Patient guide
Red eye: pink eye, allergy, a stye, or something that cannot wait
Call the same day for a red eye with any of these: pain rather than irritation, sensitivity to light, blurred or reduced vision, a white or grey spot on the clear front of the eye, a recent injury or chemical splash, or redness in a baby under a month old. If you wear contact lenses and an eye is red and sore, take the lens out now and call: an infection under a lens can damage the cornea within a day. Call (609) 246-0236. If the office is closed, or you cannot reach us, go to a hospital emergency room — most have an ophthalmologist on call. Eye pain with headache, nausea and halos around lights is an emergency at any hour.
A red eye is one of the most common reasons people call this office, and most of the time it is something that clears on its own or with a week of drops. The job is to pick out the few that are not. That can usually be done from the story and a look under the microscope, which is why a red eye gets a same-day slot here rather than a wait-and-see.
This guide covers the common causes, how to tell them apart, what helps at home, and the signs that mean a red eye should not wait.
What makes an eye red
The white of the eye is covered by a thin, clear membrane, the conjunctiva, full of tiny blood vessels. Anything that irritates or inflames it makes those vessels widen and the eye looks pink or red. The conjunctiva is the part most often involved, and inflammation of it is conjunctivitis, the medical name for pink eye.
Redness can also come from deeper layers: the cornea, the clear window at the front; the iris behind it; or the sclera, the white wall of the eye. Those are less common and more serious, and they tend to announce themselves differently, with pain, light sensitivity, or blurred vision rather than grittiness and discharge.
The common causes, and how they differ
- Viral pink eye. The most common kind in adults. Watery discharge, a gritty feeling, often starting in one eye and spreading to the other within days, sometimes with a cold or sore throat. It is contagious, it runs its course over one to two weeks, and antibiotic drops do not help it. Cool compresses and artificial tears ease it.
- Bacterial pink eye. More common in children. Thick yellow or green discharge, lids stuck shut in the morning. Antibiotic drops shorten it modestly; many cases clear on their own within a week or two.
- Allergy. Itching is the giveaway. Both eyes, watery, puffy lids, often with sneezing or a runny nose, and worse in spring and fall. It is not contagious. Rubbing makes it worse. See what helps for allergic eyes.
- A burst blood vessel. A bright red patch on the white of the eye, sharply outlined, with no pain and no change in vision. It looks alarming and is harmless. It fades over one to three weeks like a bruise. Mention it if it keeps happening or you take a blood thinner.
- A stye. A tender red lump on the edge of the lid, like a pimple at the base of a lash. Warm compresses several times a day; do not squeeze it. A painless lump deeper in the lid is a chalazion, a blocked oil gland, which takes longer to settle.
- Dry eye and lid inflammation. Chronic, mild redness in both eyes with burning and tired eyes, worse by evening. Not an infection. The dry eye guide covers it.
The red eyes that should not wait
These are less common, and each needs treatment that cannot be bought over the counter.
- An infection of the cornea, almost always in a contact lens wearer. Pain, light sensitivity, a watery red eye, sometimes a visible white spot. It can scar the cornea within days. Take the lens out and call the same day.
- Inflammation inside the eye (iritis). Aching pain, light sensitivity, redness worst in a ring around the cornea, often one eye. It needs prescription steroid drops and is sometimes linked to a condition elsewhere in the body.
- A scratched cornea or something in the eye. A sharp, foreign-body feeling after gardening, grinding, or a fingernail. Usually treatable the same day; a metal fragment left in place rusts.
- Angle-closure glaucoma. A sudden rise in eye pressure: severe pain, a hard red eye, blurred vision, halos around lights, headache, nausea. It damages the optic nerve within hours. This is an emergency room visit if you cannot reach an eye doctor at once.
- Scleritis. A deep, boring ache that can wake you at night, with a dusky red eye. Rare, and often tied to an autoimmune condition.
The pattern worth remembering: grittiness, itching and discharge usually mean the surface; pain, light sensitivity and blur mean something deeper. One eye alone, in a contact lens wearer, is the combination that gets the fastest call.
What to do at home
- Cool compresses for viral pink eye and allergy; warm compresses for a stye. A clean washcloth, a few minutes, several times a day.
- Preservative-free artificial tears to rinse and soothe. Any brand.
- Keep it to yourself. Pink eye spreads by hands and shared towels. Wash your hands often, use your own towel and pillowcase, and do not share eye makeup. Replace mascara and eyeliner used while the eye was infected.
- Contact lenses stay out until the eye has been clear for a day or two, and start again with a fresh pair and a new case. If the eye is painful, do not wait for that: take the lens out and call.
- Leave the redness-relief drops on the shelf. Drops sold to get the red out shrink the blood vessels for a few hours. They treat the look, not the cause, and the redness often rebounds when they wear off.
- Never use leftover prescription drops, yours or anyone else's. A steroid drop in an eye with a corneal infection makes it considerably worse.
What the visit involves
The history does most of the work: one eye or both, how it started, pain or itch, contact lenses, recent colds or injuries. Then the eye is examined under magnification, the inside of the lids is checked for anything trapped there, and a yellow dye is used to show any scratch or ulcer on the cornea. Eye pressure is measured if there is any question of glaucoma, and vision is recorded.
That takes a few minutes and separates the harmless from the serious far more reliably than a photograph or a phone description can. Most people leave with a plan and, where needed, a prescription; the few who need an ophthalmologist are sent the same day with the findings ahead of them.
Common questions
Do I need antibiotic drops for pink eye?
Usually not. Most pink eye in adults is viral, and antibiotics do nothing for a virus. Bacterial pink eye, with thick discharge, does improve a little faster with drops, and they are prescribed when the examination points that way. Prescribing them for every red eye breeds resistance and irritates eyes that did not need them.
When can my child go back to school or day care?
Schools and day cares set their own rules, so ask them. Many allow a child back once the discharge has settled, or 24 hours after antibiotic drops begin when they have been prescribed. Pediatric guidance does not require keeping a child home for mild pink eye without fever, but hand washing and a separate towel matter until it has cleared.
How long is pink eye contagious?
Viral pink eye can spread for as long as the eye is watering and red, often ten to fourteen days. Bacterial pink eye is considered much less contagious a day after drops begin. Allergic red eye is not contagious at all.
My eye is red but does not hurt. Can I wait?
A painless red eye with normal vision in a person who does not wear contact lenses can usually wait a day or two to see which way it goes, and a burst blood vessel needs no visit at all unless it recurs. Pain, light sensitivity, a change in vision, or a contact lens in the picture moves it to the same day.
Does a red eye visit go through my vision plan or my medical insurance?
A visit for a red eye is a medical visit and goes through your medical insurance, even though you are seeing an optometrist. Vision plans cover routine eye exams and eyewear; medical plans cover conditions. Many patients carry both and are not sure which applies. Vision plan or medical insurance explains the difference, and a call with your plan details before you book sorts it out beforehand rather than afterwards.
Call the office
Same-day slots are held for exactly this. Call rather than book online so the appointment can be scheduled today. If the office is closed, or you cannot reach us, go to a hospital emergency room — most have an ophthalmologist on call.
Khoury Eye Care, Hamilton Mall, 4403 Black Horse Pike, Mays Landing.
Sources
The figures and recommendations on this page come from the following. Ask at your visit if you would like a copy of any of them.
- American Academy of Ophthalmology. Conjunctivitis Preferred Practice Pattern. 2018.
- Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013;310(16):1721-1729.
- Sheikh A, Hurwitz B, van Schayck CP, et al. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews. 2012;(9):CD001211.
- Centers for Disease Control and Prevention. Conjunctivitis (pink eye): prevention and treatment. cdc.gov.
- American Academy of Pediatrics. Managing Infectious Diseases in Child Care and Schools (conjunctivitis guidance). Current edition.