Think It’s Pink Eye? It Could Be One of These 11 Conditions Instead

You wake up to discover that one (or both) of your eyes is watery, irritated and goopy. Plus, when you look in the mirror, you notice that the white part of your eye is actually … pink.

Uh-oh. Could it be pink eye? Or is it something else?

“‘Pink eye’ isn’t a medical term. It’s a layman’s term that can refer to many conditions,” explains optometrist Alexandra Williamson, OD. “But it most commonly refers to infectious conjunctivitis, which can present similarly to other eye conditions.”

There are multiple types of “conjunctivitis,” an umbrella term that refers to inflammation in your conjunctiva (the protective membrane over the whites of your eyes). But throughout this piece, we’ll use the term “pink eye” specifically to talk about infectious conjunctivitis. It’s typically caused by either a virus or bacteria, and it’s very contagious.

What else can mimic pink eye?

It’s easy to confuse infectious pink eye with other types of conjunctivitis and conditions like dry eye syndrome, uveitis, keratitis, blepharitis and more.

“It can be difficult to tell the difference between infectious conjunctivitis or other eye conditions,” Dr. Williamson acknowledges, “but there are signs that relate to certain problems.”

One of the symptoms that may set infectious conjunctivitis apart from other conditions is the type of eye discharge that accompanies it.

• Viral pink eye usually brings a thin, watery discharge that can crust on your eyelids and eyelashes in the morning.
• Bacterial pink eye brings a thick, goopy discharge that’s whitish, yellowish or greenish and looks like pus. It makes it difficult to open your eyes, especially when you first wake up.

There may be other telltale signs that only an eye doctor can diagnose. Viral pink eye can cause follicles (clear bumps under the eyelid), while bacterial pink eye can cause papillae (similar bumps associated with blood vessels).

“Your history, paired with the clinical signs you come in with, helps us figure out what’s going on,” Dr. Williamson says. She shares some possibilities.

1. Allergies

Yep, allergies can cause a version of pink eye, but not the contagious kind. Allergic conjunctivitis typically affects both eyes and doesn’t come with the thick, goopy discharge that bacterial pink eye does.

“Allergic pink eye, as it’s sometimes called, is typically related to exposure to allergens like pollen, grass, dust and pets,” Dr. Williamson says. “It can be crusty in the morning and red, watery and itchy throughout the day.”

2. Dry eye syndrome

Dry eye syndrome, which happens when your body can’t make enough tears or those tears evaporate too quickly, can make your eyes burn and feel gritty. Like pink eye, it can also bring redness.

“The main way to tell the difference is that dry eye syndrome is chronic and comes on more slowly than infectious conjunctivitis,” Dr. Williamson clarifies. Pink eye, on the other hand, is typically an acute (short-term) condition that can develop overnight.

3. Blepharitis

“Blepharitis” is the medical term for swollen, irritated eyelids. It can have some symptoms in common with pink eye, like redness, irritation and crustiness that can make your eyelids stick together.

“Blepharitis is a common obstruction of oil-producing glands in the eyelid,” Dr. Williamson explains. “It can go along with styes, chronic dryness or both.”

4. Uveitis

Uveitis is inflammation in the uvea, or the middle layer of your eye. The most common type is iritis (anterior uveitis), which refers to inflammation in your iris — the colored ring of your eye.

“When you have uveitis, you’re more likely to have a red circle around your iris, not widespread pink throughout your eye,” Dr. Williamson notes.

Uveitis is a serious condition that can lead to vision loss, so it warrants an immediate trip to an eye doctor.

5. Keratitis

Keratitis is inflammation in the cornea, the dome-shaped protective cover at the front of your eye. It can be the result of certain infections or accompany allergies or styes, and it can bring pain, swelling, watery eyes and sensitivity to light.

“Like uveitis, keratitis is a big deal that needs to be dealt with right away because untreated, it can cause vision loss,” Dr. Williamson stresses. “Be careful to watch for signs of keratitis in kids when they have allergies or styes because they don't always complain like adults do.”

6. A growth on your conjunctiva

Growths on your conjunctiva can cause symptoms like irritation, redness and watering. In some cases, they can cause discomfort or pain and even start to affect your vision.

There are two main types: A pinguecula is a little yellowish-whitish bump on your conjunctiva, while a pterygium (surfer’s eye) is wedge-shaped and can reach your cornea. You can typically see and even feel them on the surface of your eye.

“They’re more likely in older people who’ve had lots of UV exposure,” Dr. Williamson says. They can also go along with dry eye.

7. Subconjunctival hemorrhage

When a blood vessel breaks in your conjunctiva, it bleeds on the surface of your eye. Though it sounds unpleasant and can look scary, a subconjunctival hemorrhage doesn’t cause irritation or discharge the way pink eye does.

“When this happens, the eye will look red and bloodshot, not just pink,” Dr. Williamson states. “It involves a history of trauma or straining, like if you’ve recently been vomiting, or certain conditions, like anemia.”

8. A stye

A stye is a painful, tender lump on the edge of your eyelid that occurs when an oil gland near your eyelashes becomes blocked and infected. It can cause pink-eye-like symptoms, including itchiness, discharge and crusting — and can even happen alongside pink eye itself.

“A stye can go along with conjunctivitis, or it may be isolated, meaning it happens on its own,” Dr. Williamson says. “Either way, you should be examined by an eye doctor.”

9. A blocked tear duct

”Nasolacrimal duct obstruction,” the medical term for a blocked tear duct, is especially common in children. It can cause symptoms similar to pink eye, like watery eyes, redness and gooey or crusty buildup.

“This condition can resolve on its own but can also cause frequent infections,” Dr. Williamson says, “so it’s always best to see an eye doctor.”

10. Glaucoma medication

Prescription eye drops can help manage glaucoma and keep it from getting worse, but you may also notice some redness after you start using them.

“Sometimes, medications for glaucoma can make the eye appear pink,” Dr. Williamson confirms. “But this can be solved with other medications to control it.”

11. Other types of conjunctivitis

Infectious conjunctivitis can be confused with other types of conjunctivitis, too, which can also make your eyes look red and watery.

• Phlyctenular keratoconjunctivitis. This inflammatory disorder causes your eyes to be hypersensitive to bacteria, which can cause sore, red, itchy eyes.
• Autoimmune conjunctivitis. Chronic conjunctivitis is associated with autoimmune conditions like rheumatoid arthritis, lupus, Graves’ disease and others.

When to see a doctor for pink eye

If you’re having eye troubles — whether pain, significant discharge or issues with your vision — don’t hesitate to make an appointment with an eye doctor.

It might be pink eye, which can be treated with antibiotic eye drops (if it’s bacterial) or resolve on its own with time (if it’s viral). Or it could be something else. Often, there’s just no way to tell on your own.

“In some cases, nearby body parts that are more important to vision, like the cornea, can also be inflamed,” Dr. Williamson warns. “That poses a bigger threat to your sight, so a visit to the eye doctor is really important. They’ll use specialized magnifying tools to examine those important parts of the eye in detail.”