7 Reasons Your Eyes Are Red and Itchy: What You Need To Know

7 Reasons Your Eyes Are Red and Itchy: What You Need To Know

As an optometrist, itchy and red eyes are one of the most common things I see in practice.

And I get it, I've had dry eyes and blepharitis myself - that persistent irritation and eyelid inflammation coupled with uncontrollable itchiness - and, its frustrating, but the good news is I've managed to control it.

And as a parent, I've sat on the other side of the table watching my own son struggle with an eye condition that kept returning despite treatment.

What have I learned? Your body or eyes are asking for help and there's not always a simple solution.

From allergies to blepharitis to the lymphatic system – I've learned from longevity experts as well as hundreds of Ophthalmologists. I'll be drawing on this knowledge to give you a brief insight into what might be going in your situation.

Understanding the basics

The front of the eye is protected by a delicate tear film made up of three layers:

1. Water, to hydrate and nourish the cornea

2. Mucous, to help tears spread evenly and adhere to the eye

3. Oil, to slow evaporation and stabilise the tear film

When these layers work together, eyes feel calm and comfortable. When one layer is disrupted, the eye surface becomes exposed - leading to redness, itching, burning, and irritation.

This is why so many people with itchy eyes actually have dry eye disease, even if their eyes water.

In these early stages, I often recommend preservative-free lubricating drops that support the tear film rather than overwhelm it. Options like Hylo-Forte are designed to hydrate without irritating the eye surface with preservatives. Newer drops like Rohto Dry Aid have low traces of preservatives but have added benefits like menthol and a well balanced overall formula to allow the cornea to feel not only lubricated for longer periods but also refreshed. I'll write another article about various eye drops another time.

1. The Meibomian Glands: A Key Driver of Red, Itchy Eyes

The oil layer of the tear film is produced by the meibomian glands, which sit along the eyelid margins.

When these glands don't function well, tears evaporate too quickly. The eye surface dries out and becomes reactive - to allergens, wind, screens, and cosmetics.

This is incredibly common and is often worsened by:

1. Reduced blinking (especially with screens)

2. Chronic eyelid inflammation

3. Overnight lid issues

4. Blepharitis (which I manage myself)

Supporting these glands often requires more than drops alone. In practice, I frequently recommend dry eye heat masks and gentle lid massage tools to help soften oils and improve gland flow over time. Oil glands are like tiny tubes of toothpaste, if left in the tube for too long the oils solidify like honey, and can block it or the exit point, so it helps to be regularly squeezed out. I recommend once a month to my patients, if they have only slight signs of dry eyes, or less if there are no signs or symptoms.

2. Why Watery Eyes Can Still Be Dry Eyes

This concept didn't fully click for me until earlier in my career - and once it did, everything made sense.

Here's what's happening:

1. The balance between oil, mucous, and water is not right. i.e the ratio is wrong.

2. The tears evaporate too quickly

3. The corneal nerves become exposed

4. The brain triggers a protective reflex

5. The eye releases excess water from a gland that sits below your eyebrow, which spills over the edge of your eyelid.

That water doesn't stay on the eye because it lacks oil and mucous.

I often explain it like concrete - To make concrete, you need the right ratio - roughly 1 part cement, 2 parts sand, and enough water to bind it all together. Tears work the same way: without the correct balance of mucous (the binder), oil (the seal), and water, the tear film can't hold together and quickly breaks down on the eye surface.

The result:

1. Watery and irritated eyes

2. Red and dry eyes

3. Itchy eyes that feel gritty, irritated that may sting.

This is why lubrication alone isn't always enough - the tear film needs support, not just volume. So, it could be your lack of water or mucous in your tear film.

3. Allergies and the Inflammation Loop

Allergies are a common trigger for itchy eyes, but they rarely act alone.

When allergens contact the eye, histamine is released, leading to itching, redness, and swelling. But when the tear film is already unstable, the eye becomes far more reactive - and inflammation worsens dryness even further.

In these cases, I often focus on calming the eye surface and reducing triggers rather than relying solely on anti-allergy drops.

This is also where omega-3 based dry eye supplements can be helpful, as they support the body's natural anti-inflammatory pathways and tear quality from the inside.

This is also a great time to talk about Naphazoline – a chemical found in many "redness-relief" eye drops. It works by constricting the blood vessels on the white of the eye, making eyes look whiter temporarily without addressing the underlying cause of redness. With repeated use, it can lead to rebound redness, where the eyes become redder once the drops wear off. Naphazoline can also worsen dry eye symptoms by further destabilising the tear film and reducing natural eye-surface support. For this reason, optometrists generally avoid recommending naphazoline for ongoing eye comfort or long-term eye health. We will not be selling any eye drops containing Naphazoline at Eyehouse.

Instead, I've seen excellent results in patients who use Optimel Manuka Honey Eye Drops when inflammation is a key driver of symptoms.

They're best suited to situations where inflammation, bacteria, or biofilm are contributing to eye surface issues - rather than simple dryness alone. These aren't "comfort drops" in the traditional sense; they act more as a therapeutic reset for certain eye surface conditions, including:

1. Blepharitis or eyelid inflammation, particularly when bacterial load is involved

2. Evaporative dry eye linked to meibomian gland dysfunction

3. Recurrent redness or irritation that hasn't responded well to standard lubricating drops

4. Inflammatory dry eye, where the eye surface feels sore, reactive, or irritated rather than just dry

5. Contact lens wearers with ongoing discomfort related to inflammation (not to be used while lenses are in)

They're usually not ideal as a first-line option for:

1. Very sensitive eyes that react strongly to stinging

2. Mild, non-inflammatory dryness

3. People seeking instant soothing comfort alone

Manuka honey drops may sting briefly when first applied, which is normal. They tend to work best for people who understand why they're using them and are focused on calming inflammation, not just quick symptom relief.

One final Tip: If you suspect your red eyes may be from allergies and inflammation, use a cold eye mask, not a warm one. Here's a study they did which showed cold compress with ocular lubricants worked well and so did using an antihistamine with cold compress.

4a. Blepharitis: The Hidden Cause of Morning Itchiness

Blepharitis is inflammation of the eyelids caused by bacterial overgrowth along the lash line.

I know this one personally.

Overnight, bacteria multiply while the eyes are closed. When you open your eyes in the morning, that debris mixes straight into the tear film - causing redness, burning, and itchiness.

People often notice:

1. Red eyes on waking

2. Crusting around lashes

3. Itchy or gritty mornings

4. Improvement as the day goes on

This is where eyelid hygiene becomes essential.

In practice, I commonly recommend eyelid wipes at night, and for sensitive or inflamed lids, The Eye Doctor Hypochlorous Spray is outstanding. Hypochlorous works by reducing bacterial load without preservatives or harsh chemicals. It is one of my favourites as it's easy to use and requires minimal effort!

4b. Why Red Eyes Are Often Worse in the Morning

During sleep:

1. Tear production reduces

2. Blinking stops

3. Inflammation can increase

4. Bacteria can accumulate

Air-conditioning, fans, or incomplete eyelid closure can dry the eye surface further. In some cases, this leads to corneal surface stress, causing redness and discomfort on waking.

For patients with morning redness, I often suggest:

1. Night-time eyelid hygiene – like wipes or the Hypochlorous spray,

2. Preservative-free lubrication before bed (such as Hylo-Forte), or even Gels. Gels are best for deeper , longer hydration.

3. Reducing airflow near the face by wearing a 3D shaped sleep mask.

4. Heat mask and gentle gland expression using the Expression tool before bed to increase the oils naturally on your eye.

Small changes here can make a big difference.

5. When Red Eyes Signal a Deeper Inflammatory Issue

Unfortunately, my son developed phlyctenulosis, an inflammatory condition. The inflammation kept returning despite treatment from an Ophthalmologist.

What finally worked was a two-step approach:

1. Calm the inflammation with FML (fluorometholone eye drops - via the Ophthalmologist)

2. Then support the eye surface consistently with (preservative free eye drops and the cold compress mask), once the eye looked white and settled

We used Hyloforte 2mg nightly for several weeks after the inflammation resolved. That support phase was critical - and the condition hasn't returned.

It reinforced something I now tell every patient: healing doesn't stop when redness disappears. You still need to keep the eye hydrated and free of inflammation for as long as possible.

6. Children, Screens, and Blinking

Children blink far less on screens.

A normal blink is every 3–4 seconds. On devices, blink rate drops dramatically, reducing oil release and increasing evaporation.

What I encourage parents to focus on:

1. Put a light filter screen on their device - it's an incredible screen filter for children and parents across Australia - read this article for more info.

2. Reminding children to blink

3. Encouraging water intake

4. Balancing screen time with outdoor time, or other indoor engaging activities

5. Supporting the eye surface if symptoms appear

Here's an article for parents: click here.

7. The Lymphatic System and Eye Inflammation

One thing that really stuck with me from a longevity course I attended was just how important the lymphatic system is in helping the body clear waste and inflammatory by-products from tissues and the bloodstream. (8) Around the eyes, this matters more than most people realise. Unlike the blood supply, the lymphatic system doesn't have a pump - it relies on movement and gentle stimulation to do its job. When lymph flow is sluggish, inflammation tends to hang around longer, contributing to puffiness, redness, and irritation in the eye area.

Simple ways to support lymphatic flow include:

1. Gentle facial and peri-ocular massage

2. Regular movement and deep breathing

3. Adequate hydration

4. Reducing ongoing inflammatory triggers

We'll explore this in more depth in a future Eyehouse article.

Final Thought

When I hear about someone with itchy red eyes, I lean in. The truth is no-one knows everything in this space, as patients respond differently to similar treatments.

While the complicated cases require further intervention by an Ophthalmologist specialising in Dry eyes, the vast majority of cases will find themselves in one of the 7 categories here.

There are similarities and hence patterns, in patient symptoms that allow us to improve our treatment protocols.

When you understand what your eye surface is asking for, and support it properly, comfort becomes sustainable - not just temporary.

All products you'll find on Eyehouse have been thoughtfully curated to align with our values. Prevention, Protection and Preservation.

References

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2. Lopez Montes T, Gurnani B, Stokkermans TJ. Assessment of the Watery Eye. [Updated 2024 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

3. Liu A, Ji J. Omega-3 essential fatty acids therapy for dry eye syndrome: a meta-analysis of randomized controlled studies. Med Sci Monit. 2014 Sep 6;20:1583-9. doi: 10.12659/MSM.891364. PMID: 25193932; PMCID: PMC4165511.

4. Bilkhu PS, Wolffsohn JS, Naroo SA, Robertson L, Kennedy R. Effectiveness of nonpharmacologic treatments for acute seasonal allergic conjunctivitis. Ophthalmology. 2014 Jan;121(1):72-78. doi: 10.1016/j.ophtha.2013.08.007. Epub 2013 Sep 23. PMID: 24070810.

5. Eberhardt M, Zeppieri M, Rammohan G. Blepharitis. [Updated 2025 Feb 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

6. Zhang, H.; Wu, Y.; Wan, X.; Shen, Y.; Le, Q.; Yang, P.; Zhou, S.; Zhou, X.; Zhou, F.; Gu, H.; et al. Effect of Hypochlorous Acid on Blepharitis through Ultrasonic Atomization: A Randomized Clinical Trial. J. Clin. Med. 2023, 12, 1164. https://doi.org/10.3390/jcm12031164

7. Olson MC, Korb DR, Greiner JV. Increase in tear film lipid layer thickness following treatment with warm compresses in patients with meibomian gland dysfunction. Eye Contact Lens. 2003 Apr;29(2):96-9. doi: 10.1097/01.ICL.0000060998.20142.8D. PMID: 12695712.

8. Schwager S, Detmar M. Inflammation and Lymphatic Function. Front Immunol. 2019 Feb 26;10:308. doi: 10.3389/fimmu.2019.00308. PMID: 30863410; PMCID: PMC6399417.

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