Pink Eye vs. Allergies: What Do You Have?

A case of red, itchy eyes often means one of two things: You have “pink eye” (infectious conjunctivitis) or you’re dealing with allergies (allergic conjunctivitis). Both share overlapping symptoms, but they have very different causes that require different treatments.

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Optometrist Robert Engel, OD, shares what you need to know to protect your eyes from pink eye or allergies.

Pink eye vs. allergies

Pink eye and allergic eye reactions are two different types of conjunctivitis, a condition in which the conjunctiva (the thin tissue over the white part of the eye in the inner eyelids) becomes inflamed.

Bacterial and viral infections often cause this inflammation. But allergens — like ragweed, pet dander, dust or pollen — can affect your eyes in a similar way.

What causes pink eye vs. allergies?

Pink eye is a contagious infection caused by an organism or a germ, like a:

Virus
Bacterium
Fungus
Parasite

You can get pink eye when you come into contact with someone who has it or you rub your eyes after touching a contaminated surface.

Allergic conjunctivitis isn’t contagious, and you can experience it year-round. It’s triggered when your eyes come into direct contact with allergens. Products that commonly cause contact dermatitis (like certain soaps, detergents, or moisturizers) can also cause an allergic eye reaction, says Dr. Engel.

What does pink eye vs. allergies look like?

“Pink eye usually starts in one eye before spreading to the other, while allergic conjunctivitis can affect one or both eyes at the same time,” says Dr. Engel. “Pink eye can sometimes be connected to more than one respiratory infection symptom, like coughing, sneezing, runny nose, fever and sore throat. But allergic conjunctivitis usually has a simpler association with sneezing and runny nose.”

Pink eye and allergies share a lot of the same symptoms, but some of them are different. These symptoms include:

Common symptoms	Allergies	Pink eye
Redness	No	Yes
Itching	Moderate to severe	Mild
Burning	Yes	Yes
Swelling of the white of the eye	Yes	No
Clear, watery discharge	Often “rope-like”	Viral
Pain	No	No
Gritty feeling in eyes	Yes	Yes
Sensitivity to light	Very rare	Very rare
Thick discharge	No	Bacterial
Common symptoms
Redness
Allergies
No
Pink eye
Yes
Itching
Allergies
Moderate to severe
Pink eye
Mild
Burning
Allergies
Yes
Pink eye
Yes
Swelling of the white of the eye
Allergies
Yes
Pink eye
No
Clear, watery discharge
Allergies
Often “rope-like”
Pink eye
Viral
Pain
Allergies
No
Pink eye
No
Gritty feeling in eyes
Allergies
Yes
Pink eye
Yes
Sensitivity to light
Allergies
Very rare
Pink eye
Very rare
Thick discharge
Allergies
No
Pink eye
Bacterial

“In general, allergic conjunctivitis is paired with marked itching, redness and watery discharge, whereas infectious conjunctivitis has discomfort, chronic discharge and less itching,” clarifies Dr. Engel. “If you have light sensitivity, you should be seen promptly because this could indicate a more serious condition called uveitis.”

Home remedies for pink eye vs. allergies

Infectious conjunctivitis often improves within five to 10 days with no treatment at all or with simple drops like artificial tears. But it can still be very uncomfortable. If you have worsening symptoms after more than two days, Dr. Engel recommends making an appointment to determine if prescription eye drops are more appropriate.

Allergic conjunctivitis often gets better when you limit your interactions with the allergen that’s causing eye inflammation. But symptoms can linger for many weeks with seasonal changes that come in the spring and fall, requiring a prescription steroid eyedrop to break the cycle of itching and inflammation.

“The bottom line: Neither of these conditions is sight-threatening,” states Dr. Engel. “But it’s always best to seek an opinion from an eye doctor if you’re unable to treat symptoms adequately at home after a couple days, especially if you’re experiencing worsening vision or light sensitivity.”

Other at-home remedies for pink eye and allergies include:

Allergy (antihistamine) eye drops for allergic conjunctivitis
Preservative-free artificial tears
Cold compresses or cool water rinses (as long as you’re careful not to spread pink eye by avoiding contact with your unaffected eye)
Frequent hand washing to minimize contact risk of the allergen or germ

Avoid using drops that have only naphazoline or oxymetazoline longer than five days — these drops can improve comfort and redness, but they can cause a form of eye-drop addiction.

“Getting quick diagnosis and treatment is the key when you have irritated eyes,” reinforces Dr. Engel. “It doesn’t matter if it’s pink eye or allergies, your eye doctor can help you find the right treatment and the relief you need whenever you’re dealing with these conditions.”

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