemia,” the authors conclude, “is warranted to address patients’ clinical and aesthetic concerns.”
Conjunctival hyperemia remains one of the most common ophthalmic presentations worldwide, increasingly driven by lifestyle and environmental factors, including digital eye strain (also known as “computer vision syndrome”), contact lens wear, cosmetics, smoking, and pollution. The review authors note that dry eye disease (DED) and ocular allergy are now among the leading causes of chronic or recurrent redness, with DED prevalence estimates ranging from 5–50% and ocular allergy affecting up to 40 percent of patients.
While many cases are self-treated with over-the-counter drops, management is often suboptimal. Traditional α1- or mixed α1/α2-adrenergic decongestants provide short-term vasoconstriction but are limited by tachyphylaxis and rebound redness. By contrast, the review highlights evidence for low-dose brimonidine 0.025%, a highly selective α2-adrenergic agonist, which demonstrated significant redness reduction without tachyphylaxis over 29 days and minimal rebound on discontinuation; however, long-term real-world data remains lacking, warranting further investigation.
Beyond pharmacology, the paper underscores the aesthetic dimension of ocular redness. Patients increasingly seek redness relief for cosmetic reasons, amplified by video conferencing and social media trends. The review authors caution against surgical “eye-whitening” procedures, which have been associated with serious complications including scleral thinning, necrotizing scleritis and diplopia requiring strabismus surgery.
Globally, treatment patterns vary widely and are not always aligned with guidelines, with concerning reports of steroid self-medication in some regions (e.g. Saudi Arabia and India), which further delay management and diagnosis of conjunctival hyperemia. The review identifies a lack of dedicated management guidelines for noninfectious conjunctival hyperemia and calls for consensus recommendations, improved patient education, and better screening tools to differentiate benign redness from sight-threatening emergencies.
As screen use and contact lens uptake continue to rise worldwide, the review authors conclude that demand for safe, durable redness control will only increase – placing pressure on clinicians to balance medical necessity, aesthetic expectations, and long-term ocular surface health. “The development of diagnosis and management guidelines specific to noninfectious conjunctival hyperemia,” the authors conclude, “is warranted to address patients’ clinical and aesthetic concerns.”
