Red Eye and Pink Eye: When to See an Eye Doctor Instead of Urgent Care

A red eye sends most people to urgent care, where they are frequently handed antibiotic drops and sent home. Often that is harmless. Sometimes it is wrong, and occasionally it delays treatment for something serious.

Here is how to think about it.

“Pink eye” is not one thing

Conjunctivitis means inflammation of the conjunctiva, the clear membrane covering the white of the eye. It has at least three common causes, and they are treated completely differently.

Viral conjunctivitis

The most common kind, usually caused by adenovirus — the same family behind common colds. It typically starts in one eye and spreads to the other, produces watery discharge, a gritty sensation, and often accompanies a cold or sore throat. Lymph nodes in front of the ear may be tender.

Antibiotics do nothing for it. It resolves on its own over one to three weeks. It is also extremely contagious — the virus survives on surfaces for a long time. Wash hands relentlessly, do not share towels, and stay home from work or school during the acute phase.

Bacterial conjunctivitis

Less common in adults, more common in children. It produces thick, sticky discharge, often yellow or green, and lids that are glued shut in the morning. This is the kind that responds to antibiotic drops.

Allergic conjunctivitis

Both eyes at once, dominated by itching — that is the giveaway. Watery discharge, swollen lids, often with a runny nose and seasonal timing. Treated with antihistamine or mast-cell stabilizer drops, not antibiotics.

The shortcut: itching points to allergy, sticky discharge points to bacteria, watery discharge with a cold points to virus.

The red eyes that are not conjunctivitis

This is why an eye doctor matters. Several conditions look like pink eye and are not.

Corneal ulcer or infection — often in contact lens wearers. Red, painful, light-sensitive, with blurred vision. This is an emergency. Remove lenses and be seen the same day. Steroid drops given for an assumed allergy can make a corneal infection dramatically worse.

Iritis / uveitis — inflammation inside the eye. Deep aching pain, marked light sensitivity, redness concentrated around the cornea. Requires prompt treatment.

Acute angle-closure glaucoma — severe eye pain, headache, nausea, halos around lights, blurred vision. A true emergency. Go to an emergency room.

Corneal abrasion or foreign body — sharp pain, tearing, a sensation that something is in the eye. Sometimes there is.

Subconjunctival hemorrhage — an alarming bright red patch of blood on the white of the eye. Almost always harmless, caused by a cough, sneeze, or nothing at all. It resolves in one to two weeks. It looks worse than anything else on this list and is the least dangerous.

Dry eye — chronically red, gritty eyes with no discharge and no infection.

Red flags: be seen promptly

• Pain, as opposed to irritation
• Vision changes of any kind
• Light sensitivity
• You wear contact lenses
• Redness that persists beyond a week
• Redness following an injury or chemical exposure
• Severe headache, nausea, or halos around lights → emergency room

What an eye doctor can do that urgent care generally cannot

Examine your eye under a slit lamp — a microscope that reveals corneal ulcers, foreign bodies, inflammatory cells inside the eye, and lid margin disease. Measure eye pressure. Stain the cornea to reveal abrasions invisible to the naked eye.

That equipment is the difference between diagnosing conjunctivitis and assuming it.

Be seen at Eyepic Eye Care

• Park Slope Eye Care — 334 9th St, Brooklyn · (718) 504-8660
• Graham Eye Care — 102 Graham Ave, Brooklyn · (718) 690-2177
• Flatbush Eye Care — 1054 Flatbush Ave, Brooklyn · (718) 223-5707
• Harlem Eye Care — 2249 2nd Ave, New York · (212) 201-1201

Call your nearest location, or the central line at 1-877-239-3742. Book online.

Frequently asked questions

How long is pink eye contagious? Viral conjunctivitis is contagious while the eye is red and watering — often one to two weeks.

Can I wear contacts with pink eye? No. Remove them, and discard the lenses and case.

Do I need antibiotic drops? Only for bacterial conjunctivitis. Most cases in adults are viral.

Is redness with pain ever normal? No. Pain changes the differential entirely. Be seen.

This article is for general information and is not a substitute for a medical evaluation.