Why Do Eye Doctors Hate Visine?
December 10, 2024
If your eyes are red, you might think of using Visine eye drops. But why do so many eye doctors hate Visine? The Visine eye drop for relieving redness is available over the counter and contains the active ingredient, tetrahydrozoline which has a major negative attribute. Additionally, abnormal eye redness needs a proper diagnosis to guide an enduring root-cause treatment.
Eye redness rebound
The major problem with many eye-related vasoconstrictors – the drugs which temporarily shrink blood vessels – is that repeated use can make the eyes appear even redder when stopping. This rebound effect is called tachyphylaxis. A similar thing happens when using the nasal decongestant spray, Afrin, which contains a similar vasoconstrictor called oxymetazoline. If you use Afrin regularly for an extended period, suddenly stopping can make your nasal passages even more congested. These legacy vasoconstrictors have generic drug names that end with a suffix of -zoline, such as tetrahydrozoline, oxymetazoline, and naphazoline.
This is why using these vasoconstrictors can become habit-forming. If you continue regularly using topical vasoconstrictor eye drops like Visine, or nasal vasoconstrictor spray like Afrin, your exposed tissue gets desensitized to the drug. Then you must keep using more of the drug to obtain the same level of whitening effect. This desensitization can cause withdrawal symptoms where discontinuing Visine or Afrin can cause increased eye redness and nasal congestion, respectively. This is why gradually withdrawing the vasoconstrictor rather than abrupt stoppage can minimize rebound eye redness.
Other side effects
Besides shrinking blood vessels on the eye surface, tetrahydrozoline stimulates an involuntary muscle in the upper eyelid, called the superior tarsal muscle (also called the Müller muscle). This is why Visine can temporarily lift the upper eyelid. For patients with a droopy upper eyelid, called ptosis, this can cosmetically help. In fact, the prescription drug Upneeq is specifically marketed for eyelid lifting. The active ingredient in Upneeq is oxymetazoline, the same drug in the nasal decongestant spray, Afrin.
Finally, tetrahydrozoline in Visine can temporarily enlarge the pupils. Patients with an eye condition called anatomically narrow angles should not use tetrahydrozoline unless allowed by their eye doctor, since pupil enlargement could trigger a sight-threatening episode of acute angle closure glaucoma.
The better alternative
For minor cosmetic eye redness, most eye doctors prefer their patients use the newer over-the-counter eye drop Lumify. The active ingredient in Lumify, brimonidine tartrate, has a longstanding use for lowering eye pressure in glaucoma. A beneficial side effect of brimonidine is that it temporarily constricts the blood vessels on the white part of the eye without the rebound effect that plagues legacy vasoconstrictors. Lumify represents the commercialization of brimonidine at a concentration and dosing for temporary eye redness relief.
When to seek professional care
Many cases of temporary eye redness are due to environmental irritants including dust, pollen, and dander. These instances are generally self-limiting and self-resolving making over-the-counter cosmetic eye redness drops appropriate.
But if the redness persists or worsens – especially when accompanied by other symptoms such as decreased vision, pain, light sensitivity, and discharge – immediately seek care with your eye care professional.
When the white part of the eye is red or pink, timely and effective treatment requires an accurate diagnosis. Eye redness can be due to infection (viral, bacterial, fungal), foreign body, allergy, dry eye, UV exposure, uveitis, or even a malignant Bowen’s conjunctival carcinoma, among many other possibilities. In other words, eye redness is non-specific and just indicates the eye tissue is irritated. Your eye care professional can identify the underlying cause and subsequently give proper treatment for effective resolution. As you might imagine, an over-the-counter eye redness remover would not effectively solve abnormal eye redness due to a foreign particle imbedded on the eye surface or due to a serious fungal infection. Although you may have found this webpage trying to self-diagnose, your best bet is to seek care with an eye care professional so that your eye condition potentially does not worsen.
ReVision Optometry is a referral-based practice in San Diego providing contact lens services for patients with keratoconus. To schedule an appointment, request your appointment online, or call our office at 619.299.6064.