“I would like to stop my eye discharge”
I often get patients coming to see me because of eye discharge and they want to know how they can stop their troublesome problem. First of all, I ask them how long they have had their eye discharge, then I examine them and provide them with a way forward. Often they are surprised to find out what the cause of their eye discharge is. Fortunately, eye discharge is virtually always very treatable.
Eye discharge can result from a variety of different conditions, which range from very mild to potentially very serious:
- Sleep in eyes
- Crusty eyes
- Pink eye
- Eye mucous
- A stye or chalazion
- Infected corneal ulcer
In this blog post, I am going to briefly review each of these, explain their significance and how I approach them and treat your eye discharge. However, a lot can be done to stop this discharge.
1. Sleep in Eyes
It is very common for people to wake up in the morning having had a watery eye overnight and sleepy dust in their eyes. This occurs commonly among people who have an allergy or simply because their eyes have watered during the night and the tears have accumulated at the corner of the eye and led to a yellow crystalline deposit or mucous.
The treatment is to clean the eyelids after waking with warm tap water, which will gently remove the crystalline deposits or mucous blob from the corner of the eye. It will also remove any crusts on the eyelashes and sleepy dust stopping the eyes from opening comfortably.
It also removes any bacteria that have gathered and will make the eyes feel a lot fresher. What you must not do if you have sleep in your eyes is to start poking them with your finger and attempt to remove them with a fingernail or a cotton bud because that can exacerbate the condition, giving rise to more sleepy dust or mucous production.
2. Crusty Eyes
Crusty eyes usually represent low-grade blepharitis with red rimming of the eyelid margins where the patient has not been cleaning them. They have crusts and collarettes formed on the lashes and lash roots, which give a crusty looking appearance associated with red, thickened eyelid margins, called red rimming, and predispose the patient to an overt blepharoconjunctivitis.
Crusty eyes do not necessarily mean that you have conjunctivitis, but you may well have blepharitis. You can treat Blepharitis by maintaining simple eyelid hygiene at home. You can do this by using warm compresses to clean the eyelids twice a day, either with warm tap water or water from the kettle. You can also use a cold cleaning solution such as a micelle solution, or eye makeup removal solution without any preservatives or perfumes in it, which will effectively clean the eyelids of the crusts.
Once this has been done for a few days the crusty eyes should disappear. Occasionally, crusty eyes are associated with a low-grade infection and require some antibiotic ointment.
3. Pink Eye
Pink eye covers a broad range of conjunctivitis conditions, including infective bacterial and viral conjunctivitis and allergic conjunctivitis.
Infective conjunctivitis has a watery discharge if it is viral and a sticky discharge if it is bacterial. Very often it will settle quite quickly within a few days with simple eyelid hygiene but occasionally may require soothing treatment such as lubricants, antibiotic drops or steroid drops to reduce inflammation. Allergic conjunctivitis requires identifying the allergen, which can be:
- Animal dander
- Eye drops etc.
Once the doctor has identified the offending allergen, the watery discharge will stop. The condition may also require active treatment with anti-allergy eyedrops such as sodium cromoglycate, or even steroid eye drops, to dampen down the inflammation, which makes allergic conjunctivitis give such pink or red eyes.
4. Eye Mucus
A patient can exacerbate the production of eye mucus by trying to remove it from the corner of their eye. Or they might pick at it so much that it becomes strands of mucus that they must wipe away repeatedly, either digitally or with a tissue or cotton bud.
This causes microdamage and leads to the vicious circle of a condition called mucus mop-wipe syndrome or mucus fishing syndrome. These lovely names for eye discharge with mucus describe a very real and troublesome condition, which I see frequently at Clinica London. The patient is very surprised when I explain that they must not mop away or fish out their mucus.
The reason is that they are inducing microdamage to the conjunctival epithelial cells and this microdamage is leading to the production of more mucus because more goblet cells are formed on the fleshy bit at the corner of the eye, which is called the caruncle.
A caruncle normally has some mucus goblet cells but if it has microdamage then the tarsal conjunctiva develop more mucus-producing cells, leading to exacerbation of the very problem they are trying to solve.
I tell patients who have mucus mop-wipe syndrome or mucus fishing syndrome that they have to sit on their hands instead of removing the mucus, to let it dry and fall off.
They can clean the eyelids with micelle solution or with a warm flannel, and they can put in eye lubricant drops to wash out the mucus. But the one thing they must not do is to touch their eyes with their fingers, or any other material, as this can lead to worsening of the situation. It can take about three to six weeks for this condition to settle with no touching, but using lubricants and gently cleaning the eyelids. It always does settle.
Blepharoconjunctivitis is when someone who has crusty eyelids with blepharitis gets low-grade conjunctivitis as well. The blepharoconjunctivitis responds well to topical treatment with antibiotic drops or ointment plus eyelid-cleaning hygiene. Sometimes, though, a complication can arise in the formation of a marginal corneal ulcer. This is where there is a little white spot on the edge of the transparent part of the eye called the cornea, with some focal redness. This marginal ulcer is the body’s immune response fighting off the low-grade infection, and if this is present, then a weak steroid-antibiotic combination drop will be required under the supervision of your urgent eye care general ophthalmologist.
6. Stye and Chalazion
Styes and chalazions, when they are active and acute, can cause eye discharge depending on the severity and tenderness present in the eyelid and the amount of discharge. This is treated either with systemic antibiotics and eyedrops or ointment, or just eyedrops and ointment together with eyelid cleaning four times a day. If the stye develops into a full-blown chalazion, which does not go away after a couple of weeks, the chalazion will require surgical removal.
7. Infective Corneal Ulcer
This is one of the most dreaded causes of eye discharge. Various bacterial infections can cause conjunctivitis, the most common being staphylococcal conjunctivitis. But the most severe form is indeed pseudomonas aeruginosa conjunctivitis and corneal ulcer or keratitis. Pseudomonas is a rapidly penetrating bacterial keratitis, which can melt the cornea and can result in total cloudiness and scarring of the cornea. It can even result in loss of the eye from infection getting into the eye and causing endophthalmitis. It is a medical ophthalmic emergency if this is suspected.
Dacryocystitis is inflammation of the lacrimal sac. It can be painful, with a red lump over the lacrimal sac. There can be discharge from the sac either out through the skin if it is an acute on chronic dacryocystitis or just a discharge back over the eye from the dacryocystitis.
The lacrimal sac is situated at the corner of the eye just by the nose, but quite deep so you cannot normally feel it. It becomes enlarged and full of discharge because the duct beyond it is blocked. This leads to dacryocystitis and eye discharge.
First, the ophthalmologist must identify the cause so that they can unblock the duct and release the mucus and discharge from the sac back into the nose and stop it recurring.
An oculoplastic lacrimal surgeon is required to do that. Initially, however, it is treated with antibiotic eyedrops and systemic antibiotics.
The causes of eye discharge are diverse, varying from simple sleepy dust through to pink eye, a severe corneal ulcer to tear duct obstruction. If you have an eye discharge and you are not sure why you have it, then you should see your ophthalmologist for assessment and advice. At Clinica London, we have six ophthalmologists who are ready to see you at short notice, if necessary, for your eye discharge. They will help you to find out why you have it and then they will treat it.