Are all pink eyes the same?

There are three main types of pink eye: 

1. Allergic
2. Viral
3. Bacterial

Allergic

Allergic conjunctivitis usually affects people who have a history of environmental allergies, commonly with a seasonal component. Allergies will typically affect both eyes simultaneously and in a similar manner. Allergy symptoms include an itchy or scratchy sensation in or around the eyes. Often, people get a watery, clear, tear-like discharge and have sinus issues at the same time. Also, the whites of the eyes will show light-red, mild infection along with mild swelling.  

Mainstream treatments of allergic conjunctivitis are topical antihistamine eye drops and oral antihistamine pills.   

Viral  

When you think of traditional pink eye, the culprit is usually viral conjunctivitis. Symptoms are itching, burning, tearing, and a mild foreign-body or sandy/gritty sensation. An upper respiratory infection could be present in conjunction with these symptoms. Viral conjunctivitis frequently comes from being around contagious people. The condition will start in one eye and then show in the other eye a few days later. Infection or redness of the white of the eye can vary from mild to extreme in presentation, often accompanied by watery discharge, eyelid redness, and swelling.  

Viral conjunctivitis can be very contagious—it's best to avoid touching the eyes, sharing towels or pillows, shaking hands with others, or making close contact. It's also best to stay home from work or school until the redness and watery discharge are gone. Treatments can include cold compresses, preservative-free artificial tears, antihistamine drops, and frequent handwashing.   

Bacterial  

If you wake up in the morning with your eyelids crusted shut, you could have bacterial conjunctivitis. With this type of infection, there is typically a purulent white-yellow-green discharge from the eyes. It can range from mild to severe and can be in one or both eyes. This causes a foreign-body-type sensation for many. The white of the eye is typically red, more so in the lower part of the eye. There may be mild swelling but not much itchiness.  

The usual treatment is the use of antibiotic drops or ointments. In some severe cases, an oral antibiotic may be used as well. Keeping the eyelids clean from the discharge is helpful. Bacterial conjunctivitis usually resolves quickly with antibiotic treatment.   

With any pink eye situations, you should stop contact lens use until the eye condition is resolved. In many cases, it's best to dispose of the contact lenses and the contact lens case you were using. If you wear contacts and have significant redness, pain, swelling, sensitivity to light, or cloudy vision, you should be evaluated very quickly. These can potentially be the signs of a corneal infection that needs to be treated.