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Conditions Commonly Misdiagnosed as Pink Eye

Pink eye, or conjunctivitis, is redness of the eyeball and inner surface of the eyelid due to infection or inflammation. Depending on the cause, you may also experience itchiness, grittiness, drainage, and eyelid swelling.

Conjunctivitis is highly contagious and easy to contract. Pinkeye affects about 6 million people in the U.S. each year.1 It quickly spreads from person to person, especially in schools and childcare centers. However, other conditions cause similar symptoms. If you have any of the following symptoms, contact your in-person or online doctor to verify whether you have conjunctivitis or another condition that causes eye redness.

Pink eye can be caused by a minor infection that goes away on its own, or it can be a sign of something more serious. Symptoms that may indicate another condition:

  • Eye pain
  • Vision symptoms
  • Light sensitivity
  • Symptoms that don’t improve within 24 hours
  • Swelling, redness, or tenderness around the eye or eyelids
  • Fever

How To Recognize Pink Eye

Pinkeye has fairly classic signs and symptoms, including the following:

  • Discharge, which varies from clear to yellow-green
  • Crusting of the eyelids and eyelashes
  • Gritty feeling
  • Watery eyes
  • Itching
  • Irritation
  • Burning
  • A feeling that there is something in your eye
  • Swollen eyelids

Treatment For Pink Eye

The treatment for pink eye varies depending on the cause.

Viral Conjunctivitis

Treat with symptomatic care, including:

  • Saline eye drops
  • Cold or warm compresses, don’t share compresses or use the same compress for an infected and noninfected eye

Bacterial conjunctivitis

Treat with medical care, including:

  • Antibiotic cream, eye drops, ointment

Allergic conjunctivitis

Treat with a combination of symptomatic and medical care, including:

  • Saline drops
  • Cool compresses
  • Mast cell stabilizers
  • Nonsteroidal anti-inflammatory drugs
  • Steroid eye drops
  • Antihistamines
  • Decongestants

See a doctor in person or online and experience the benefits of telemedicine if your symptoms worsen or persist, or if you are unsure whether you have pinkeye or need antibiotics to treat an infection.

What Else Can Be Mistaken for Pink Eye?

While conjunctivitis is the most likely cause of pinkeye, other conditions can cause similar symptoms. Since pink eye is nonspecific, it is important to consider conditions that can be misdiagnosed as pink eye.

Allergies

There is a lot of overlap between the symptoms of a cold and allergies. Likewise, it’s hard to tell whether a virus or an allergen causes conjunctivitis.

There are many similarities between viral and allergic conjunctivitis. They both cause:

  • Eye redness
  • A watery eye discharge
  • A gritty feeling in the eyes

Viral Conjunctivitis

Viruses cause most cases of conjunctivitis. Although over 200 different viral strains can cause conjunctivitis and cold symptoms, adenovirus causes the vast majority of cases.2   

Symptoms that may suggest viral conjunctivitis instead of allergic include:

  • No other allergy symptoms
  • Clear to yellow eye drainage
  • Symptoms start in one eye and spread to the other
  • Highly contagious

Allergic conjunctivitis

Allergic conjunctivitis is very common, especially in the spring and fall. Most people with allergic conjunctivitis will have other allergy symptoms as well.

Symptoms that suggest allergic conjunctivitis instead of viral include:

  • History of having allergies
  • Seasonal pattern
  • Itchiness

The treatment for viral and allergic conjunctivitis differs from bacterial causes of conjunctivitis. If you have allergy symptoms or allergic conjunctivitis, contact an online doctor to get an online prescription for one of the many potential treatments for allergic conjunctivitis: antihistamines, decongestants, mast cell stabilizers, nonsteroidal anti-inflammatory drugs, and steroid eye drops.

Dry Eyes

Dry, irritated eyes from exposure to pollution, wearing contacts too long, or not producing enough tears can cause a reddened conjunctiva that looks like conjunctivitis. Typically, there is no drainage or cold symptoms, and symptoms improve when using an eye moisturizer or artificial tears.

Abrasion or Foreign Body in the Eye

An abrasion or foreign body in the eye can cause eye redness and discomfort. You may also experience a gritty sensation that something is still in your eye, along with photophobia (light sensitivity), tearing, blurred vision, hazy vision, and pain. These symptoms are similar to those seen with pink eye. Abrasions can be misdiagnosed as pink eye.

Unlike conjunctivitis, abrasions and foreign bodies have a sudden onset. Something gets into the eye and scratches it or remains in the eye. It causes significant discomfort that is not relieved until the foreign body is removed and the abrasion is treated.

Styes

A stye or hordeolum is a small, painful lump that forms at the base of your eyelash or under your eyelid. Most styes are caused by a bacterial infection, typically Staphylococcus, and are often filled with pus and irritate the conjunctiva.

Since the stye irritates the eye, you may have the following symptoms:

  • Sensitivity to light
  • A sensation of a foreign body in the eye
  • Eyelid tenderness
  • A gritty feeling in the eye
  • Eyelid redness and swelling
  • Yellowish discharge
  • A crust on the eyelid

Subconjunctival hemorrhage

A subconjunctival hemorrhage occurs when one of the tiny blood vessels under the conjunctiva breaks open and blood layers out under the conjunctiva. Sudden pressure increases, such as when coughing or sneezing, can cause the blood vessel to break, as can rubbing the eye too hard.

You will notice an area of bright red blood. Most subconjunctival hemorrhages don’t cause any symptoms except possibly a small amount of tenderness. In most cases, no treatment is needed.

Blepharitis

Blepharitis is a chronic inflammation of the eyelid. It usually affects the eye along the edges of the eyelid and has a crusty appearance. Tiny oil glands near the base of the eyelashes help lubricate the eyelid. When these glands get clogged, it causes irritation and redness. This is called posterior blepharitis.

Anterior blepharitis occurs when bacteria infect the glands on their outer surface. Allergies and mites can also cause anterior blepharitis. Keeping the eyes clean is the primary treatment for blepharitis.3

Keratitis

Keratitis is an inflammation and swelling of the cornea of the eye. The cornea is the clear dome that covers the pupil and the iris (colored part) of the eye. When the cornea is red and swollen, it can cause difficulty seeing.

Like conjunctivitis, keratitis has infectious and noninfectious causes. For example, wearing a contact lens too long can cause corneal inflammation and a serious infection.4 If you think you might have keratitis, see your eye doctor promptly to reduce the risk of vision loss or other complications.

Uveitis

Uveitis is inflammation inside the eye. The uvea is the middle layer of the eye, which includes the iris, ciliary body, and choroid. When it is inflamed, it can cause red, painful eyes; blurry vision; vision changes; and light sensitivity. If it is not treated, uveitis can cause vision loss.5

Glaucoma

Glaucoma is increased pressure in the eye. Unfortunately, glaucoma frequently does not cause symptoms until you begin to notice vision loss. With open-angle glaucoma, peripheral vision is lost first. The earlier the conditions are detected, the better, because there are treatment options that may protect your vision.

Angle-closure glaucoma causes a more dramatic increase in eye pressure and, therefore, may cause more symptoms, including blurry vision, eye pain, headaches, and halos around lights.

There are other types of glaucoma as well. To lower your risk of losing your sight from glaucoma, you should get an eye exam and have your eye pressure checked once a year. 6

When To See a Doctor

Conjunctivitis is a common cause of pinkeye, but many conditions can cause a red eye and be misdiagnosed as pink eye. Some of these conditions can cause vision loss if they are not promptly treated. If you have symptoms that suggest conjunctivitis, see your doctor or schedule an online appointment to get help fast. The online doctor can evaluate your symptoms and refer you to an ophthalmologist if further treatment is necessary.

 Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1.  Udeh BL, Schneider JE, Ohsfeldt RL. Cost effectiveness of a point-of-care test for adenoviral conjunctivitis. Am J Med Sci. Sep 2008;336(3):254-64. doi:10.1097/MAJ.0b013e3181637417

2.  Grief SN. Upper respiratory infections. Prim Care. Sep 2013;40(3):757-70. doi:10.1016/j.pop.2013.06.004

3.  Duncan K, Jeng BH. Medical management of blepharitis. Curr Opin Ophthalmol. Jul 2015;26(4):289-94. doi:10.1097/icu.0000000000000164

4.  Maier P, Betancor PK, Reinhard T. Contact Lens-Associated Keratitis-an Often Underestimated Risk. Dtsch Arztebl Int. Oct 7 2022;119(40):669-674. doi:10.3238/arztebl.m2022.0281

5.  Burkholder BM, Jabs DA. Uveitis for the non-ophthalmologist. Bmj. Feb 3 2021;372:m4979. doi:10.1136/bmj.m4979

6. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. Jama. May 14 2014;311(18):1901-11. doi:10.1001/jama.2014.3192

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