Objective:

To highlight the growing global burden of noninfectious conjunctival hyperemia and call for clearer diagnostic pathways and management guidelines.

Key Findings:

• Conjunctival hyperemia is increasingly driven by lifestyle factors such as digital eye strain, contact lens wear, and environmental pollution.
• Dry eye disease (DED) and ocular allergy are leading causes of chronic redness, with DED affecting 5-50% and ocular allergy up to 40% of patients.
• Traditional decongestants are limited by tachyphylaxis and rebound redness, while low-dose brimonidine 0.025% shows promise without these issues.
• Patients seek relief for cosmetic reasons, influenced by social media and video conferencing trends.
• There is a concerning trend of steroid self-medication in some regions, delaying proper management.

Interpretation:

The review underscores the need for dedicated management guidelines for noninfectious conjunctival hyperemia to address both clinical and aesthetic patient concerns.

Limitations:

• Lack of long-term real-world data on the efficacy of low-dose brimonidine.
• Variability in treatment patterns globally, often misaligned with guidelines.

Conclusion:

The demand for safe and effective redness control is expected to rise, necessitating the development of specific diagnosis and management guidelines for noninfectious conjunctival hyperemia.