The phrase "pink eye" covers a few completely different conditions that look almost identical: bacterial conjunctivitis (needs antibiotic drops), viral conjunctivitis (no antibiotics, supportive care), and allergic conjunctivitis (antihistamines or other allergy treatment).
Why does the distinction matter? Antibiotic drops won't help a viral infection. Antihistamines won't fix bacterial pink eye. Both bacterial and viral conjunctivitis are highly contagious; allergies are not.
Bacterial conjunctivitis
Bacterial pink eye is what most people picture when they hear "pink eye":
- Thick yellow or green discharge. Often crusted shut in the morning.
- Usually starts in one eye and may spread to the other within a few days.
- Redness of the white of the eye.
- Mild discomfort — burning or gritty feeling, rarely severe pain.
- Eyelid sticking together after sleep.
Treatment is topical antibiotic drops or ointment. Most cases resolve in a few days with treatment. Children usually need to stay home from daycare/school until 24 hours after starting antibiotics.
Viral conjunctivitis
Viral pink eye is more common and looks slightly different:
- Watery discharge rather than thick pus.
- Both eyes often affected within a day or two of each other.
- Pink-red eye with a "blood-shot" appearance.
- Often follows a recent cold or other upper respiratory infection.
- Highly contagious for up to 2 weeks.
Treatment is supportive: cool compresses, artificial tears, avoiding eye contact and shared towels. Antibiotics don't help. Most cases resolve in 1-2 weeks.
Allergic conjunctivitis
Allergic pink eye is distinguished by:
- Itching is the dominant symptom — often intense.
- Both eyes always affected at the same time.
- Watery discharge, not pus.
- Other allergy symptoms — sneezing, itchy nose, sometimes itchy throat.
- Seasonal pattern or trigger-specific (cat dander, dust).
- Eyelid swelling can be prominent.
Treatment is antihistamines — either oral (cetirizine, loratadine) or topical eye drops (olopatadine, ketotifen).
How we tell at urgent care
Diagnosis usually comes from history and physical exam:
- Discharge type. Thick and yellow = bacterial. Watery + crusty = viral. Watery + itchy = allergic.
- One eye or both. Bacterial often starts in one. Viral and allergic typically affect both.
- Itching vs. burning. Itching is the hallmark of allergic.
- Recent exposures. Sick contacts, recent cold, allergy seasons, new contact lenses, makeup.
- Other symptoms. Cold symptoms suggest viral. Allergy symptoms suggest allergic.
When pink eye needs more than urgent care
Some presentations warrant ophthalmology or emergency referral:
- Severe eye pain beyond mild discomfort
- Vision changes — blurring that doesn't resolve with blinking
- Light sensitivity (photophobia)
- Trauma or foreign body sensation
- Contact lens wearers with eye pain — concern for keratitis
- Newborns or infants with eye discharge
- Pink eye not improving after 3-5 days of antibiotics
What to do at home
- Cool compresses relieve discomfort for all types.
- Artificial tears flush irritants and provide comfort.
- Don't share towels, washcloths, or pillows if contagious cause is suspected.
- Avoid contact lenses until the eye is clear.
- Wash hands frequently.
Walk in for same-day pink eye evaluation
Sage Urgent Care is open every day from 8 AM to 8 PM. Pink eye visits are usually under 30 minutes.
Authoritative sources: CDC: Conjunctivitis.