Stye vs. Pink Eye: Differences

Both a stye (hordeolum) and pinkeye (conjunctivitis) may cause symptoms such as: 

• Eye irritation
• Burning, sandy, gritty, or scratchy feeling in the eye
• Eye discharge
  • May be watery or thick
  • May be yellow (stye is usually yellowish), white, or green, and usually continues to drain throughout the day

Additional symptoms of a stye include: 

• Red and painful lump on the edge of the eyelid
• Eye tearing
• Eyelid pain and swelling    
• Feeling as if something is in the eye
• Crustiness along the edge of the eyelid 
• Sensitivity to light

Additional symptoms of pink eye include: 

• The affected eye often is crusty and stuck shut in the morning
• Eye redness
• Cold symptoms (viral conjunctivitis)
  • Swollen lymph nodes (glands)
  • Fever
  • Sore throat
  • Runny nose
• Itchy eyes (allergic conjunctivitis)

Styes (hordeolums) are usually caused by bacterial infections, such as Staphylococcus aureus, bacteria commonly found in the nose that does not usually cause problems. But in some cases, if the bacteria are present in your nose and you rub your nose and then your eye, this can transfer the infection to the eye and result in a stye. 

Risk factors for developing a stye include: 

• Rubbing the eyes
• Underlying skin conditions affecting the eyelids, such as seborrheic dermatitis and acne rosacea
• Leaving eye makeup on overnight
• Eye makeup usage, especially eyeliner or mascara contaminated by bacteria
• Having a stye or chalazion in the past
• Inflammation of the eyelid (blepharitis) 
• Itchy eyes, such as from allergies
• Diabetes or other medical problems

Causes of pink eye (conjunctivitis) include: 

• Viral infections 
  • Most often caused by a virus that can cause the common cold
  • Most cases of infectious conjunctivitis are caused by viruses
• Bacterial infections
  • More common in children than in adults
  • Frequently affects multiple people in a classroom or household
• Allergies
  • Caused by airborne allergens that come in contact with the eye
• Toxic 
  • Chronic inflammation of the surface of the eye from an offending agent, usually a preservative or a medication
• Nonspecific conditions
  • Foreign body irritation (e.g., dust, eyelash) 
  • Dry eye
  • Irrigation after a chemical splash

Viral and bacterial conjunctivitis can be very contagious and easily spread from person to person by:

• Close personal contact, such as touching or shaking hands
• Coughing and sneezing
• Touching an object or surface with germs on it, then touching your eyes before washing hands

A stye (hordeolum) is diagnosed with a patient’s medical history and a physical examination of the lesion. No special tests are needed. 

Pink eye (conjunctivitis) is diagnosed with a physical examination of the eye and a diagnosis is often made based on the presence of symptoms such as eye redness and discharge, and the patient’s vision being normal with no evidence of other eye conditions.

Swabbing the eye for a culture, stains, and direct antibody or polymerase chain reaction (PCR) testing is generally only used in uncommon or chronic cases that do not get better on their own or respond to treatment.

A rapid (10-minute) test for conjunctivitis caused by adenoviruses may be available but it often is not covered by insurance so it is not widely used. 

A stye (hordeolum) may be treated with home care in some cases, to relieve symptoms and reduce healing time. Home remedies to treat a stye include: 

• Warm, wet compress
  • Soak a clean washcloth in hot water and hold it to the eyelid for 10 to 15 minutes
  • Repeat 3 to 5 times daily
• Gently massage around the area with a clean finger to help the gland clear itself 
• Do not:
  • Wear eye makeup or contact lenses until the stye is healed
  • Squeeze or pop a stye, which can make it worse and spread the infection into the eyelid

If a stye doesn’t improve within 48 hours or symptoms worsen, medical treatment may include: 

• Antibiotics
• A procedure to drain the stye

Treatment for pink eye (conjunctivitis) depends on the cause. 

Viral conjunctivitis treatment: 

• Topical antihistamine/decongestant eye drop to relieve eye irritation 
  • Available without a prescription in most pharmacies
  • Take care to avoid spreading the viral infection from one eye to the other
• Warm or cool compresses may be used as needed

Bacterial conjunctivitis treatment: 

• Antibiotic eye drops or ointment
• Treatment can help shorten the duration of symptoms when started early
• Most cases go away on their own even if no treatment is used
• Contact lens wearers should not wear lenses the first 24 hours of treatment, or until the eye is no longer red
• Contact cases should be discarded and contacts disinfected overnight or replaced (if disposable)

Allergic conjunctivitis treatment:

• Eye drops that contain naphazoline-pheniramine, ketotifen, olopatadine, and others

Toxic conjunctivitis treatment:

• Removal of the offending agent
• Stop use of any topical eye medications 
  • Don’t stop taking any prescribed eye medications without first talking to your doctor, especially glaucoma drops, because an increase in eye pressure may cause irreversible vision loss

Nonspecific conjunctivitis treatment:

• Usually goes away within a few days without treatment
• Lubricant drops or ointments may help the eye feel better as it heals
• Antibiotic or steroid eye drops/ointments are not recommended unless there is an accompanying bacterial infection or inflammation