Why Does Bulimia Cause Red Eyes?

Red eyes in individuals with bulimia can result from repeated vomiting, which may cause tiny blood vessels in the eyes to burst – known as subconjunctival hemorrhage. This is often accompanied by other signs of bulimia, like facial purpura, bleeding gums or calloused knuckles. 

Bulimia & Red Eyes

Bulimia nervosa can impact both physical and emotional health. Among its many symptoms, some individuals may notice unusual signs, such as red or bloodshot eyes. Visual indicators of bulimia nervosa, often caused by purging and self-induced vomiting, can increase appearance anxiety or cause feelings of shame around being identified as having an eating disorder.

How Does Purging Causes Red Eyes?

Due to repeated and forceful self-induced vomiting, a sudden increase in pressure from retching can increase the pressure inside the eye and cause the blood vessels in the eye to rupture, known as subconjunctival hemorrhage.¹

Are red eyes dangerous?

Although subconjunctival hemorrhaging can be concerning, it's a benign finding and poses no long-term risk.

Purging & Self-Induced Vomiting

Compensatory behavior is an essential criterion present in multiple eating disorder diagnoses. Compensatory behaviors are any eating disorder behaviors used to compensate for food intake, prevent weight gain or relieve feelings of shame or guilt. Compensatory behaviors are divided into two categories, purging behaviors and non-purging behaviors.

Purging behaviors involve eliminating food to compensate for excessive intake. The most common purging method is self-induced vomiting, which is used by up to 90% of those with bulimia nervosa, up to 39% of patients with anorexia nervosa and up to 56% of those with other specified feeding or eating disorder (OSFED).²

Other purging methods include:

• Laxative misuse
• Diuretic misuse
• Enemas

Purging in diagnostic criteria

Bulimia nervosa

Bulimia nervosa is characterized by cyclical episodes of binge eating, where they cannot control their eating, and compensatory behaviors to prevent weight gain, including self-induced vomiting.³

Anorexia nervosa binge eating/purging subtype

Anorexia nervosa binge eating/purging subtype includes regularly engaging in binge eating or purging in addition to the other criteria for anorexia nervosa, like food restriction, intense fear of weight gain and distorted body image.³

Other specified feeding or eating disorder

Other specified feeding or eating disorder (OSFED) applies to those whose eating is disordered but do not meet the full criteria for another eating disorder, which may include purging behaviors.³

Other Physical Signs of Bulimia Nervosa

There are a variety of noticeable physical signs of BN, some of the common ones including facial purpura, calloused knuckles and bloody or inflamed gums. While these are largely harmless hallmarks of bulimia nervosa, they can cause distress for patients who are concerned with their appearance.

Facial purpura

Self-induced vomiting may also cause small red dots around the face (facial purpura). In addition to capillaries in the eyes, vomiting can also break capillaries around the face, typically around the eyes, causing a red speckled appearance.⁴

Calloused Knuckles

Calloused knuckles, or Russell’s sign, is another sign of BN and purging.⁴ Calloused knuckles occur due to pushing the fingers into the mouth, causing irritation and abrasions on the back of the hand. This is rarely encountered nowadays.

Bleeding or irritated gums

Another common sign of bulimia nervosa and self-induced vomiting is irritated gums. Contact with stomach acid can cause the gums and soft tissue of the mouth to bleed or become inflamed, red or swollen.

Find Help for Bulimia Nervosa

Red or bloodshot eyes can be an uncomfortable and sometimes surprising symptom of bulimia nervosa. While it might feel worrying, it’s completely treatable. With the right treatment, these symptoms can get better. Recovery is always possible.

References

1. Brown, C. A., & Mehler, P. S. (2013). Medical complications of Self-Induced vomiting. Eating Disorders, 21(4), 287–294. https://www.acute.org/medical-complications-self-induced-vomiting
2. Grave, R. D., Calugi, S., & Marchesini, G. (2009). Self-induced vomiting in eating disorders: Associated features and treatment outcome. Behaviour Research and Therapy, 47(8), 680–684. https://doi.org/10.1016/j.brat.2009.04.010
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.
4. Strumia, R. (2005). Dermatologic Signs in Patients with Eating Disorders. American Journal of Clinical Dermatology, 6(3), 165–173. https://doi.org/10.2165/00128071-200506030-00003