No one wants to deal with itchy, red eyes for longer than they need to. While different things can cause these symptoms, two of the most common culprits are allergies and pink eye. We asked doctors to explain pink eye vs. allergy symptoms and treatment options so you can find the right treatment.
Meet the Experts: Purvi Parikh, M.D., an allergist at Allergy & Asthma Associates of Murray Hill; Howard R. Krauss, M.D., a surgical neuro-ophthalmologist and co-founder of the Pacific Neuroscience Institute at Providence St. John’s Health Center in Santa Monica, CA; William Reisacher, M.D., director of allergy services at Weill Cornell Medicine and NewYork-Presbyterian Hospital and in New York; Ray Chan, M.D., an ophthalmologist at Texas Health Surgery Center Arlington
Pink eye (also called conjunctivitis) and allergies have many overlapping symptoms, including sneezing and congestion. But there are some key differences in how these two eye conditions present and develop over time.
The good news is that both conditions can often be managed at home, but it’s a good idea to see a doctor to confirm which condition you’re dealing with. Below, experts explain the differences between pink eye and allergies.
Allergies vs pink eye
Purvi Parikh, M.D., an allergist at Allergy & Asthma Associates of Murray Hill, says the symptoms of seasonal allergies and pink eye can be identical, which is frustrating when you’re trying to decide if you should see a doctor. Both pink eye and allergy symptoms can include:
- Itchy eyes
- Watery eyes
- Red swollen eyes
- Nasal congestion
- Sneezing
- Chest tightness
- Shortness of breath
Issues with congestion may seem specific to seasonal allergies, but viral pink eye can be paired with flu-like symptoms.
As for the differences between the two, While it may seem obvious, the biggest difference between pink eye and allergies is typically how many eyes are affected. “Pink eye usually affects one eye whereas allergies affect both,” Dr. Parikh says. “Pink eye may be associated with viral symptoms like headache, fever over 100, and coughing with [saliva and mucus].”
If you’re noticing symptoms around a change in season or after spending more time than usual outside, it might be allergies.
More differences between pink eye vs. allergies are:
- Allergies typically affect both eyes at once, while pink eye typically starts in one eye before spreading to infect both eyes.
- Pink eye is associated with mild itchiness while allergies have intense itchiness and burning.
- Pink eye can have a mucus-like discharge of pus while allergies can produce a white stringy discharge.
- Pink eye can crust your eyelashes, causing your eye to stick shut—allergies should not.
- Pink eye is contagious, so people around you or living with you may be infected as well.
What is pink eye?
Pink eye happens when the conjunctiva—the clear tissue covering the white of the eye—gets irritated by germs, viruses, or allergens. The conjunctiva keeps your eyes moist, which is why an infection of this tissue can lead to discomfort, dryness, swelling, redness, and discharge.
Pink eye symptoms
Pink eye typically occurs in one eye, but it can eventually spread to the other eye. Mayo Clinic and Cleveland Clinic say these are common pink eye symptoms you can experience in one or both eyes:
- Redness
- Itchiness
- Green or white mucus-like discharge
- Dried, yellow crust in eyes (especially in the morning)
- Sensitivity to bright lights
- Swollen around the eye(s)
- Gritty feeling in the eye(s)
Types of pink eye
There are actually three types of pink eye with slight differences in symptoms and causes:
Viral pink eye
The most common type, viral pink eye is caused by exposure to—you guessed it—a viral infection. (Usually, the same one that causes the common cold.) It’s highly contagious and can cause burning, redness, and watery discharge, according to the American Academy of Ophthalmology. Viral pink eye can also be caused by infectious tears, fecal matter, or respiratory discharge getting into the eye. Even COVID-19 subvariant Arcturus has been linked to pink eye, but this is uncommon and seen more in children than adults.
Bacterial pink eye
Just like viral pink eye, the bacterial version is super contagious. The difference? Bacterial pink eye is caused by exposure to a bacterial infection (like the one that causes strep throat) instead of a viral one. It can also leave your eyes sore and pus-filled.
Viral and bacterial pink eye tends to start in one eye and infect the second eye a few days later. It spreads by contact, like by shaking hands or sharing a towel with someone who’s already infected. But you won’t notice it right away. “It could be seven to 10 days before symptoms appear,” says Howard R. Krauss, M.D., a surgical neuro-ophthalmologist and co-founder of the Pacific Neuroscience Institute at Providence St. John’s Health Center in Santa Monica, CA.
Allergic pink eye
Most people don’t realize this, but eye symptoms caused by seasonal allergies are actually another type of pink eye. It tends to make your eyes itchy, watery, and puffy. “The symptoms are caused by the release of the chemical histamine, which occurs when the eyes are exposed to an allergen you’re sensitive to,” says William Reisacher, M.D., director of allergy services at Weill Cornell Medicine and NewYork-Presbyterian Hospital and in New York. Unlike the other types of pink eye, allergic pink eye is not contagious.
Your symptoms can often give you a clue. Allergic pink eye tends to cause more itching than soreness or burning, explains Ray Chan, M.D., an ophthalmologist at Texas Health Surgery Center Arlington. It usually strikes both eyes at the same time, and it can come on quickly, usually within minutes or hours after exposure to an allergen.
Treatment options
Pink eye treatment
An ophthalmologist can diagnose pink eye with a slit lamp exam, testing an eye culture, or checking your sight with a visual exam. If you think your symptoms are caused by allergies, an allergist or immunologist can perform a prick skin test or blood test to determine what substances you are allergic to and provide the appropriate care.
When in doubt, head to your general practitioner who can often diagnose pink eye or seasonal allergies by examining the eye as well as asking about your medical history and symptoms.
Allergy treatments
Dr. Parikh recommends seeing a board-certified allergist or immunologist to get tested. Your doctor can then prescribe or recommend specific medicine or treatments based on what exactly you are allergic to. If you need immediate relief for allergies or your symptoms are relatively mild, you can get over-the-counter remedies. These include nasal sprays, decongestants, and oral antihistamines.
Over-the-counter treatment options
Whether you’re using medications or not, there are other steps you can take to feel better. “Applying a cold or warm compress, along with using artificial tears two to three times a day may ease discomfort,” Dr. Chan says. As for those gross crusties? Instead of trying to pick them off, Dr. Chan recommends the following: dab a drop of baby shampoo on a wet cloth, gently wipe your eyelids, and rinse with warm water.
Prevention
Pink eye
Just like most common infections, there are simple practices you can do to prevent the spread and contraction of pink eye. Wash your hands often (especially if someone you live with has pink eye), avoid touching your eyes with dirty hands, do not share eye makeup brushes, only use clean towels to dry/wipe your face, and clean pillowcases often.
Finally, take steps to stop the viral or bacterial pink eye from spreading. If you only have the infection in one eye, try to keep it that way by using a separate cloth or towel to clean the infected eye, says Dr. Chan.
Allergies
The worst part about seasonal allergies is they come around every year, but at least this gives us the opportunity to prepare. “Start taking your preventative or controller meds early if possible so for spring, March is a good time, for fall, August,” Dr. Parikh advises.
Dr. Parikh also recommends taking allergy medicine for seasonal allergies, but to see a doctor if the problem persists or you cannot self-manage the symptoms. “You can go on immunotherapy (allergy shots) by a board Certified allergist which makes you less allergic over time and desensitizes you. [It’s the] closest thing to a ‘cure’ we have.” It can help to take your allergy medicine before your symptoms start, especially on days with a high pollen count.
As many people who get bad allergies know, sometimes the medicine doesn’t help as much as we want it to.
Here are a few additional tips you can try, according to Mayo Clinic:
- Stay inside when the humidity is low and the wind is high.
- Dust and vacuum inside your home.
- Shower and change into clean clothes after being outside (this will ensure there is no pollen on you).
- Opt out of yard work and gardening, or wear a face mask while doing so.
- Close windows when the pollen count is high.
- Use an air conditioning or dehumidifier to keep indoor air clean and dry.
When to see a doctor
If you know that your pink eye is definitely caused by allergies, it’s fine to manage your symptoms with your usual allergy meds (like antihistamines or allergy eye drops) or other at-home remedies—but when in doubt, see a doctor.
If you don’t know the culprit of your conjunctivitis, definitely head to the doctor. They can confirm if you have a contagious form of pink eye—like viral or bacterial. Your doctor might also prescribe antibiotic eye drops for bacterial pink eye, which can help you recover faster. As for viral pink eye? Most meds won’t be effective, so you’ll likely have to wait a week or two for the infection to clear up on its own, according to the Centers for Disease Control (CDC).
It’s also a good idea to call your doctor if your symptoms become severe. Think: eye pain, blurred vision, sensitivity to light, intense redness, or symptoms that don’t improve with antibiotics, according to the CDC. You should also seek medical care if you have a condition that causes a weakened immune system.
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