Red, Irritated, Itchy, Watery Eyes: How to Tell If It's Pink Eye or Something Else
Are Your Eyes Making You Miserable?
Is It Allergies, Pink Eye, or Something More Serious?
Do you see that red, irritated, itchy, watery eye? That's mine on a good day lately. Actually, I have two of them, although one tends to look and feel a lot worse than the other. Over the last six months, I've struggled with both recurring pink eye as well as scleritis, a serious eye condition that involves inflammation of the whites of the eyes.
At first, I delayed seeking medical treatment because I assumed I was suffering with seasonal allergies (e.g., tree, ragwood, mold, pollen). But my eyes became so red they looked like demon's eyes, and they hurt intensely—a stabbing pain.
I wondered if it was pink eye or even some small foreign object in my eye, like an eyelash. However, over-the-counter medications and flushing my eyes did not seem to help.
I waited longer than I should have to consult a professional. If you have bloodshot, uncomfortable eyes that are bothering you, I'd like to help you avoid making that mistake by understanding possible causes and knowing when to see your ophthamologist.
The Misery of Red, Itchy Eyes
We often take our eyes for granted until something goes wrong.
Your eyes feel red, irritated, itchy, uncomfortable or even painful. Maybe you have crusty discharge or watery eyes that make you look like you're crying. There are a number of potential causes. Could you be suffering from allergies, pink eye, or something more serious?
Ultimately, only an opthamologist can tell you, but here are some common possible reasons for red eyes and associated symptoms.
Why Are My Eyes Red? Common Causes
It Could Be
Or Even This
allergies or hay fever
foreign object in eye
episcleritis (inflammation of the membrane covering the white part of the eye)
pink eye (conjunctivitis)
blepharitis (inflammation that affects your eyelids)
broken blood vessel in eye
corneal abrasion (scratch)
corneal ulcer or corneal herpes infection
chalazion (painless bump or nodule inside the eyelid.
iritis (inflammation of the colored part of the eye)
stye (a red, painful lump near the edge of the eyelid)
eye injury (trauma or burn)
an eyelid that is turned inward or outward
scleritis (inflammation of the white part of the eye)
uveitis (inflammation of the middle layer of the eye)
keratitis (inflammation of the cornea)
dry eyes (decreased tear production)
Moist, Weepy Eyes Are Uncomfortable
Common Causes of Eye Boogers
Description of Eye Booger
viral conjunctivitis, allergic conjunctivitis, eye allergies, dry eyes, eye injury, blocked tear duct
blocked tear duct, bacterial conjunctivitis and other eye infections, stye
sticky and gooey
stye, bacterial conjunctivitis and other eye infections, corneal ulcer, blocked tear duct
dry eyes, corneal ulcer, allergic conjunctivitis, eye allergies
Pink Eye (Conjunctivitis)
Also called conjunctivitis, pink eye involves redness or pinkness of the conjunctivae, the membranes that cover the whites of the eyes and inner eyelids. Pink eye is a common ailment and can be highly contagious.
How to Prevent Pink Eye from Spreading
If you suspect you may have pink eye, keep this uncomfortable and potentially very contagious condition from spreading to others.
Here are some helpful tips:
- Wash your hands frequently
- Avoid touching the eyes
- Change pillowcase frequently
- Avoid shaking hands when you have pink eye
- Cover coughs and sneezes
- Avoid sharing towels, washcloths, makeup, eyedrops, handkerchiefs and tissues.
This illness is typically transmitted via direct contact with an infected person's eye secretions or bacteria living in the nose or sinuses—a good reason to cover those sneezes, wash those hands, and avoid touching your eyes!
Symptoms of pink eye can include
- redness in the eye
- gritty feeling and an urge to rub the eye(s)
- itchiness, irritation and/or a burning sensation
- discharge that may be green, yellow, or clear
- eyelid and eyelash crusting, particularly upon waking
- enlargement or tenderness of the lymph node in front of the ear and
- contact lenses that do not stay in place on the eye and/or feel uncomfortable.
Causes and Potential Consequences
Pink eye can be caused by a variety of factors, including viruses, bacteria, allergies, and irritants (e.g., a chemical splash, foreign object). Viral and bacteria forms are highly contagious.
Applying a wet compress—a clean, wet washcloth—to the eyes can help alleviate the symptoms of viral or bacteria pink eye. Viral pink eye typically resolves on its own after a week or two. Bacterial pink eye, however, calls for a prescription of antibiotic eye drops.
Potential complications of pink eye may include an inflammation of the cornea which can impair vision. Repeated bouts of pink eye such as the kind I've been having suggest an underlying systemic disease. See an opthamologist if your suspected pink eye persists, if the discharge from your eyes is yellow or green (suggesting bacterial pink eye), or if you are unsure what it might be.
If it's allergy season where you live, you may at first assume that's what is wrong with your red, itchy eyes. It's not necessarily the case.
As a rule of thumb, allergies carry with them fewer symptoms than infections. These symptoms typically include redness, itching, burning, and a clear watery discharge. (If the discharge from your eyes is anything more than this (e.g., colored, thick), assume an infection.)
With allergies, you may also have symptoms that extend beyond the eyes, such as nasal congestion, a runny or stuffy nose, sneezing, scratchy or sore throat, and a cough from post-nasal drip.
Allergies occur when your immune system recognizes a substance as harmful and overreacts to it. Your environment is filled with potential allergens:
- Dust mites
- Pollen from trees, plants, grasses, ragweed, etc.
- Animal dander
- Contact lenses and lens solution and
Symptoms are often alleviated with allergy eye drops, artificial tears, and over-the-counter allergy medications (e.g., Benadryl, Flonase, Claritin, Zyrtec). Sometimes, however, a prescription is necessary, including general allergy medications (e.g., Singular), anti-inflammatory drops, and/or steroids.
Inflammation of the whites of the eyes
Who knew the whites of your eyes could become inflamed? The sclera is the tough membrane that forms the outer wall of your eyeball.
Scleritis is an uncommon but serious eye disease, and its symptoms include:
- an angry red color (sometimes with a violet or even blue tinge) affecting one or both eyes; it can be either diffuse or comfined to a pie-shaped area
- tenderness to the touch
- blurred vision
- extreme light sensitivity (photosensitivity)
- teary eyes (you feel like your eyes are involuntarily leaking) and
- moderate to severe pain that feels deep and penetrating (a stabbing "ice pick" pain) and may radiate to the face, jaw, and down the neck.
Causes and Potential Consequences of Scleritis
The cause of scleritis is unknown in about half of all cases. However, the other half of scleritis cases involve a manifestation of a systemic autoimmune condition, including:
- Rheumatoid Arthiritis (RA) and other types of inflammatory arthiritis
- Wegener Granulomatosis
- Lyme Disease
- Mixed Connective Tissue Disease
- Inflammatory Bowel Disease
- Sjogren's Syndrome
- Vasculitis and
If you're thinking "I don't have any of these diseases, so I'm fine," then be careful. Scleritis may be the initial symptom, meaning that you don't know you have one of these autoimmune diseases until you are faced with this eye condition. My opthamologist refered me to a rheumatologist for extensive testing for a wide range of conditions, including those above. The results were that I may have lupus.
Potential complications of scleritis include retinal detachment, angle-closure glaucoma, and loss of vision. Don't risk your eyesight. If you are concerned that you may have symptoms of scleritis, see your opthamologist immediately.
Summary of Similarities and Differences: Bacterial and Viral Pink Eye, Allergies & Scleritis
Bacterial or Viral Pink Eye
Description of condition
A common eye ailment involving redness or pinkness of the conjunctivae, the membranes that cover the whites of the eyes and inner eyelids
A common condition that occurs when the body's immune system recognizes a substance as harmful and overreacts to it. May be chronic or last a long time.
A serious eye disease involving inflammation of the whites of one's eyes. Typically associated with underlying autoimmune conditions.
Affects one or both eyes?
One or both eyes
One or both eyes
Redness, swelling, watering, grittiness, urge to rub one's eyes, discharge (yellow, green or clear), eyelid crusting upon waking, contact lenses that are uncomfortable or won't stay in place
Redness, itching, burning, clear watery discharge
Moderate to severe pain, redness, tearing, light sensitivity, eye tenderness, decreased visual acuity. Usually no eye discharge.
Painful or merely uncomfortable?
Uncomfortable or mildly painful
Uncomfortable, not painful
Moderately to severely painful; deep, penetrating pain
Direct contact with an infected person; touching an item that an infected person has touched then touching one's eyes; poor handwashing
Dust mites; pollen from trees, plants, grasses, and weeds; animal dander; molds; contact lenses and lens solution; and cosmetics.
Half of cases have no apparent cause. The other half are due to underlying systemic diseases such as connective tissue disorders, autoimmune diseases, or vasculitic abnormalities.
Can be highly contagious
Exam by opthamologist may include sampling eye discharge for testing
Your family physician or opthamologist may refer you to an allergist who will take your personal and medical history and may perform allergy testing.
Exam by ophthamologist; blood tests for possible underlying medical conditions.
Artificial tears; antibiotic eyedrops for bacterial pinkeye or secondary infections caused by scratching; viral pink eye should simply run its course in 1-2 weeks
Allergy drops, artificial tears, and over-the-counter allergy medications,
Specific treatment for underlying autoimmune condition, anti-inflammatory eye drops; NSAIDS, steroids, or immune modulating medications.
Inflammation of the cornea which can impair vision
If left untreated, severe asthma, sinus problems, headache and gastrointestinal problems may occur.
Must be diagnosed, treated, and monitored by an ophthamologist to avoid long-term vision loss. Retinal detachment and angle-closure glaucoma are possible.
Avoid touching the eyes; wash hands; cover sneezes and coughs; don't share items such as makeup, towels, eyedrops
Keep windows closed; use an air purifier/dehumidifier, zippered "allergen-impermeable" covers on pillows and mattresses; wash bedding in hot water weekly.
Generally no prevention. Be aware of any underlying autoimmune conditions.
An opthamologist can professionally examine, diagnose, and treat your eye conditions.
Don't take your vision into your own hands.
When Should I Consult an Opthamologist?
When to Consult an Eye Doctor (Ophthamologist)
Seek An Opthamologist If You Have Any of These Symptoms
Especially If You ...
Physical changes to the eye, including crossed, bulging, or misaligned eyes, signs of infection (e.g., swelling, discharge, redness), unequal pupil size
Have a history of high intraoccular eye pressure
Pain in the eye
Have had a previous eye injury or are already experiencing eye conditions such as cataracts, glaucoma, macular degeneration, etc.
Changes in vision such as double vision, flashes of light, sudden spots, jagged lines or lightning streaks, wavy lines, haloes around lights
Are living with diabetes, HIV/AIDS, thyroid disease, rheumatological diseases such as lupus, or other immune compromising illnesses.
Loss of vision in one or both eyes, changes in color vision
Are of Hispanic or African descent
Changes in the field of vision, including shadows, black spots or blurriness, shadows, curtain-like loss of vision
Have a family history of glaucoma, cataract, macular degeneration, or retinal detachment
Are taking medications that can impact vision (e.g., Plaquanil, Prednisone, Ethambuto, many others)
Family members or others in close associate with you have the same symptoms (suggests contagion)
4 Key Things to Tell Your Eye Doctor
When you call your eye doctor about red and irritated eyes, offer the following information so they can help triage you:
- Symptoms: Redness in one eye or both? Pain or mere discomfort? Clear, yellow, green, and/or crusty discharge? Tearing? Itchiness? Changes in vision?
- When your symptoms started
- Anything you've tried, such as over-the-counter medications, compresses, eyedrops
- Any associated medical conditions that you know of (e.g., autoimmune diseases)? Previous eye injury or conditions? History of high intraoccular pressure?
Providing a precise description of your problem will help you get an immediate appointment, if needed. It will assist the opthamologist in the diagnosis and treatment of your condition.
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