Red eye erosion refers to the redness and erosion of the eyelid skin, the edge of the eyelid, or the palpebral margin and skin at both canthi. Redness of the eyelid skin is called "wind red sore (eyelid dermatitis)"; redness, swelling, and erosion of the eyelid margin are called "red ulceration of palpebral margin (marginal blepharitis)" or "palpebral margin redness and erosion"; redness and erosion of the palpebral margin and skin at both canthi are called "canthal redness and erosion"; if it occurs in newborns, it is also known as "infantile blepharitis marginalis".

This condition was first mentioned in Zhubing Yuanhou Lun, referred to as "red eye erosion canthus condition". Shiyi Dexiao Fang separately referred to it as "infantile blepharitis marginalis" and "wind red sore (eyelid dermatitis)". "Gujin Yitong" called it "eroded eyelid wind". Zhengzhi Zhunsheng provided detailed classifications, including "wind-induced eyelid erosion", "red ulceration of palpebral margin (marginal blepharitis)", "marginal blepharitis due to wind attack", and "canthus redness and erosion". Yinhai Jingwei referred to it as "wind string red eye". Yizong Jinjian called it "wind red sore (eyelid dermatitis)". Although there are many names, the condition is the same.

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1. Dampness-heat︰The main clinical symptoms include eyelid redness, swelling, and ulceration, severe pain and itching, photophobia and tearing, crusting at the eyelash roots, and visible ulcerated areas or small pustules beneath the scabs. The tongue is red with a greasy coating, and the pulse is wiry and slippery. This condition is often caused by internal accumulation of dampness-heat in the spleen and stomach, where dampness and heat contend and accumulate in the eyelids. Yinhai Jingwei states in "Discussion on Wind-String Red Eye": "Due to the accumulation of dampness-heat in the spleen-earth, the spleen-earth weakens and fails to resolve dampness. Thus, the qi of dampness-heat attacks and transmits to the spaces between the eyelids, leading to photophobia and tearing. The tears, containing heat-toxin, result in red and ulcerated palpebral margins." When heat predominates, there is redness and decay; when dampness predominates, there is erosion and fluid discharge. When dampness-heat pathogens combine, they cause putrid ulceration and pus formation. Therefore, the key diagnostic features are redness, erosion, tearing, and ulceration with pus on the palpebral margins. Treatment should focus on clearing heat and dispelling dampness, with prescriptions such as Qingfeng Powder or Sanhuang Powder.
2. Upward Attack of Stagnant Fire︰It belongs to the category of "wind red sore (eyelid dermatitis)." The main symptoms include itching and burning of the eyelid skin, redness, swelling, erosion (redness more severe than erosion), a cinnabar-like coloration, and the discharge of sticky, purulent fluid with a foul, gluey odor. It may also present with crusting or scabbing. Some cases may be accompanied by eye distension, headache, bitter taste in the mouth, hypochondriac distension, irritability, a red tongue, and a wiry, rapid pulse. This condition is mostly caused by overthinking, melancholy, qi depression transforming into fire, and stagnant fire surging upward. Shenshi Yaohan states: "When redness is more severe than erosion, it is often due to overthinking, melancholy, and reckless thoughts, injured by formless fire." Qi depression leads to discomfort, hence the hypochondriac and chest distension. Stagnant fire surging upward causes eye distension and headache. Qi depression transforming into fire manifests as a bitter taste in the mouth, a red tongue, and a wiry, rapid pulse. Locally, the distinguishing features are redness, swelling, and erosion, with redness more severe than erosion and a cinnabar-like coloration. Treatment should focus on purging fire and relieving depression. Recommended formulas include modified Four Ingredients Decoction or Peony and Gardenia Peripatetic Powder.
3. Wind Invasion Due to Blood Deficiency︰The main symptoms include dryness and itching of the eyelids, dandruff attached to the roots of the eyelashes, or thickening and roughness of the eyelid skin. It is commonly seen in the elderly or those with weakened constitutions. This condition arises due to spleen-stomach deficiency, insufficient blood, and weak pulses, leading to eyelid cervical malignancy with cachexia, allowing wind pathogens to invade and accumulate at the palpebral margin. Blood deficiency causes dryness, wind dominance leads to severe itching, wind stagnation transforming into fire results in burning pain along the eyelid margin, and blood deficiency with wind-dryness causes skin peeling and dandruff. The key diagnostic features are severe dryness and itching, along with dandruff at the palpebral margin. Treatment should focus on nourishing blood and dispelling wind, with the recommended formula being the Nourish Blood and Expel Wind Decoction.
4. Spleen Deficiency with Dampness Retention︰The symptoms include slightly red and itchy palpebral margins, mild redness but severe erosion, sticky erosion, or white scales around the eyelashes, accompanied by epigastric stuffiness, abdominal distension and fullness, frequent belching, poor appetite, a swollen and tender tongue with a greasy coating, and a soggy or wiry-slippery pulse. This condition is often caused by dietary irregularities or excessive worry damaging the spleen. When the spleen is impaired, its transportation and transformation functions fail, leading to fluid retention around the eyelids and resulting in erosion and stickiness of the palpebral margins. The key diagnostic features of this condition are mild redness but severe erosion and clustered eyelashes. Treatment should focus on {|###|}invigorating the spleen and draining dampness{|###|}, and the recommended formula is Ginseng, Poria and White Atractylodes Powder.

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1. Puji Fang．Eye Disorders: "Red and ulcerated canthus refers to the condition where both canthi are red and ulcerated, and the condition worsens upon exposure to wind, also known as wind-induced red eye. This is caused by exposure to wind and sun, where the wind-heat qi injures the canthi and interacts with body fluids, leading to redness and ulceration. Exposure to wind causes tearing, and heat leads to excessive eye discharge and ulceration. Treatment should focus on calming the heart and regulating the normal circuit qi, as well as cleansing the eyelid skin, to restore clarity and brightness to the eyes. It is also said that red and ulcerated eyes are all caused by wind-heat. Initial red eye that does not heal over time is externally caused by wind-cold injury and internally by accumulated heat in the lungs and spleen. The combination of internal and external factors gradually leads to itching, resulting in red and ulcerated eyes.
2. 《Zhang Jiechun's Ophthalmology Treatment．Flesh Orbiculus Disorders》: "The main causes of red and ulcerated canthi are wind, dampness, and heat, with the main symptoms being itching, ulceration, and redness. The severity of itching and redness can be used to determine the predominance of wind, dampness, or heat. For example, severe itching indicates a predominance of wind, severe ulceration indicates a predominance of dampness, and severe redness indicates a predominance of pathogenic heat.