You know that feeling before you even fully open your eyes when you know something is wrong. “Oh no…do I have pink eye?!?” Those thoughts swarm as soon as you realize that heavy, goopy feeling upon opening your eyes in the morning. As a parent, that’s also a phone call from school I don’t look forward to. We should be on guard and know what to do should you find yourself in that situation.
Despite its unmistakable red-eye appearance, it’s surprisingly easy to misdiagnose especially when you make the call without visiting your optometrist for an eye exam. When we receive a call at our office with someone who is concerned about pink eye, we have them come right in that day for evaluation. With prompt treatment, you can get back on the road to recovery and prevent spreading it on to friends, coworkers and family.
Conjuctivitis or “pink eye” can share symptoms with other eye conditions, but finding the root cause is essential to getting proper treatment. Some conditions commonly misdiagnosed as pink eye include:
- Dry eyes
- Blepharitis
- Ocular Rosacea
- Styes / Hordeolum
- Uveitis / Scleritis
- Eye allergies
- Corneal Ulcers – especially in contact lens wearers
What Is Pink Eye?
Conjunctivitis or “pink eye” as it’s commonly known as, refers to the inflammation or infection of the conjunctiva, the thin transparent layer covering the white part of the eye and the inside of the eyelid. This is why medically you may hear it referred to as conjunctivitis.
There are different kinds of conjunctivitis, though some general symptoms they all share include:
- Red or pink eyes
- Eyelid swelling
- Foreign body sensation
- Irritation or gritty feeling
- Tearing or watery discharge
- Photophobia
- Decrease in vision
When we look at them closer, the differences become apparent:
- Viral conjunctivitis: Often linked to the common cold virus, viral conjunctivitis is highly contagious and can spread when an infected person coughs or sneezes and the virus reaches your eyes. Viral conjunctivitis tends to cause a watery discharge and could start in 1 eye before spreading to the other.
- Bacteria conjunctivitis: As you may expect, bacterial conjunctivitis results from bacteria entering the eye. This type often produces thicker, pus-like discharge compared to viral infections and could occur alongside an ear infection
- Allergic conjunctivitis: Allergic conjunctivitis arises from an allergic reaction to substances like pollen or dust. It isn’t contagious and usually affects both eyes. It’s often accompanied by other allergy symptoms, like sneezing or a scratchy throat.
Conditions Often Misdiagnosed as Pink Eye
It’s easy to see why people might confuse other conditions with pink eye, given their overlapping symptoms. Let’s explore these conditions further.
Dry Eyes
Dry eyes also known as Ocular Surface Disease (OSD) occur when tears aren’t able to provide adequate lubrication for the eyes, either because you don’t produce enough tears or the tears are low-quality. They can cause a lot of symptoms similar to pink eye, including:
- Redness
- Gritty or burning sensation
- Feeling like something is stuck in your eye
- Watery eyes without relief from irritation
- Vision fluctuating when blinking
While pink eye can be caused by viruses or bacteria, dry eye can result from:
- Contact lens wear
- Extended periods of screen time
- Changes in hormones
- Aging
- Certain medications like Accutane, antihistamines, decongestants, and blood pressure
- Cosmetics – lash growth serums are a common culprit
- Medical conditions such as diabetes, rheumatoid arthritis, and thyroid disorders
- Windy, smoky, or dry climates
Your optometrist can offer relief through artificial tears, prescription eye drops, punctal occlusion, meibomian gland treatments and modifying lifestyle changes.
Blepharitis
Blepharitis is an eyelid infection caused by an overpopulation of staphylococcus aureus (s.aureus) which is a common bacteria found on our skin. Demodex folliculorum (mites) are also normal flora found on our skin and eyelids. When there is an imbalance and overpopulation of s. aureus and demodex you can end up with dry, painful eyes. Patients who have rosacea (facial and ocular) often have more issues with blepharitis, dry eye and meibomian gland dysfunction. Blepharitis and demodex affect the delicate oil producing meibomian glands that are found on the upper and lower eyelid and dysregulate the intricate pathways of tear film stability . These glands are an integral part of tear production as they provide the top layer of tear film which prevents evaporation between blinking. Patients with untreated lid disease can feel frustrated with dry eye symptoms as rewetting eye drops are not sufficient to improve symptoms.
This condition can produce symptoms that some may mistake for pink eye, such as:
- Itching – around the upper and lower lid margins
- Styes / Hordeolum / Chalazion
- Eyelid redness
- Eyelid swelling
- A burning or stinging sensation
- Watery eyes
- Crusty or flaky deposits at the base of the eyelashes
- Sensitivity to light
- Foreign body sensation – feeling like there is something in your eye
I recommend to all of my patients to first and foremost, keep your eyelids clean! Yes, they need specific cleaning just like brushing your teeth. However, if your symptoms keep coming back, your optometrist can suggest a procedure like BlephEx or Zest to clean and exfoliate your eyelids, promoting greater eyelid hygiene and fewer frustrating symptoms.
Uveitis
Uveitis is a rare, but serious, inflammation of the uvea, the eye’s middle layer. It can appear a lot like pink eye, with symptoms that include:
- Severe redness
- Blurred vision
- Light sensitivity
- Eye pain
- Floaters
Misdiagnosing uveitis as pink eye can delay necessary treatment. Uveitis often requires immediate medical attention because, if left untreated, it can lead to vision loss. An eye doctor will usually prescribe steroids through eye drops, pills, or injections, but each case is unique and requires a comprehensive examination. With chronic cases of uveitis blood work should be ordered to rule out systemic causes.
A Special Case: Eye Allergies
Allergic conjunctivitis is caused by eye allergies. . However, when most people talk about pink eye, we tend to think of the highly infectious ones that run rampant through school. Since they’re different types of the same condition, it’s no wonder they may get misdiagnosed. The important difference is that eye allergies are not contagious.
Antihistamine can help reduce symptoms, but it pays to be proactive. Preventing allergies means trying to avoid allergens that trigger you, such as pollen, dust, mold, or pet dander.
How to Treat Pink Eye
Finding relief from pink eye depends on its cause. In some instances, without antibiotic or steroid treatment it clears up on its own. If your symptoms begin to worsen or your vision is affected, immediate evaluation and treatment is recommended in order to prevent further discomfort and long term complications. Patients who wear contact lenses are more susceptible to corneal ulcers, which are painful and sight threatening. Immediate treatment is recommended to prevent loss of vision and corneal scarring.
Artificial tears can provide temporary relief and a cool compress can help relieve acute symptoms. Careful handwashing and replacing towels, linens and replacing eye makeup are all things that can help prevent reinfection. No matter the type, keeping your eyes clean and steering clear of irritants helps speed up recovery. Focus on not spreading pink eye to family, friends, and co-workers by washing your hands, not touching your face, and avoiding sharing items.
Clear Vision Ahead
I tell my patients “you only have 2 eyes, please let me help you keep them healthy!”. That usually gets a good laugh, but honestly if you wake up and you think you have an infection, please call your eye doctor. I’ve learned through the years that patients tend to suffer more and not get the treatment they need due to thinking it will get better on its own. Your optometrist has the knowledge and experience to get you on the road to recovery. So bypass that urgent care and call your optometrist…they’ve been trained for this!
At Bella Vision, we make it easy to learn about these issues so you can help your family’s eyes stay healthy. Whether you’re experiencing symptoms or prepping for your next eye exam, we’re ready to provide the care you need. Book your appointment today!
