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Red eye, commonly known as "fire eye" or "red eye," refers to hyperemia of the ocular conjunctiva in one or both eyes.

This condition is referred to as "red eye" in both Neijing and the "Cold-Damage Disease Treatise." Later, based on the different characteristics of the disease cause and symptoms of red eye, various medical practitioners throughout history have given it different names such as "fulminant wind and invading fever," "epidemic red eye (acute contagious conjunctivitis)," "red vessels crossing the white eye," "red pain as if caused by evil," "redness of the outer canthus," and "yellowish-red sclera." Additionally, in Shenshi Yaohan, the term "red eye" also includes conditions such as "static blood flooding the eye," "hyphemia," and "subconjunctival hemorrhage." In Zhangshi Yitong , the term "red eye" also encompasses "red vessels crossing the white eye (angular conjunctivitis)." Although these conditions all exhibit symptoms of red eye, they are primarily caused by other eye diseases and will be discussed separately under specific entries, not within the scope of this condition.

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1. External Contraction of Wind-heat︰It belongs to the category of "fulminant wind and invading fever." Its main clinical manifestations include sudden redness of the white of the eye, heat tearing like boiling water, and photophobia with a gritty sensation. It may also be accompanied by aversion to cold with fever, headache, nasal congestion, a thin white tongue coating, and a floating, rapid pulse. External contraction of wind-heat red eye is primarily caused by exposure to wind-heat pathogens, generally tending to be more wind-dominant. Yizong Jinjian. Yanke Xinfa Yaojue states: "This condition originates from lung-intruding pathogen heat, externally summoning wind evils." Although the onset of this condition is acute, its infectiousness is not particularly strong and does not lead to epidemics. Symptoms mainly include sudden redness of the white of the eye, heat tearing like boiling water, along with external contraction wind-heat symptoms. Treatment involves dispersing wind and clearing heat, with prescriptions such as Jingfang Tang or Notopterygium Shengfeng Tang.
2. Seasonal Pathogen︰Equivalent to "epidemic red eye (acute contagious conjunctivitis)." Clinically, it commonly presents with hyperemia of ocular conjunctiva, burning sensation, sticky eye discharge, photophobia, and difficulty opening the eyes due to dryness. It may initially affect one eye and then spread to both, or both eyes may be affected simultaneously. The infection is highly contagious, often spreading among family members or within a community, affecting both young and old at the same time. Seasonal pathogen red eye is caused by exposure to seasonal epidemic toxins and is often associated with excessive heat. Yizong Jinjian. Yanke Xinfa Yaojue states: "Epidemic red eye (acute contagious conjunctivitis) is caused by the infection of wind-heat toxins prevalent in the four seasons." The onset is rapid and highly infectious, often starting with one person and quickly spreading, leading to widespread outbreaks. Symptoms include hyperemia of ocular conjunctiva, burning sensation, and sticky eye discharge, often causing the eyelashes and eyelids to stick together upon waking in the morning. The severity of the illness depends on the depth of pathogen invasion and the strength of the constitution. If the pathogen is weaker than the body's resistance, recovery occurs within five to seven days; if the body's resistance is deficient and the pathogen is strong, recovery may take two weeks. Treatment focuses on dispersing wind, discharging heat, and removing toxins, with the prescription of choice being the Qufeng Sanre Yinzi.
3. Pathogenic Heat Lurking in the Collaterals︰It falls under the category of "red veins and coiled vessels." Commonly, the white of the eye appears pale red, with crisscrossing red vessels on the surface, coiled and twisted, varying in thickness and density, persisting for a long time without healing. Associated symptoms include photophobia, tearing, or slight itching and pain, visual fatigue that worsens in the afternoon. It often arises from untreated heat-related eye diseases, evolving into this condition. Alternatively, prolonged exposure to wind and dust, long-term proximity to fire and smoke, or engaging in meticulous work that strains the eyes can lead to heat stagnation and blood stasis, triggering the illness. The main characteristics are a pale red sclera with crisscrossing, coiled red vessels that persist chronically. Treatment should focus on clearing heat and dispersing stasis, with the prescription Re Xue San recommended.
4. Alcohol Toxin Internal Accumulation︰It is equivalent to the "white of the eye turning yellow-red" syndrome. This condition often occurs in patients with a history of heavy alcohol consumption. Symptoms include the white of the eye gradually turning yellow-red, dryness and itching of the eyes, accompanied by internal dampness-heat symptoms, yellow and greasy tongue coating, and a soggy and rapid pulse. There must be a long-term history of alcohol abuse, with alcohol toxins accumulating internally, spleen weakness and liver hyperactivity, and dampness-heat ascending, causing the eyes to gradually turn yellow-red. Zhangshi Yitong, Volume 8, "Red Eye": "When a person's white of the eye gradually turns yellow-red, it is all due to alcohol toxicity, dampness damaging the spleen meridian, and pathogenic fire from the liver and gallbladder overflowing into the lung meridian." The characteristics include the gradual yellow-red discoloration of both eyes, with indistinct red vessels, and a history of alcohol abuse. Treatment involves clearing heat and draining dampness, and the recommended formula is Powder of Capillaris and Five Ingredients with Poria.
5. Excessive Liver and Gallbladder Fire︰The symptoms manifest as hyperemia of ocular conjunctiva with heat pain, and in severe cases, crisscrossing red vessels, heat tearing with excessive eye discharge, and distension in both eyes. Accompanied by aversion to heat, headache (especially at the vertex and bilateral taiyang acupoints), bitter taste in mouth, dry throat, hypochondriac region distending pain, dark urine or constipation, red tongue, and wiry rapid pulse. Excessive fire in the liver and gallbladder surges upward, affecting both eyes, resulting in red eye. Zhubing Yuanhou Lun (General Treatise on the Causes and Symptoms of Diseases) states: "The liver qi of humans connects to the eyes. When liver qi is heaty, the heat rushes to the eyes, thus causing red eye." The condition is characterized by red and distending pain in both eyes, bitter taste in mouth, dry throat, irritability, and pain in the hypochondriac region. Treatment should focus on clearing liver heat and draining gallbladder fire, using the formula Gentian Liver-Draining Decoction.
6. Liver-kidney Yin Deficiency︰Equivalent to "redness and pain as if caused by evil." This condition often occurs in individuals with chronic illness and weak constitution. Symptoms include pale redness of the white of the eye, a slow tendency of disease progression, intermittent occurrences, often recurring several times a year. Accompanied by soreness and weakness in the waist and knees, vexing heat in the chest, palms and soles, tidal fever and night sweats, and a thin, rapid pulse. The liver stores blood, and the kidney stores essence. When liver blood is insufficient and kidney essence is deficient, essence and blood cannot ascend to nourish the eyes. Coupled with deficiency fire flaming upward, it manifests as red eye. Suwen·"The Generation of the Five Zang-Organs" states: "The liver receives blood and thus enables vision." Lingshu·Dahuo Lun: "The eyes are the essence of the five zang and six fu-organs, where nutrient-defense, ethereal soul, and corporeal soul are constantly nourished, and where spirit-qi is generated." Currently, liver-kidney yin deficiency leads to eye disorders, characterized by pale redness of the white of the eye, mild pain, intermittent occurrences, recurring several times a year, accompanied by soreness and weakness in the waist and knees, tidal fever, night sweats, and other symptoms. Treatment involves nourishing yin and blood, clearing the liver and reducing fire, with the formula Shizhen Decoction selected.

In the case of red eye, the first step is to distinguish between deficiency and excess. Excess conditions manifest acutely, while deficiency conditions develop slowly. For excess conditions, further differentiation is needed between external contraction and internal damage. Red eye caused by external contraction, if due to a pestilence that leads to an epidemic, is known as seasonal pathogen red eye. If the pestilence is less severe and does not cause an epidemic, it is generally due to external contraction of wind-heat. Red eye caused by liver fire is accompanied by internal heat pattern, while external contraction is accompanied by exterior heat pattern. Deficiency conditions are often due to liver and kidney yin deficiency. If a complex condition of deficiency and excess is observed, treatment should be tailored to reinforce healthy qi and eliminate pathogenic factors as appropriate.

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1. 《Silver Sea Guide, Volume 1, Fire》: "The eyes do not become ill without fire; when the white part turns red, it is because fire has invaded the lungs."
2. Leizheng Zhicai．Eye Conditions: "For redness and swelling, disperse dampness-heat. For redness and dry pain, disperse fire toxin. For redness and excessive tearing, disperse wind evil. For redness without pain, promote urination."