Red eyes? What is conjunctival hyperemia. The most common causes of conjunctivitis

06.08.2020 Analyzes

Conjunctivitis is a disease characterized by the presence inflammatory process the connective membrane of the eye (conjunctiva). This disease has another name, which reflects the main symptoms - red eye or pink eye.

The reasons may be the ingress of viruses (airborne transmission), bacteria (during childbirth from mother to child, through dirty hands from a sick person). Chlorine in the eye, household chemicals while swimming in the pool or at home can also provoke inflammation. can occur as a reaction of the body to pollen or other irritants. The wearers also face this unpleasant condition.

Conjunctivitis symptoms

It is not for nothing that this disease is called red eye, since this is the most important visual symptom of its manifestation, while redness is observed in the protein or in the inner eyelid. A feeling of pain, lacrimation, photophobia appears in the eye. After sleep, a thick, purulent yellow crust appears on the eyelashes, and a similar white or green film may appear on the eye itself. Puffiness around the sore eye becomes noticeable, vision becomes blurry. If purulent discharge from the eye is abundant, then the causative agent of the disease is a bacterium, and not purulent and scanty discharge indicates that the causative agent is a virus. The manifestation of viral conjunctivitis is usually preceded by an increase in body temperature, damage to the upper respiratory tract,. Typically, this form of the disease begins in one eye, but soon spreads to the other.

The diagnosis by the doctor is carried out by visual examination, the patient's complaints. In addition, the ophthalmologist asks a number of questions that help to find a possible pathogen. To obtain more reliable information, a bacteriological study of purulent discharge, conjunctival scrapings and smears is carried out.

Conjunctivitis treatment

Depending on the causative agent of the disease, appropriate treatment is also prescribed.

1.need to be treated with eye drops or antiviral drugs... But, any appointment should be made only by a doctor.

2. The bacterial form of the disease is treatable with antibiotics. The ophthalmologist may prescribe instillation eye drops, put an ointment behind the eyelid or taking pills. Improvement can occur in a few days, that is, redness, swelling, itching, stinging, and many patients stop treatment without permission. But in no case should this be done, because the antibiotic, regardless of its form - be it tablets, ointment or drops - should be taken for at least a week, and more specific recommendations will be given by the attending physician. Why is it dangerous to stop halfway to recovery? The fact is that during these few days the bacterium is not destroyed, but only loses its strength, and if the antibiotic supply has stopped, then the pathogen gains strength and the disease continues, while the sensitivity to the antibiotic of a certain group is significantly reduced.

3. The easiest way to get rid of conjunctivitis, which was caused by a chemical in the eye. In this case, we are not talking about an infection, and there are no purulent discharge among the symptoms. Treatment consists of flushing the eye with clean running water. True, you need to be very careful, if an acidic or alkaline agent gets into the eye, then you need to urgently seek medical help.

4. Allergic conjunctivitis occurs when exposed to an allergen. Its treatment consists in relieving an allergic attack and removing the source of the allergy.

The treatment of conjunctivitis in children cannot be carried out on their own, buying drops, ointments at the pharmacy on the recommendation of pharmacists, girlfriends or advisers from Internet forums. The doctor will make the necessary examination and, on its basis, prescribe medications. Along the way with drug treatment you can rinse the sore eye every two hours with a decoction of chamomile.

Traditional medicine for conjunctivitis

Frequent rinsing of the eyes using a decoction of such herbs: chamomile, nettle, larkspur have proven themselves well. Use (sold in any pharmacy) helps to relieve inflammation: apply it on the eyelids before going to bed. Indispensable and well-known to everyone. Fresh juice from its leaves is instilled into the eyes, and a decoction is prepared from the dried leaves for compresses and rinses. Dried blueberry tea has a beneficial effect on the body in general and the organs of vision in particular.

Prevention of conjunctivitis

1. Hygiene: frequent hand washing, especially after walking outside, contact with animals, going to the toilet.

2. Frequent stress and overstrain should be avoided.

3. If you have to work a lot at the computer, then you need to take short breaks so that your eyes can rest.

4. The use of drugs, herbal teas to increase the body's defenses.

5. It is not necessary to use the objects of the toilet of strangers, as well as not to give your personal belongings for use to anyone.

Our eye is perhaps the most unprotected organ in the entire body. Therefore, no one is immune from various unpleasant sensations in it and serious pathologies that can develop against the background of other diseases. But today we will focus on such a fairly common disease as conjunctival hyperemia. It can be recognized by the uncomfortable sensations in the eye: itching, pain, feeling of sand, photophobia. But the most striking sign of the disease is the inflammatory process, which affects the conjunctiva and causes its redness. Another name for this pathological condition is "red eye syndrome". This painful condition can develop as a result of a large accumulation of blood in arterial or venous vessels and capillaries. It develops with a general change in vascular tone, metabolic disorders and other pathologies. Therefore, hyperemia is considered in conjunction with serious pathological changes in the body.

It should also be borne in mind that the conjunctiva is the outer mucous membrane of the eye, which provides protection against the penetration of infectious bacteria, viruses, foreign bodies and mechanical damage. Therefore, this shell takes on the entire "blow". As a result, it is this part visual organ most often prone to inflammatory processes. In addition, hyperemia is very often accompanied by a number of other eye diseases. Among them:

  • diseases of the eyelids;
  • tumor neoplasms of the orbit;
  • compression of blood vessels in acute glaucoma;
  • scleritis, uveitis and other inflammatory processes.

Therefore, any discomfort in the eye, and even more so those that are accompanied by reddening of the conjunctiva, should be the reason for an immediate appeal to an ophthalmologist. The doctor, based on the diagnosis, will determine the type of hyperemia, as well as concomitant diseases and causes of the disease, and on the basis of a complete anamnesis, he will prescribe appropriate treatment.

Types of hyperemia

Hyperemia of the conjunctiva of the eyes, depending on the depth of the lesion, is divided into several types.

Acute conjunctivitis is accompanied by redness of the eyeball and the surface of the cartilage.

The chronic course of the disease, as a rule, manifests itself in the form of reddening of the cartilage near the transitional fold.

Also, ciliary hyperemia is distinguished - this is the penetration of the infection into the depths, into the area of ​​the iris. They are distinguished by the cyanotic shade of the vessels, while they are not traced with the naked eye. This symptom is characteristic of deep arterial lesions.

Mixed hyperemia includes damage to both the conjunctiva and the ciliary body. Infection occurs in the hematogenous route.

During the examination, the ophthalmologist also looks at other symptoms that very often accompany conjunctival hyperemia. The most typical for this diagnosis is the blurring of the contours of the iris and a change in its color, as well as the presence of exudate.

Causes

In order for inflammation of the protective membrane of the eye to occur, two main factors are necessary:

  • infection (ingress of pathological microorganisms);
  • irritation.

Depending on the type of mucosal damage, there are acute conjunctivitis and chronic. The first is characterized by instantaneous development. As a rule, after inflammation of one eye, the disease spreads very quickly to the other. At acute form there is significant mucous or purulent discharge, which sticks together the eyelids and cilia so much that it is sometimes very difficult for a person to open his eyes, especially after sleep. The conjunctiva has a bright red tint. There is swelling.

Chronic conjunctivitis is slow, accompanied by rapid eye fatigue, heavy eyelids, itching and a feeling of "grit". Hyperemia is poorly expressed, and there is also little discharge.

Both types of conjunctivitis have specific causes. Acute occurs as a result of:

  • hitting adenovirus infection, which also causes an increase in lymph nodes in the area lower jaw and near the ears, and also provokes a decrease in vision;
  • infection with gonorrhea is the most severe type of conjunctivitis, hyperemia is pronounced, the mucous membrane itself swells and even begins to bleed, the disease may spread to the cornea, with complications, the death of the eye occurs;
  • infection with urogenital chlamydia, which causes not only inflammation of the mucous membrane, but also the formation of granular follicles on it;
  • penetration of the virus, this type is typical for children's groups;
  • eye reactions to allergic irritants (seasonal allergies, reactions to cosmetics and household chemicals);
  • high air temperature and dry climate, it can cause conjunctival hyperemia in the elderly.

The causes of chronic inflammation of the conjunctiva can be:

  • mechanical damage to the mucous membrane of the eye, as a rule, occurs under certain working conditions, where there is a possibility of soap with impurities;
  • harmful factors associated with chemical reagents and their physical manifestations (poisonous fumes, smoke);
  • illness gastrointestinal tract, lack of vitamins and other nutrients in the body;
  • anemia;
  • paranasal sinus disease;
  • helminthic invasions and others.

After the defeat of the conjunctiva, its blood supply is disrupted, which also affects the tissues located nearby. Scales may come off, ulcers may form. There is soreness of the eye, its swelling, itching.

Treatment

First of all, we note that a person sees the world around him thanks to a complex visual system. Any disturbances and changes that lead to a decrease in visual acuity, and without qualified assistance, can cause complete blindness. Therefore, everything related to the eyes should be the prerogative of a specialist. If inflammation of the conjunctiva occurs, you should not self-medicate and use grandmother's methods, you should immediately contact an ophthalmologist who will conduct an examination and prescribe adequate treatment.

All you can do yourself to relieve symptoms is to rinse the affected eyes. The crane must do this carefully in this way:

  • take a weak solution of potassium permanganate, you can furacilin or just strong tea (without sugar);
  • you will also need cotton pads (an individual amount will be required for each eye, depending on the degree of damage);
  • moisten the disc in the solution and with careful movements wash the eye from the outer corner to the inner one;
  • all- and cotton pad, and the solution is used purely individually for each eye.

With regard to medicines, in this case, eye drops are used, but which ones exactly depend on what exactly caused the disease.

At the first painful symptoms, the eyes are instilled with anesthetics. To do this, you can use drops "Pyromecaine", "Trimecaine", "Lidocaine".

Conjunctivitis treatment is carried out by means of the following directions:

  • antibiotics;
  • sulfonamides;
  • antiviral;
  • antihistamines.

The choice of drug depends on the nature of the disease. At bacterial infections use antibiotics or sulfonamides. As a rule, tetracycline ointment and albucid are actively used.

If a virus has become the cause of conjunctivitis, then of course you cannot do without antiviral drugs.

Allergic inflammation of the mucous membrane requires the use of drops with antihistamines.

It is important to remember that with conjunctivitis, compresses and eye patches should not be applied, they only contribute to the further development of the disease.

About treatment folk remedies it is necessary to consult with an ophthalmologist and use them in combination with medications.

To eliminate the inflammatory process, freshly squeezed dill juice is used, which is applied in the form of lotions to the sore eye for fifteen to twenty minutes.

For instillation, honey water is used, in a ratio of one to two. Distilled water is needed. It is heated to a warm state (two parts) and natural honey is diluted (one part). The resulting product is dripped into the eyes several times a day.

Washing with rosehip infusion is also useful. To do this, the berries are crushed and the resulting mixture (two teaspoons) is brewed with a glass of boiled water. The broth should be infused for thirty minutes. After it is used for rinsing the eyes and for lotions.

Conjunctival congestion can be caused by a variety of aggressive factors affecting the mucous membrane of the eye. It can occur with or without concomitant eyelid hyperemia.

Causes

Hyperemia of the conjunctiva of the eyes can develop for the reasons:

  • weather conditions (wind, dust, dry air);
  • irritation of the mucous membrane due to strain on the organs of vision;
  • radiation from the display;
  • toxic effects;
  • wearing inappropriate glasses and lenses;
  • viral process in the body;
  • organ dysfunctions (liver);
  • vascular and other diseases.

Symptoms

The general appearance of the patient explains the cause of the reddening of the mucous membrane. In case of irritation of the organs of vision with dust, intense visual work, unsuccessful selection of lenses:

  • the mucous membrane looks more or less pinkish;
  • the patient experiences moderate dryness and irritation in the eyes.

Here, the process of hyperemia affected only the shallow layers of the conjunctiva.

The toxic effect of any etiology (alcoholic and other) causes changes in the venous capillaries, leading to the sweating of erythrocytes outside the conjunctival vessels. As a result, the hyperemic conjunctiva look like:

  • reddened;
  • loosened;
  • with a clear pattern of dilated capillaries forming a "vascular network".

The picture of hyperemia in persons suffering from diseases with strained phenomena looks similar:

  • in regularly coughing (smokers with bronchitis);
  • patients with arterial hypertension;
  • not cured glaucoma.

In option viral disease the whole face of the patient changes. In addition to the classic rise in temperature, catarrhal phenomena occur not only from the side of the eyes, but also:

  • lacrimation due to irritation of the conjunctiva with viral poisons;
  • nasal congestion and mucus discharge from its cavity;
  • swelling of the entire face;
  • enlargement and tension of the lymph nodes.

Local (limited) irritation of the conjunctival mucosa can be caused by:

  • hit foreign body(mascara or otherwise);
  • chalazion () or other local inflammatory process on the mucous membrane.

The picture of a conjunctival burn deserves a separate description. The eyes look directly "glowing" - the surface of the mucous membranes becomes so bright. A burn can be caused by vapors of ammonia, vinegar essence, any acid. In this case, the picture of mucosal hyperemia will be similar to a viral infection:

  • significant pain and burning, not only in the eyes, but also in the eyelids;
  • profuse lacrimation;
  • photophobia;
  • increasing edema of the entire orbital region.

Which doctor treats flushing of the eyes?

Whatever the reason is caused by the "pinkness" of the eyes, the patient becomes the object of the study of an ophthalmologist. After the initial examination, this specialist decides whether it is necessary to consult doctors of other specialties:

  • therapist;
  • neuropathologist;
  • narcologist;
  • angiologist (vascular specialist);
  • ENT doctor.

In case of eye burns, call the emergency team.

Diagnostics

After detecting hyperemia - irritation with a change in the color of the surface structures of the mucous membrane of the eyes - a visual examination by an ophthalmologist using a slit lamp is performed.

It is complemented by an assessment:

  • reactions of the pupils of the eyes to light:
  • visual acuity;
  • intraocular pressure;
  • fundus conditions.

In case of presumptive glaucoma, a study of the organs of vision is carried out by the method of elastotonometry and gonioscopy - to determine the indicators of intraocular pressure and to study the state of the anterior chamber of the eye.

Treatment

The treatment regimen will depend on the cause of the red color of the sclera.

So, if the process is caused by fatigue, the eyes will have a rather minor interruption in work in combination with topical procedures:

  • lotions for eyelids;
  • by instilling drops containing local anesthetic and neutralizing formulations.

Chilled tea leaves can be used as lotions. Applying gruel from grated raw potatoes to the eyelids is also suitable.

Solutions are suitable as drops:

  • Taufon.

If antimicrobial action is necessary, drugs are applicable:

  • Tsiprolet.

Drops give an antiviral effect:

  • Ophthalmeron.
  • Aktipola.

A conjunctival burn may require hormonal drugs with content:

  • Hydrocortisone.
  • Prednisolone.

Drugs with antihistamine action are prescribed in all cases, and in case of an allergic response, the conjunctiva of the eyes - by all means. This group:

  • Allomida.

The patient should remember: the means he willfully used to treat the conjunctiva of the eyes and restore vision can aggravate the condition of the organs of vision.

Prophylaxis

You can protect yourself from red eye syndrome by following simple rules.

  • Vision needs to be given rest, so short breaks are needed.
  • The organs of sight should not be exposed to the influence of solar and other radiation.
  • When using makeup, avoid contact with eyes of its components (the same - when working on grinding machines and similar tools).
  • You should take care of the balance of food, lead the most mobile lifestyle.
  • Using contact lenses each must be stored strictly in the case designated for it (right or left).
  • At the slightest trouble with the organs of vision, you should visit an ophthalmologist.

Usually, the issue of hyperemia of the conjunctiva and sclera is solved simply: treatment of the viral process, a short rest - and everything returns to normal. But sometimes the question is blunt: high salary or peace of mind? All eye protection measures should be taken here. If there is no choice, health should be preferred.

But there are serious diseases, including those that are outwardly expressed in a change in the color of the eyes with the maximum tension of their capillaries. There is only one way - strict adherence to the doctor's prescriptions.

Useful video about eye flushing

Hyperemia of the conjunctiva of the eye is observed with conjunctivitis. In the acute form of the disease, hyperemia is localized on the eyeball and the surface of the cartilage. In chronic conjunctivitis, only the cartilage near the transitional fold turns red.

In addition, the following types of hyperemia of the organs of vision are distinguished:

  • ciliary hyperemia of the conjunctiva of the eye - occurs when the pathological process spreads to the iris;
  • mixed hyperemia of the mucous membrane of the eye - affects both the ciliary body and the conjunctiva.

Causes of redness of the eyes

Hyperemia around the eyes is a fairly common pathology that almost everyone has encountered. Redness occurs when the blood vessels in the eyes become inflamed or dilated, often as a result of infections or eye conditions.

Hyperemia of the sclera of the eyes can be one of the symptoms of glaucoma, conjunctivitis, inflammation of the eye membranes, barley, blepharitis, corneal ulcers.

In addition to eye diseases, the causes of hyperemia can be:

  • fatigue;
  • ingress of a foreign body into the eye;
  • insomnia or chronic lack of sleep;
  • weather;
  • allergy;

Quite often, redness of the sclera of the eyes is observed in people who wear contact lenses. In this case, the inflammation is usually caused by worn-out lenses, on the surface of which protein accumulates, which rubs the cornea and causes redness and irritation of the eye.

Symptoms of redness of the eyes

The first signs of redness of the eyes can be seen during a routine examination. Due to the fact that they increase blood vessels, the eyes turn red, bloody spots may appear in the sclera.

In addition to redness, a person may feel discomfort and dryness in the eyes, stinging, burning, pain when blinking. Sometimes there is lacrimation, pain appears in the nose and forehead.

Diagnosis of eye hyperemia

An accurate diagnosis is made after interviewing and examining the patient, as well as conducting a number of instrumental studies.

During the interview, the doctor listens to the patient's complaints and finds out possible reasons development of hyperemia. The inspection consists of the following stages:

  • test of visual acuity;
  • measurement of intraocular pressure;
  • examination of the eye with a slit lamp, the specialist pays special attention to the state of the cornea, conjunctiva, eyelids, in addition, the reaction of the pupils to light is determined;
  • fundus examination.

If the cause of eye hyperemia is an infection, then a bacteriological analysis is performed, which includes sowing patches of material on nutrient media to determine the type of pathogen and its sensitivity to antibiotics.

If glaucoma is suspected, then gonioscopy and tonometry are indicated.

Hyperemia of the eyes: treatment

Hyperemia of the eyes can be a symptom of a number of serious illnesses, therefore, when it occurs, you must make an appointment with an ophthalmologist. The doctor will conduct a thorough diagnosis, diagnose and prescribe treatment.

Depending on the symptom of which disease is hyperemia around the eyes, the following therapeutic measures can be prescribed:

  • instillation in the eyes of local anesthetics (trimecaine, lidocaine);
  • washing the mucous membrane of the eye and eyelids with an antiseptic;
  • appointment antiviral agents or antibiotics (depending on the type of pathogen);
  • taking corticosteroid drugs;
  • the appointment of antihistamines (if the cause of hyperemia is allergy).

Selection medicines should be carried out by the attending physician, taking into account the diagnosis and the individual characteristics of the patient's body. Self-medication is unacceptable!

In case of hyperemia, bandages should not be applied to the eyes, this can only worsen the patient's condition.

In our online store we offer you the following drugs for the treatment of redness of the eyes, which can be used in the composition complex therapy this disease:

  • Amino complex - amino acid complex;
  • Complex B-50;
  • Beta Carotene;
  • L-carnitine;
  • Ocu Support;
  • Taurine;
  • Blueberry complex.

Before using this or that drug, you should consult with your doctor.

Prevention of eye flushing

Even if red eyes are not a sign of any medical condition, it is a serious cosmetic defect that makes a person look tired and unhealthy. In order to avoid the development of this unpleasant condition, the following recommendations must be followed:

  • observe the work and rest regimen, sleep at least 8 hours a day;
  • observe the rules of hygiene, do not rub your eyes with dirty hands;
  • follow the rules for using contact lenses, take them off at night and change them in time;
  • women need to remove all decorative cosmetics before going to bed;
  • in the spring, when the body lacks nutrients, take vitamin complexes for eyes;
  • eat right, include in the diet foods containing microelements and vitamins useful for the eyes (carrots, chicken eggs, fish, parsley, nuts, cabbage, blueberries, citrus);
  • when working at a computer, take a break every hour and give your eyes a rest;
  • wear sunglasses in clear weather;
  • move more, walk, play sports;
  • regularly visit an ophthalmologist for a routine examination.

Conjunctival hyperemia is characterized by reddening of the eye tissues. It can be caused by minor causes and can be cured as soon as possible. However, there are cases when hyperemia is a signal of a serious illness with a concomitant inflammatory process. Therefore, such a pathological change in the organ of vision should in no case be ignored: consultation of an experienced ophthalmologist is imperative.

The conjunctiva is called the protective mucous membrane of the eyeball, which protects it from injury and infection. Conjunctival hyperemia or red eye syndrome always speaks of trouble in this part of the visual apparatus. How much tissue will be affected depends on the causative agent of the disease, the state of the mucous membrane and immune system organism.

Hyperemia can be not only a symptom indicating the development of an inflammatory process in the eye (conjunctivitis, scleritis, uveitis, iridocyclitis), but also a sign of other ailments of the organs of vision (for example, a tumor or injury to the eye socket, glaucomatous attack, eyelid diseases).

In addition, red eye syndrome can be associated with:

  • general changes in vascular tone,
  • systemic metabolic disorders;
  • congestion in the brain;
  • chronic diseases of the cardiovascular and endocrine system.

The state of the vessels in the conjunctiva of the visual organs can change, for example, due to arterial hypertension or diabetes.

In this case, due to the loss of tone of the vascular walls during their expansion, aneurysms occur, which causes redness of the mucous membrane of the eye. In this regard, conjunctival hyperemia should be considered as a possible part of a serious pathology, indicating damage to the nervous or hormonal regulation.

Types of hyperemia, depending on the degree of damage

Conjunctivitis is divided into acute and chronic, differing in clinical symptoms:

  1. In the first case, the lesion occurs almost instantly, and first the inflammation covers one eye, then the other. The patient's eyelashes stick together due to discharge, sometimes purulent. Blushes eyeball and the surface of the cartilage.
  2. In the chronic form, the patient suffers from itching in the eyes, a feeling of sand, and fatigue of the organs of vision. There is very little discharge, and redness extends only to the area of ​​cartilage near the surface of the transitional fold.

In each case, the doctor prescribes an individual treatment.

There are two more common types of pathology:

Hyperemia of the conjunctiva of the eyes is accompanied by swelling, painful sensations and concomitant diseases.

The most common ones are:

  1. Barley. A very painful abscess on the eyelid is usually surrounded by localized redness.
  2. Blepharitis. The edges of the eyelids become inflamed, which is accompanied by their hyperemia and thickening.
  3. Chaliazion. The inflammatory process occurs in the internal subcutaneous gland (meibomian).

An ailment such as phlegmon of the orbit can also become a concomitant disease. It is a serious consequence of the inflammatory process and is characterized by the protrusion of the eye forward with blue-red hyperemia, severe edema and general poor health.

Drug therapy and treatment with folk remedies

Conjunctival hyperemia requires immediate medical attention. To prescribe the correct therapy, the ophthalmologist uses a thorough diagnosis. But initially, therapeutic measures are taken to help get rid of painful sensations and purulent discharge. To do this, local anesthetic drugs (lidocaine, pyromecaine, trimecaine) are instilled into the sore eye and the eyelids and mucous membranes are washed with an antiseptic agent (a weak solution of potassium permanganate or furacilin).

After identifying the cause of hyperemia, the doctor may prescribe:

  • antibiotic drugs and sulfonamides;
  • antihistamines;
  • corticosteroids;
  • antiseptic washings;
  • antiviral agents.

All medicines are selected individually, depending on the causative agent of the disease.

With such a pathology, eye patches cannot be applied, they can worsen the condition. The same goes for self-administration of drops, ointments and other remedies.

After consulting with an ophthalmologist, red eye syndrome can be further mitigated using folk methods:

MeansHow to cookHow to apply
Dill compressWash fresh dill, shake off water drops and grind in a meat grinder or blender. Filter the substance through cheesecloth. Moisten a clean cotton rag in the resulting juice.Put the compress on the sore eye for fifteen minutes.
Honey dropsDilute with clean (preferably distilled) water in a 1: 2 ratio.Bury it three times a day.
Rosehip lotionsGrind the berries in a blender or coffee grinder. Pour two small spoons with a glass of boiling water. After 30-40 minutes, filter and moisten a clean cotton rag in the infusion.Apply to the sore eye for a quarter of an hour. The liquid can be used to rinse the eye in case of inflammation with the release of pus.

All eye inflammations that accompany red eye syndrome require mandatory medical care... Self-medication can be dangerous.

In severe cases, hospitalization in specialized department... But in most cases, therapy is carried out at home as directed by a doctor.