Why Does Bulimia Cause Red Eyes?

Bulimia & Red Eyes

A rare but very visible sign of bulimia nervosa (BN) is broken blood vessels in the eye (subconjunctival hemorrhage). In this piece, we explain why this happens and how to get help.

Bulimia nervosa is an eating disorder that consist of episodes of binge eating and purging. Purging is a compensatory method used to compensate for food eaten during a binge or to alleviate guilt. Common purging methods include:

• Self-induced vomiting
• Laxative and diuretic use
• Enemas

How purging causes red eyes

Due to repeated and forceful self-induced vomiting, a sudden increase in pressure from throwing up can increase the pressure inside the eye and cause the blood vessels of the sclera to rupture. This can create the appearance of bright red eyes.

Petechiae from vomiting

Self-induced vomiting can also cause small red dots around the eye (periorbital petechiae). Like rupturing the blood vessels within the eyes, purging can also cause the capillaries around the eyes to break, causing a red speckled appearance across the face.

Other physical signs of bulimia nervosa

There are a variety of noticeable physical signs of BN, some of the common ones including chipmunk cheeks, calloused knuckles and inflamed gums. While these are largely harmless hallmarks of bulimia nervosa, they can cause distress for patients who are concerned with their appearance or of people knowing they have an eating disorder.

Chipmunk cheeks

One of the most ubiquitous signs of bulimia nervosa is what’s known as “chipmunk cheeks,” or sialadenosis. Chipmunk cheeks are an enlargement of the parotid glands and give the sides of the face a swollen “chipmunk” appearance.

The exact cause of sialadenosis is unknown but develops shortly after patients stop engaging in self-induced vomiting. Sialadenosis usually resolves with time, and treatment primarily consists of supportive care and sialagogues (medications that promote saliva production).  

Calloused Knuckles

Calloused knuckles, or Russell’s sign, is another sign of BN and purging. 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.

Inflamed gums

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

Last Reviewed: October 2024 by Dennis Gibson, MD, FACP, CEDS