Causes - Redness of the whites of the eye (sclera) may have several causes with different types of presentations. Here are some common problems and their most usual cause, but there can be some variations:
Periorbital cellulitis - This presents with very swollen and red tissue around the eye caused by a bacterial infection. It may occur as a complication of a cold or sinus infection or as a result of an insect bite or scratch near the eye. The eye itself may or may not be red and there may or may not be eye discharge. Fever and nasal congestion may also be present. This is considered an emergency because these children need to be seen quickly and started on antibiotics. If this infection progresses quickly, they may require hospitalization and even surgery to drain the infection.
Viral and bacterial conjunctivitis ("pink eye") - This is usually accompanied by a cold. It often starts with just redness without discharge and then yellow eye discharge appears, especially noted when the child wakes from sleep. When the yellow discharge appears, this usually responds to antibiotic eye drops. An ear infection may accompany this in about 40% of cases.
Allergic conjunctivitis - These children usually have a history of allergies and it may be triggerred by a contact to which the child is allergic (like a cat). The eye is itchy, watery and sneezing and clear runny nose may be present. Treatment with over-the-counter allergy eye drops and oral antihistamines may be helpful. If symptoms are persistent or severe, prescription allergy eye drops may be helpful.
Foreign body or chemical in the eye- A foreign body lodged in the eye or under the eyelids will cause irritation, redness and pain in the eye. It may sometimes be dislodged at home by gently flushing the eye with water. Chemicals may also be flushed. Consult your local poison control if chemicals are suspected. If pain persists after flushing or if poison control recommends it, the child should be seen by a physician. A corneal abrasion, which is a scratch on the cornea also needs to be ruled out. These cause persistent pain of the eye and a sensation like something is scratching the eye every time they blink.
Trauma - Any significant trauma to the eye, or possiblity of a penetrating injury (like a small metallic chip from striking metal on metal) should be seen immediately.
Stye - A stye is an acute infection of the glands located at the
eyelid margin. There is swelling, pain, itching and redness in a small area at the lid
margin. Treatment consists of using frequent warm compresses on the eye.