Rebound Hyperemia: Causes And How To Get Rid Of Them

Having bloodshot eyes suck….What’s worst? Having them constantly.

Do you have constant bloodshot eyes? If you do, you may be suffering from rebound hyperemia (also known as rebound redness).

This article will share with you what causes it and how to get it treated.

Let's roll.

What Causes Rebound Hyperemia?

The most common known cause of rebound redness is actually redness relief eye drop.

Yeah especially those OTC (over-the-counter) ones. 

OTC (over-the-counter) redness relief eye drop can be a godsend when you are suffering from bloodshot eyes and had to meet someone important later. Other than the immediate relief, it also comes with a nice benefit - making your eyes aesthetically pleasing with pearly whiteness. 

In fact, some of us are addicted to the effects and administer it on a daily basis. 

However, as with most medication-like treatment methods, over-reliance of redness relief eye drop has its share of side effects.

Most OTC red eye drops contains vasoconstrictors such as tetrahydrozoline and naphazoline (also found in nasal spray for nose congestion). 

These chemicals reduce the size of the blood vessels in sclera (white part of the eye) and  the amount of blood flow to the conjunctiva (transparent tissue that covers the front of the eye and lines the inside of the eyelids). 

As a result, your eyes look less reddish.

But not without its consequences.

Reducing the amount of ocular blood inflow causes the amount of oxygen and nutrients that reaches the eye to decrease. Weakening the structure of the eye further.

Extended period causes these areas to become oxygen deprived and when the chemical effect of the constrictors wears off, the affected areas will signal a need for more oxygen. 

The body responds by enlarging the blood vessels (often larger than before) which then makes the eyes look much redder and the blood vessels to look more prominent. 

The enlarging process also weakens the walls of the blood vessels causing them to tear and leak easily, thus increases the likelihood of getting bloodshot eyes.

Evidence is that you will often hear people complained about experiencing redder eyes and eye dryness when they stopped using redness relief eye drops.

Similar effect occurs if you use nasal decongestants too much. Your nose will stay clogged up all the time at some point due to the bigger blood vessels.

Examples of popular over-the-counter decongestant eye drops include (vasoconstrictor in brackets): It is usually indicated as redness relief for eye drops.

  • Bausch and Bomb, Clear Eyes, Rohto (naphazoline HCL) 
  • Refresh (phenylephrine HCL)
  • Visine (tetrahydrozoline HCL, oxymetazoline HCL)

Other Side Effects

Other than eye drop addiction, rebound redness may mask a number of eye problems.

From minor ones such as lack of sleep, smoking, dusty environment, sun exposure, foreign bodies to ones that may need medical help like dry eye syndrome, infection, allergic infection, trauma and glaucoma. 

Treating some of these problems with eye drops can cause the condition to worsen.

For example, it reduces tear production which further worsen dry eye syndrome, and some eye drops are reported to elevate pressure in the eyes which is extremely risky for people with glaucoma.  

Therefore it is advisable to seek medical consultation first rather than using OTC red eye relief.

It is also noticed that long term user gradually need to increase the frequency of their eye drop and they complained of drier eyes and burning sensation when the effect of the eye drop wear off. 

There are other undesirable effects such as stinging or burning of the eye, blurred vision, headaches, sweating, fast or irregular heartbeats, or nervousness.

How To Prevent 

Dr. Abelson cited that ‘While there are no studies done on how much is safe, the FDA Over-the-Counter Code of Federal Regulations Title 21 Parts 349 and 369 recommend “up to four times daily dosage” for these first-generation vasoconstrictors due to theoretical safety concerns, and this labeling has remained unchanged.’

If you wish to continue to use the eye drops, make sure you do not use too many drops per dose and limit use to no more than three to four days. 

Since the drops only treat the symptoms and not the cause of the redness, it is best to consult an optometrist or ophthalmologist to diagnose your problem. 

If your eye dryness is bothering you, it is way better to use artificial tears (choose the ones without preservatives!) instead.

How To Get Rid Of Rebound Hyperemia

“But I already have red eye for weeks!”

Fret not.

Firstly, you have to find out the underlying reason for the redness and get it treated first. In many cases, the cause of red eye is due to dry eye syndrome which can be relieved with artificial tear drops. So consult your eye doctor first.

Once you addressed the causes and is certain that it is rebound redness, go cold turkey on eye redness relief drops. This gives your eyes the opportunity to recover naturally and shrink the eye vessels. 

Cold turkey

However, recovery time may vary depending on how long you have been using the drops. It can take weeks and even months to fix the issue. During the period, you may also feel certain burning sensation in the eyes due to inflammation. 

Do note that rebound redness is pretty significant for the first 4 days of the cold turkey. Plan your schedule carefully so you won’t appear on important meetings or dates looking like an enraged bull.

During cold turkey, cut down on smoking and alcohol as both cause irritation and dehydration which lead to bloodshot eyes. 

Consider using chilled artificial tears during the recovery as not only does it feels good, coldness is also a natural vasoconstrictor. It will help you look more "normal" after you stop the chemical vasoconstrictor.

Cold compress can be helpful too in providing comfort from the burning sensation. Just make sure that you don’t use the same cloth for both eyes if you are having an infection.

To assist recovery, I will recommend that you wear sunglasses while you are outdoor during the day. This can help to prevent further dryness and oxidation of the eye cells due to UV rays.

Sometimes, your eye doctor may prescribe steroid eyes drop to reduce the inflammation. Personally, I will recommend not taking them as there are users who reported that steroid drop worsening their eyes. Also, no point getting addicted to any other form of drops.

If the condition persists for several months, do check with your eye doctor again. Rebound hyperemia is not supposed to be a long lasting condition. There might be other conditions which cause the redness such as dry eyes, blepharitis and allergy.  

Do ask for second opinion if you find your doctor’s advice ain’t working for you.

Lastly, there is possibility that you are just born with more eye-catching blood vessels. In this case, play Bruno Mars’ “Just the way you are” on infinite loop. Let's celebrate that you have a good pair of eyes that can see just fine. 

Life is all good and you are amazing just the way you are. ^_^

What About Eye Whitening Surgery?

There have been lots of hype on eye whitening surgery being a quick and harmless fix for unsightly eye color. Being a skeptic, I have to find out more.

I-Brite is a registered trade name of this eye whitening surgery procedure developed by Ophthalmologist Brian Boxer-Wachler in Beverly Hills.  It was first introduced in 2008 and then became popular in South Korea. 

This surgery involves removing a large portion (technically, it removes a tissue called tenon’s capsule) of the conjunctiva to reduce blood vessels to the eyes thus “whitens” the eye.

Additionally, after surgery a drug called mitomycin C or anti-VEGF meds such as Avastin® (bevacizumab) is administered to help further reduce redness and inflammation. 

The cost is between $3,000 to $5,000 per eye. 

The website reported that in USA, hundreds of patient had underwent this procedure and had amazing results. 

But~ Hold your horses! Don’t jump on the wagon so quickly.

Firstly, no reports on this body of work have been published in the scientific peer reviewed literature. This makes it difficult for the professionals in the same field to express opinion regarding the actual safety of the surgery.

Secondly, studies had reported that the complication rate in more than 1700 patients was 83% with 56% of them considered serious. The most commonly recurring complications include chronic conjunctival epithelial defects, scleral thinning, calcific plaques, dry eye syndrome, diplopia (sometimes requiring strabismus surgery), elevated intraocular pressure and scleral thinning.

In fact, this procedure was considered so risky that the Korean Ministry of Health and Welfare banned it in 2011, mainly due to high number of lawsuits.

Don’t let the surgeon fool you by saying that the procedure is similar to pterygium which is relatively harmless and simple.

This procedure has been heavily modified and unlike pterygium which is a foreign benign eye growth that should be removed, this procedure removes parts of the eye structure that are supposed to be there. 

In addition, many of these cells cannot regenerate as we are born with a fixed number of them. 

In conclusion, it is not worth it. Too many risks at stake just for possible “brighter” eyes.  

So friend, let’s stick to the natural stuff. While it may take longer time, it has zero risk and cost you almost next to nothing.


  1. Arijit Coondoo, Meghana Phiske, Shyam Verma, and Koushik Lahiri, Side-effects of topical steroids: A long overdue revisit, Indian Dermatol Online J. 2014 Oct-Dec; 5(4);  416–425.
  2. Charles N. S. Soparkar, MD, PhD; Kirk R. Wilhelmus, MD; Douglas D. Koch, MD; et al Gary W. Wallace, MD; Dan B. Jones, MD, Acute and Chronic Conjunctivitis Due to Over-the-counter Ophthalmic Decongestants, Arch Ophthalmol. 1997;115(1):34-38
  3. Mario J. Saldanha, Patrick T. Yang, Clara C. Chan, Scleral thinning after I-BRITE procedure treated with amniotic membrane graft, Canadian Journal Of Ophthalmology, 2016, Volume 51, Issue 4, Pages e115–e116
  4. Vo RC, Stafeeva K, Aldave AJ, Stulting RD, Moore Q, Pflugfelder SC, Chungfat NC, Holsclaw DS, Margolis TP4, Deng SX, Complications related to a cosmetic eye-whitening procedure, Am J Ophthalmol, 2014: 158(5):967-73
  5. Yoon, SC, Seo, KY. The safety and effectivenss of cosmetic wide conjunctivectomy with postsurgical mitomycin C to treat chronic hyperemic conjunctiva. Cornea. 2013;32:379.

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