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What Is Commonly Misdiagnosed As Pink Eye?

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A close up of a woman with a red, irritated eye

You’ve likely heard of pink eye—it’s uncomfortable, common, and often very contagious.

But what if the red, itchy eyes, swollen eyelids, and gooey discharge you’re experiencing turn out not to be pink eye? What other eye conditions present like this, and how can you tell the difference?

Let the professionals at 20/20 Vision Associates Optometry guide you through how pink eye presents, what else may be contributing to your irritated eyes, and how we can examine your eyes to determine the right treatment for you. 

If you suspect pink eye, book an appointment to be sure, and read on to discover more about your eye health.

What is Pink Eye?

Pink eye is the commonly used name for conjunctivitis. Conjunctivitis is an inflammation of the conjunctiva, a thin membrane that covers the white of the eye (the sclera).

Pink eye can affect 1 or both eyes simultaneously. Symptoms of pink eye (or conjunctivitis) include:

  • Red eyes
  • Itchy eyes
  • A feeling of grittiness
  • Discharge
  • Crusty eyelids that make it difficult to open the eyes after sleep
  • Watery eyes

Though pink eye often doesn’t have long-term visual effects, it can sometimes harm the cornea. 

Types of Conjunctivitis

There are different types of conjunctivitis, which have a wide range of causes and various treatment methods.

Infectious

Infectious conjunctivitis is the most common form of pink eye. It’s caused by either bacteria or a virus. Bacterial conjunctivitis can travel from one contaminated person or object to another, is highly contagious, and can be treated with antibiotics.

Viral conjunctivitis is caused by a virus similar to the common cold. It can be spread person to person in droplets or can travel to your eyes from your body’s other mucus membranes. Viral conjunctivitis can’t be treated; it just needs to run its course.

Allergic

Allergic pink eye is related to allergens coming into contact with the eye and inflaming the conjunctiva. It can be treated with antihistamines and eye drops, but it’s safest to visit your optometrist to get the go-ahead for any course of treatment.

Chemical

When an irritant enters the eye from the environment around you, a reaction can cause the conjunctiva to become inflamed. Usually, flushing the eye can remove the irritant and ease symptoms.

Eye Conditions that are Mistaken for Pink Eye

Let’s take a look at some other eye conditions that present like pink eye.

Keratitis

Keratitis is an open sore on the cornea, the clear layer over the front of the eye. It has many of the same symptoms as pink eye, such as:

  • redness
  • Eye pain
  • Soreness
  • The feeling of having something in your eye
  • Watery eyes
  • Pus or discharge
  • Blurry vision
  • Light sensitivity
  • Swollen eyelids
  • A white spot on the cornea

This list looks almost identical to the symptoms of pink eye and illustrates why it’s so important to visit your optometrist when you suspect an eye infection of any sort. While pink eye can often resolve on its own, severe cases of keratitis may require a corneal transplant.

Iritis

Iritis is inflammation of the iris, or the colored part of your eye. It can come on quickly and generally only affects one eye at a time. Symptoms include:

  • Pain in your eye or brow area
  • Severe eye pain in bright light
  • Redness, especially around your iris
  • A pupil that’s abnormally small or strangely shaped
  • Blurry vision or vision loss
  • Headache

Iritis may be misdiagnosed as pink eye, which is concerning because iritis can lead to damage, including vision loss. It can be treated with medication.

Glaucoma

One type of glaucoma, acute angle-closure glaucoma, can also result in red eyes and blurry vision. There is also pain, nausea, headaches, and vomiting associated with this vision-threatening condition. It is considered an eye emergency and requires fast treatment.

Blepharitis

Blepharitis is a chronic inflammation of the eyelids. It’s often responsible for dry eye syndrome, which also shares some symptoms with pink eye. This condition can be caused by a buildup of bacteria around the eye and certain skin conditions. It can result in symptoms such as:

  • Burning eyelids
  • Blurry vision
  • Crusting of eyelashes and eyelid corners
  • Excessive blinking
  • Eyelids sticking together
  • Watering eyes
  • Flaking skin around the eyes
  • Oily eyelids
  • Itchy eyes
  • Light sensitivity
  • Red, swollen eyelids
  • Red, irritated eyes

Though there is no permanent cure, your optometrist will be able to help you manage blepharitis and ease the symptoms.

Stye

A stye is a small bump on the inner eyelid that can lead to pink eye like symptoms, like:

  • Pain around the bump
  • Eyelid swelling
  • Crusting near the eye
  • Light sensitivity
  • Soreness
  • Itchiness
  • Watery eyes
  • The feeling of something in the eye

Styes are similar to pimples. They are often caused by blocked oil ducts in the eyelids and can occur on the edge, outside, or inner part of the eyelid. Unlike many forms of pink eye, styes are not contagious.

Chalazion

A chalazion is very similar to a stye, but while styes tend to form along the lash line, chalazia tend to form in the center of the lid. Sometimes a stye can develop into a chalazion. 

These small bumps are characterized by:

  • Soreness
  • Redness
  • Swelling
  • Tenderness around the spot
  • Watery eyes
  • Mild eye irritation
  • Blurry vision
A boy suffering from conjunctivitis (pink eye) in both of his eyes

Children & Pink Eye

Children seem to be prone to bouts of pink eye—if you’ve ever had a child in school or daycare, you know how fast any contagion can spill through their group. Since children tend to spend their time in close quarters, playing and sharing toys, they may spread pink eye more quickly than adults.

Kids may not yet possess the hygiene skills to wash their hands properly, or the level of control required not to rub or itch the eye when it’s irritated or hurting (understandably—it’s difficult for many adults, too.) This can lead to reinfecting the eye or spreading the infection to the other eye.

If your child develops pink eye, help them recover by visiting the optometrist for a children’s eye exam and keeping them home from school or daycare if their conjunctivitis is the infectious type.

Newborns & Pink Eye

Newborns are also susceptible to more serious conjunctivitis infections. In infants, pink eye can be caused by a bacterial or viral transmission during a vaginal birth (culprits include gonorrhea and chlamydia.) It can also be caused by a blocked tear duct, other bacteria or viruses, or allergies.

Watch for signs of pink eye in your baby. The condition can happen at any time, but many types of bacterial conjunctivitis passed on when leaving the birth canal are especially likely to surface in the first 5–14 days after birth. 

Eye Hygiene

Good eye hygiene is always key and can prevent certain types of conjunctivitis. To help keep your eyes healthy, follow these simple tips:

  • Don’t touch your eyes.
  • Wash your hands often
  • Don’t share towels or washcloths.
  • Use clean linens
  • Change & wash pillowcases regularly
  • Don’t use cosmetics, such as mascara, past their expiry date
  • Don’t share eye products like cosmetics or personal care products

If you or your child wear contact lenses, there are some extra precautions to take to prevent eye hygiene issues:

  • If you notice signs of infection or irritation, stop wearing contacts & switch to glasses for a while
  • Only ever use approved contact solution to clean & store contacts—NEVER water, NEVER saliva
  • Don’t sleep in contact lenses (unless they are designed and prescribed for it)
  • Replace your lenses on time—you can even order contacts online from your optometrist to keep your supply stocked
  • Always use thoroughly cleaned hands when managing contacts

Good hygiene is always a wise choice—ensure you’re keeping your eyes clean and healthy.

Visit Your Optometrist to Manage Pink Eye—Or Whatever Else Comes Up

A host of eye problems may be misdiagnosed as pink eye, especially to those untrained in eye diseases. Don’t compromise your eye comfort (and your vision) with the wrong treatments. Visit your optometrist for a thorough exam and carefully tailored treatment for any eye symptoms.

Written by Cheryl Everitt

Cheryl M. Everitt, OD, received her Doctor of Optometry degree from the Southern California College of Optometry in Fullerton, California in 1994. She holds a bachelor’s degree in biology from California State University, Fullerton. Dr. Everitt takes a special interest in treating patients with a variety of difficult eye conditions, such as chronic headaches and migraines. Dr. Everitt has been a conference speaker on topics ranging from contact lenses to practice management to trigeminal dysphoria. She has also participated in a mobile eye clinic in Riverside, and medical missions to Mexico. Dr. Everitt is one of the original founders of 20/20 Vision Associates Optometry and has practiced for 25 years. She was an associate research scientist for 4 years prior to becoming an optometrist. She is also an active member of her church.
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