Global Perspectives on Therapy for Noninfectious Conjunctival Hyperemia: A Narrative Review

Conjunctival hyperemia is one of the most frequent ophthalmologic presentations and may adversely affect quality of life due to associated discomfort and aesthetic concerns. In many countries, the prevalence of noninfectious conjunctival hyperemia is increasing due to lifestyle factors and the shift to technology-based employment. Management of noninfectious conjunctival hyperemia is typically aimed at addressing the underlying cause while alleviating signs and symptoms. However, an underlying cause might not be identified, treatment may not immediately reduce redness, or residual redness might persist. Topical treatment options include lubricants, decongestants, antihistamines/mast cell stabilizers, and anti-inflammatory drugs. Among these, ocular decongestants provide effective short-term relief, but the use of α1- (phenylephrine, tetrahydrozoline) or mixed α1/α2- (naphazoline, oxymetazoline) adrenergic receptor agonists is associated with tachyphylaxis and rebound redness. A highly selective α2- adrenergic receptor agonist (brimonidine 0.025%) reduces ocular redness without evidence of tachyphylaxis over 29 days and with minimal rebound redness upon discontinuation; however, longer-term effectiveness has not been evaluated. Other unmet needs pertain to the management of noninfectious conjunctival hyperemia as an aesthetic issue and the need to educate patients about the risks of surgical eye-whitening procedures and national recalls. Region- or country-specific unmet needs include a lack of awareness of the need for clinical assessment and appropriate treatment of ocular redness. While many cases of noninfectious conjunctival hyperemia can be self-treated, unmet needs remain with respect to access to care and patient awareness/knowledge of safe and appropriate treatment options and the importance of clinical consultation. The development of management guidelines specific to noninfectious conjunctival hyperemia is warranted to address patients' clinical and aesthetic concerns.