What is commonly misdiagnosed as pink eye

By MedDigester Doctors on July 22, 2023


Pink eye, also known as conjunctivitis, is a common eye condition that causes redness and inflammation of the conjunctiva, which is the thin layer of tissue that covers the white part of the eye and the inner surface of the eyelids.

While pink eye is usually a mild and self-limiting condition, several other eye conditions can present with similar symptoms and are often misdiagnosed as pink eye.

In this blog post, we will explore some of the serious causes of red eye that are commonly misdiagnosed as pink eyes, such as acute angle closure glaucoma, anterior uveitis, corneal ulcer, and contact lens-related red eye, corneal foreign body, scleritis, and endophthalmitis.

We will also discuss some of the more common and usual causes of red eyes, such as subconjunctival hemorrhage, dry eye, and blepharitis, and how to differentiate them from more serious eye conditions.

Serious and potentially sight-threatening causes of red eye which is commonly misdiagnosed as pink eye:

Acute angle closure glaucoma

It is a serious eye condition that can cause vision loss if left untreated. It happens when the fluid inside your eye can’t drain properly and builds up, leading to increased pressure in your eye.

This can cause damage to your optic nerve, which is responsible for transmitting visual information to your brain.

Jonathan Trobe, M.D., CC BY 3.0, via Wikimedia Commons

The main symptoms of acute angle closure glaucoma include

  • severe eye pain.
  • blurred vision.
  • halos around lights.
  • nausea, and vomiting.
  • a red eye.
Pink eyeAcute angle closure glaucoma
rednessredness
itchingsevere eye pain
wateringblurred vision.
dischargehalos around lights.
a gritty feelingnausea, and vomiting.

If you experience these symptoms, it’s important to seek medical attention right away.

immediate treatment in the hospital for acute angle closure glaucoma is to lower the pressure inside your eye. This can be done with eye drops, oral medications, or laser surgery.

 In some cases, you may need surgery to create a new drainage channel to help the fluid inside your eye drain properly.

Anterior uveitis

Anterior uveitis is a condition where the middle layer of the eye, called the uvea, becomes inflamed. This can cause pain, redness, and sensitivity to light.

It’s important to seek medical attention if you suspect you have anterior uveitis, as prompt treatment can help prevent complications and preserve your vision.

Jonathan Trobe, M.D., CC BY 3.0, via Wikimedia Commons

The main symptoms of anterior uveitis include

  • eye pain (usually a dull ache in or around your eye)
  • eye redness
  • sensitivity to light (photophobia).
  • blurred vision
  • small shapes moving across your field of vision(floaters).
  • a feeling of pressure in the eye.
Pink eyeAnterior uveitis
rednessredness
itchingdull aching eye pain
wateringblurred vision
dischargesensitivity to light
a gritty feelingfloaters

These symptoms can develop suddenly or gradually and may affect one or both eyes. If you experience any of these symptoms, it’s important to see an eye doctor as soon as possible.

The main treatment for anterior uveitis involves reducing inflammation in the eye. This may involve using eye drops or oral medications, such as corticosteroids.

Your eye doctor may also recommend wearing sunglasses or an eye patch to help alleviate symptoms. It’s important to follow your doctor’s instructions carefully and attend any follow-up appointments to monitor your progress.

In some cases, surgery may be necessary to treat complications or manage severe cases of anterior uveitis.

Corneal ulcer and contact lens-related red eye

A corneal ulcer is a condition that affects the clear front part of your eye, known as the cornea. It occurs when a sore or lesion develops on the cornea, which can be caused by various factors such as infection, injury, or prolonged use of contact lenses.

Corneal ulcers can be a serious condition that requires prompt medical attention to prevent complications and vision loss.

ulcer seen by a stain, Yoanmb, CC BY-SA 4.0, via Wikimedia Commons

People who wear contact lenses are more likely to get corneal ulcers. This risk is 10 times higher if you use extended-wear (overnight) soft contacts.

Bacteria on the lens or in your cleaning solution could get trapped under the lens. Wearing lenses for long periods can also block oxygen to your cornea, raising the chances of infection.

Scratches on the edge of your contact might scrape your cornea and leave it more open to bacterial infections. Tiny particles of dirt trapped under the contact could also scratch your cornea

The main symptoms of corneal ulcer include

  • eye pain
  • eye redness
  • eye tearing
  • sensitivity to light.
  • blurred vision,
  • discharge from the eye,
  • and the feeling that there is something in your eye.
  • A round white spot on your cornea
Pink eyeCorneal ulcer
rednessredness
itchingPain(something in your eye)
wateringblurred vision
dischargesensitivity to light
a gritty feelingExcessive watering
 A round white spot on your cornea

These symptoms can be very uncomfortable and may affect your ability to carry out your daily activities, If you suspect that you have a corneal ulcer, it is important to seek medical attention as soon as possible.

Treatment for corneal ulcers may include prescription eye drops or ointments to control infection and promote healing according to the cause which may be anti-bacterial, anti-viral, or anti-fungal. In some cases, oral antibiotics or antiviral medications may also be necessary

If you are a contact lens wearer you will be advised when you will be able to start wearing lenses again by your doctor or optometrist.

Corneal foreign body

A corneal foreign body is a condition where a small object like a piece of metal, wood, or dust gets stuck in your eye’s cornea. The cornea is the clear, outer layer of your eye that helps you see clearly.

E van Herk, CC BY-SA 3.0, via Wikimedia Commons

When a foreign object gets lodged in your cornea, it can cause discomfort and pain. It is important to seek medical attention if you suspect you have a corneal foreign body.

  The main symptoms of a corneal foreign body include

  • eye redness
  • eye tearing
  •  eye pain
  • sensitivity to light.
  • feel like something is stuck in your eye
  • your vision may become blurry.
Pink eyeCorneal foreign body
rednessredness
itchingPain(something in your eye)
wateringblurred vision
dischargesensitivity to light
a gritty feelingExcessive watering
 History of foreign body lodged in the eye

 If you experience any of these symptoms, it is important to avoid rubbing your eye as this can cause the object to move around and cause further damage.

The treatment for a corneal foreign body usually involves removing the object from your eye after using a numbing eye drop to reduce pain and discomfort. They may also use a small, specialized tool to remove the object.

If the object is too difficult to remove or has caused significant damage to your cornea, you may require surgery.

After the object is removed, your doctor may prescribe antibiotic eye drops to prevent infection and promote healing.

If you normally wear contact lenses, you should not do so until the eye injury has completely

healed.

Scleritis

Scleritis is an inflammatory disease that affects the white outer layer of your eye, called the sclera. It is a rare condition that can be quite painful and can lead to serious complications if left untreated.

Kribz, CC BY-SA 3.0, via Wikimedia Commons

Scleritis is often caused by an underlying autoimmune disease, such as rheumatoid arthritis or lupus. Sometimes, it can also be caused by an infection or injury to the eye.

The main symptoms of scleritis include

  • severe eye pain which may radiate to the forehead and jaw.
  • Eye redness,  occasionally changing to a purple hue. Redness may not always be present.
  • blurred vision,
  • sensitivity to light,
  • and feeling of pressure in the eye.
Pink eyeScleritis
rednessRedness (changing to a purple hue)
itchingsevere eye pain
wateringblurred vision
dischargesensitivity to light
a gritty feelingHistory of autoimmune disease
  

If you experience any of these symptoms, it is important to seek medical attention right away. Your doctor will perform a thorough examination of your eye to determine if you have scleritis and what type of treatment is needed.

The initial treatment is usually with nonsteroidal anti-inflammatory drugs. Most patients respond well to this treatment. Some patients require stronger immunosuppression treatment, such as steroid tablets, or alternative immunosuppressive medications.

Endophthalmitis

Endophthalmitis is an inflammation of the internal eye tissues, most commonly caused by an infection

pus appear behind cornea Imrankabirhossain, CC BY-SA 4.0, via Wikimedia Commons

this is normally a post-operative infection that occurs within the first 2 weeks of surgery and can rapidly cause blindness

  • There is a history of recent surgery, trauma, intravenous drug use, or immune compromise.
  • markedly reduced vision,
  • significant pain/headache,

you could be admitted into a hospital for more intensive treatment such as intravenous antibiotics.

Other USUAL causes of red eye which is commonly misdiagnosed as pink eye:

Conjunctivitis

Conjunctivitis, also known as pink eye, is a common eye condition that can cause redness, itching, and discharge in one or both eyes. It is caused by inflammation of the conjunctiva, which is the thin, clear tissue that covers the white part of the eye and the inner surface of the eyelid.

Public domain, via Wikimedia Commons

There are several possible causes of conjunctivitis, including viruses, bacteria, allergies, and irritants such as smoke or chemicals.

Viral conjunctivitis is the most common type and is highly contagious, often spreading from one eye to the other or from person to person through contact with infected eye secretions.

Bacterial conjunctivitis is less common but can also be contagious and may require antibiotics to treat.

 The main symptoms of conjunctivitis include

  • eye redness,
  • eye itching
  • eye-watering
  • discharge from the eye. The discharge may be watery or thick and yellow or green in color, depending on the cause of the infection.
  • a gritty feeling in the eye.

Treatment for conjunctivitis depends on the cause of the infection.

Viral conjunctivitis usually clears up on its own within a week or two, but you can relieve symptoms with warm compresses and over-the-counter eye drops or ointments.

Bacterial conjunctivitis may require antibiotic eye drops or ointments prescribed by your doctor.

Allergic conjunctivitis can be treated with antihistamines or other allergy medications. It is important to follow your doctor’s instructions for treatment and avoid touching your eyes or sharing towels or other personal items with others to prevent the spread of infection.

Subconjunctival hemorrhage

A subconjunctival hemorrhage, also known as “red eye,” is a condition where a small blood vessel in the eye bursts and causes bleeding under the conjunctiva (the clear membrane that covers the white part of the eye).

Daniel Flather, CC BY-SA 3.0, via Wikimedia Commons

It can happen to anyone and is usually harmless, but it can be alarming to see the redness in the eye.

The most common cause of subconjunctival hemorrhage is injury or trauma to the eye, such as rubbing or scratching the eye, or even sneezing or coughing too hard.

It can also be caused by high blood pressure, blood thinners, or eye infections. In some cases, there may be no apparent cause.

The main symptom of subconjunctival hemorrhage is

  • a bright red patch on the white part of the eye, usually without any pain or vision changes.
  • It may start small and gradually spread over a few days,
  • but it usually clears up on its own within two weeks.
  • However, if you experience pain, vision changes, you have had a significant injury to your eye, you cannot see the edge of the red area, you have experienced other unusual/unexplained bleeding or bruising, or the redness doesn’t go away after two weeks, you should seek medical attention.
Pink eyeSubconjunctival hemorrhage
rednessRedness (a bright red patch)
itchinggradually spread
watering No blurred vision
dischargeNo pain
a gritty feeling 
  

There is no specific treatment for subconjunctival hemorrhage, as it usually resolves on its own without any complications.

However, you can relieve any discomfort by using artificial tears or cold compresses. It’s important to avoid rubbing or touching the affected eye, as this can worsen the bleeding.

If the hemorrhage is caused by an underlying medical condition, your doctor may recommend treatment for that condition, such as controlling high blood pressure or changing your medication.

Dry eye

A dry eye is a condition that occurs when your eyes do not have enough tears to keep them moist and comfortable.

This can happen for a variety of reasons, such as aging, hormonal changes, medication side effects, and certain medical conditions. A dry eye can also be caused by environmental factors, such as dry air, wind, and smoke.

If you are experiencing dry eye, you may notice symptoms such as

  • itching
  • burning
  • a gritty sensation in your eyes.
  • redness
  • sensitivity to light
  • blurred vision.
  • excessive tearing as your eyes try to compensate for the lack of moisture.
Pink eyeDry eye
rednessRedness
itchingburning
wateringitching
dischargewatering
a gritty feelingGritty feeling
 Especially after air, wind, and smoke

Fortunately, there are several treatments available to help alleviate the symptoms of dry eye. One common treatment is the use of artificial tears, which are eye drops that help to lubricate and moisturize your eyes.

Your doctor may also recommend prescription eye drops, which can help to reduce inflammation and increase tear production.

In addition to eye drops, several lifestyle changes can help to reduce the severity of dry eye symptoms. For example,

  • try to avoid environmental irritants such as smoke and wind.
  • use a humidifier to add moisture to the air in your home.
  • take frequent breaks when using a computer or reading, as this can help to reduce eye strain and dryness.
  • make sure your computer screen is just below eye level
  • if you wear contact lenses, take them out and wear glasses to rest your eyes.

If you are experiencing symptoms of dry eye, it is important to speak with your doctor or eye care professional. They can help to diagnose your condition and recommend the best treatment options for your specific needs.

With the right treatment and self-care, you can manage your dry eye symptoms and enjoy clear, comfortable vision.

Blepharitis

 Blepharitis is a common and usually harmless condition that causes inflammation of the eyelids. It can occur in people of all ages and is often caused by bacteria or an overgrowth of normal skin flora on the eyelids. Other possible causes include allergies, hormonal changes, and certain skin conditions like rosacea.

crusting or flaking skin around the eyelashes, Imrankabirhossain, CC BY-SA 4.0, via Wikimedia Commons

 The main symptoms of blepharitis include

  • redness and swelling of the eyelids.
  • itching or burning sensation.
  • a feeling of grittiness or irritation in the eye.
  • crusting or flaking skin around the eyelashes.
  • eyelids sticking together in the morning when you wake up.
  • eyelashes may become misdirected and grow inwards towards the eye.
  • In severe cases, blepharitis can lead to vision problems, such as blurry vision or sensitivity to light.

Treatment for blepharitis usually involves a combination of self-care measures and medication. To manage the symptoms, patients may be advised to use warm compresses or wash their eyelids with a gentle cleanser to remove any crusting or debris.

In some cases, antibiotics eye drops may be prescribed to help reduce inflammation and prevent infection. In addition, it may be helpful to avoid using eye makeup or contact lenses until the symptoms have resolved.

Trichiasis

Trichiasis is a condition where the eyelashes grow inwards towards the eye instead of outward. This can cause the lashes to rub against the surface of the eye, leading to irritation, redness, and discomfort.

In some cases, trichiasis may be caused by an underlying eye infection, injury, or inflammation. Other times, it may be a result of aging or certain medical conditions.

The main symptom of trichiasis is the

  • sensation of something in the eye, as the lashes irritate the surface of the eye.
  • redness, soreness, and watering of the eye.
  • Blurred vision.

If left untreated, trichiasis can lead to more serious complications such as corneal ulcers, scarring of the cornea, and even blindness.

Treatment for trichiasis typically involves removing the affected lashes or redirecting them away from the eye.

This can be done through a variety of methods, depending on the severity of the condition. In some cases, a simple epilation (pulled out) of the affected lashes may give temporary relief for several weeks.

or treated more permanently by electrical treatment to the roots of the lashes (electrolysis). This is performed under local anesthesia and takes a few minutes.

SOURCES
MedDigester Doctors depend on high-quality medical evidence as peer-reviewed studies, academic research institutions, and medical associations. We don’t use low-quality or tertiary references

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• Azari AA, et al. (2013). Conjunctivitis.
ncbi.nlm.nih.gov/labs/pmc/articles/PMC4049531

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