Pink Eye (Conjunctivitis)

What is pink eye?

Pink eye is inflammation of the conjunctiva, a clear membrane layer that covers parts of your eyes and the inside of your eyelids. This condition is extremely common, partly because it happens for so many different reasons. Many of those reasons are also common.

Pink eye can be acute (short-term), meaning it lasts under four weeks. Or it can be chronic (long-term), meaning it lasts more than four weeks. You can have it in one eye only or both at the same time.

How common is pink eye?

Between 15% and 40% of people experience allergic conjunctivitis because of seasonal allergies. Other types of conjunctivitis are more common in different age groups and/or at certain times of the year. It’s similar to how the common cold and flu are more common during winter months.

What does pink eye look like?

Just like the name sounds, pink eye can make the sclera of your eye look pink or reddish instead of white. It can also make your eyelids look puffy or droopy, and it’s common to have fluid (discharge) coming from your infected eye.

What are the symptoms of pink eye?

Pink eye has many common symptoms. And many of the symptoms happen with other eye diseases. The common symptoms include:

• Redness in the white of your eye (sclera) or on your eyelid’s inner surface.
• Eye discharge (usually thicker than normal tear fluid and can be yellowish, greenish or white; it can cause crusting on your eyelashes or eyelids).
• Foreign object sensation (feeling like something’s stuck in your eye, but there’s nothing there).
• Dry eyes or watery eyes (epiphora).
• Itchy or irritated eyes.
• Burning eyes.
• Blurred vision (may come and go).
• Light sensitivity (photophobia).
• Swollen eyelids (blepharitis).
• Eye pain or discomfort (usually mild).

What causes pink eye?

Conjunctivitis has dozens of potential causes, but there’s one simple way to organize them: infectious and noninfectious.

Infectious causes

“Infectious” means the disease that causes pink eye is contagious and can spread to the unaffected eye or other people. Pink eye’s most common infectious forms spread very easily.

Infectious causes come in four subtypes: viral, bacterial, fungal and parasitic. Viral and bacterial conjunctivitis are extremely common. Fungal and parasitic conjunctivitis are generally uncommon or even rare.

Viral conjunctivitis

Viruses are the most common cause of acute (short-term) conjunctivitis. The most common virus type that can cause it is the adenovirus family. Adenoviruses cause upper respiratory infections similar to colds or the flu.

Many other viruses can cause pink eye, too. Examples include:

• Common systemic viruses like measles or mumps.
• Viruses that cause forms of eye herpes.
• Molluscum contagiosum.
• Enteroviruses or coxsackieviruses, better known for causing hand, foot and mouth disease (uncommon).
• SARS-CoV-2 virus, the virus that causes COVID-19 (uncommon).

Bacterial conjunctivitis

Bacteria rank second among the most common causes of infectious conjunctivitis. The most common bacterial culprits are:

• Staphylococcus, the same family of bacteria that cause staph infections.
• Streptococcus, the bacteria family that causes strep throat and pneumococcal disease.
• Haemophilus influenzae, a bacteria family best known for causing meningitis in young children.
• Sexually transmitted infections (STIs), like chlamydia, gonorrhea and syphilis. When these conditions pass from mother to child during birth, it can lead to neonatal conjunctivitis, a condition that can cause permanent eye damage and blindness.

Noninfectious causes

These include causes that don’t spread to people from other people, animals, or contaminated objects or surfaces. Examples include:

• Allergens, including molds, pollen or other substances that cause allergies.
• Irritants or toxic substances, including shampoos, cosmetics, contact lenses or contact solution, dirt, smoke and pool chlorine. It can also include certain types of medications, especially medications that treat open-angle glaucoma.
• Eye Injuries that damage the conjunctiva.
• Immune disorders and conjunctival tumors or cancers.

What are the risk factors for conjunctivitis?

There are many possible risk factors for conjunctivitis, including:

• Hand hygiene. Conjunctivitis can easily spread from your hands to your face. If you aren’t washing or sanitizing your hands frequently, you might be more likely to develop this condition.
• Age. Viral conjunctivitis is common in adults and children, while bacterial conjunctivitis is far more likely in children under age 4. There’s also a higher risk for people in their 20s, but experts aren’t certain why.
• Time of year. Allergic conjunctivitis is much more common in spring and summer. Infectious forms of conjunctivitis are also more common during cold and flu season.
• Medical history. Having seasonal allergies or allergy-related conditions like eczema or atopic dermatitis can make you more likely to develop conjunctivitis.
• Sharing personal items. The contagious forms of conjunctivitis spread easily on certain objects, especially eye-related items like cosmetics and contact lens containers. The contagious forms can also spread easily on cloth, like washcloths, towels and pillowcases.

What are the complications of pink eye?

Pink eye usually isn’t a dangerous condition, and many cases — especially less serious cases — go away on their own as your immune system handles the infection. But some types of pink eye won’t go away and need treatment.

Though they aren’t common, conjunctivitis complications can sometimes cause permanent eye damage and even blindness if they go too long without treatment. Complications like this include:

• Trachoma.
• Uveitis.
• Corneal inflammation (keratitis) and cornea-conjunctiva inflammation (keratoconjunctivitis).
• More severe corneal diseases, especially corneal ulcers and recurrent corneal erosions.

Because of the risk of permanent damage, you shouldn’t ignore pink eye symptoms if they’re still getting worse after more than a few days.

How is pink eye diagnosed?

Eye care specialists usually aren’t the ones to diagnose conjunctivitis. Instead, 80% of diagnoses come from primary care providers and pediatricians. Urgent care and emergency room providers also diagnose many cases.

Providers may also recommend taking a swab to test for bacterial infections. To do that, they’ll use a soft-tipped swab to collect some of the fluid oozing from your eye for lab testing. Your provider can use the results to guide your treatment.

In the following days or weeks, your provider may recommend that you have a follow-up visit with an eye care specialist to check on how your eye is healing and adjust your treatment if necessary.

How is pink eye treated, and is there a cure?

Pink eye is treatable, regardless of the cause. Some treatments are more specific, while others help many types of pink eye or its most common symptoms.

Most pink eye treatments are medications. Many of these focus on treating the symptoms of pink eye, regardless of the type causing them. These medications usually include corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil® or Motrin®). The medications for the different types of conjunctivitis also include:

• Bacterial conjunctivitis: Antibiotics (eye drops, ointments or pills) treat bacterial conjunctivitis.
• Viral conjunctivitis: Pink eye from viruses doesn’t need treatment unless the virus causing it is herpes simplex, varicella-zoster (chickenpox/shingles) or an STI. These viral infections need antiviral drugs because viral pink eye can cause permanent damage and vision loss without treatment.
• Fungal/parasitic conjunctivitis: Antifungal and antiparasitic drugs are often the main treatment for these forms of pink eye.
• Immune-related conjunctivitis: These medications limit the damage your immune system can cause to your eye tissues.
• Allergic conjunctivitis: If allergies cause your pink eye, prescription or over-the-counter (OTC) antihistamines and decongestants are often the first treatments a provider will recommend.
• Irritant-related conjunctivitis: If an irritating substance is behind your conjunctivitis, the first step is to flush (rinse) your eyes with plenty of warm water for five minutes. If it’s a strong acid or alkaline substance (like drain cleaner), flush your eyes the same way and then get immediate emergency medical attention. Eye injuries from stronger toxic substances are medical emergencies.

It’s important to remember that antibiotics only treat bacterial infections. They don’t help viral or allergic pink eye. And if your provider prescribes antibiotics, take them exactly as prescribed until you finish them. Don’t stop taking them once you start feeling better, or the infection could get worse again.

Non-medication treatments

There are other treatments your provider or eye specialist may recommend other than medications. These vary widely, but some of the more common ones include:

• Over-the-counter lubricating eye drops. These are often known as “artificial tears.”
• Warm or cool compresses. You can also use a wet washcloth to clean away any crusting or buildup if your eyelids are sticking together.

Depending on your condition and situation, your provider or eye specialist may recommend other treatments, too. It’s a good idea to ask them about your options because they can provide the most relevant information for your case.

What can I expect if I have pink eye?

The outlook for pink eye is generally good, especially when treated as needed. Milder cases often go away on their own with no treatment.

If you notice treatments aren’t working to help your pink eye, call the provider treating you. They may be able to adjust your treatment to better help you.

How long does pink eye last?

Pink eye can have different expected timelines, depending on the type you have. Allergy-related pink eye lasts as long you’re around the allergen causing the reaction. Bacterial infections last up to 10 days (and fewer when treated). Viral infections typically last up to two weeks, but some may last longer in rare cases.

If you suspect you have pink eye and it keeps worsening after a few days, it’s a good idea to see a primary care provider or go to urgent care.

When can I (or my child) return to work, school, etc.?

You or your child can usually go back to daycare, school or work as soon as symptoms go away. This might be as soon as 24 hours after antibiotic treatment for a bacterial infection and between two and seven days after a viral infection.

Being symptom-free means you don’t have:

• Yellowish discharge.
• Crusting on your eyelashes or in the corners of your eyes.
• Pink color.

Be sure to check with your healthcare provider about when it’s safe to return. If an allergy or something else that’s not contagious caused your pink eye, you don’t need to stay home.

Is conjunctivitis preventable?

Some forms of conjunctivitis are preventable, and you can lower your risk of developing many others. Some of the most important things you can do to prevent pink eye or make developing it less likely include:

• Washing or sanitizing your hands frequently. Use soap and water if your hands look or feel dirty. If they don’t look or feel dirty, you can use an alcohol-based hand sanitizer (at least 60% alcohol).
• Using eye protection. Make sure you use the right kind of protection for the job. If you wear glasses, don’t assume they’re enough to protect your eyes.
• Never, ever sharing things that touch your eyes. Eye-related grooming and hygiene items can spread conjunctivitis very easily, and contagious forms spread before you ever have symptoms.
• If you’re putting in eye drops, making sure not to contaminate the bottle. Wash your hands before picking the bottle up. Be sure to only touch your face (or the face of whomever you’re giving the eye drops to) with the hand that isn’t holding the bottle. When putting drops in, be sure the bottle tip doesn’t touch the eye. After you put the drops in, set the bottle down, wash your hands and then close the bottle.

Should I go to the doctor for pink eye?

You don’t necessarily need to see a doctor for pink eye. Most of the time, you can treat the symptoms at home until they go away on their own. But you should never hesitate to call your healthcare provider if you have any concerns.

If you’re a contact lens wearer and have symptoms of pink eye, you should stop wearing your contacts immediately and see an eye care specialist.

Some symptoms can be a sign of a serious problem, such as an ulcer, which can result in permanent vision loss. Call your healthcare provider or seek medical care right away if you experience:

• An increase in sensitivity to light, especially if it’s severe.
• Blurred vision or decrease in vision.
• Eye pain.
• Feeling like there’s something stuck in your eye.
• Large amount of discharge from your eyes.
• Worsening symptoms.

Can pink eye come back?

Pink eye can come back, especially if you have allergy-related pink eye. Every time you’re in contact with an allergen (a substance that triggers allergies) you have a sensitivity to, your eyes may react.

If you have bacterial or viral pink eye, you can also accidentally reinfect yourself. To avoid that, you should:

• Wash your bed linens, pillowcases, towels and washcloths in hot water and detergent. Change them frequently.
• Avoid wearing eye makeup until the infection goes away. Throw out old eye makeup, makeup tools and any makeup used just before the start of the infection.
• Wear glasses instead of contact lenses. Clean your glasses often.
• Throw away contact lenses and the contact lens case. Use only sterile contact solution. Wash your hands before inserting or removing lenses.
• If you’ve used eye drops for an infected eye, don’t use the same eye drops in a noninfected eye.

What questions should I ask my doctor?

You may want to ask your provider:

• What’s causing my pink eye?
• How can I relieve my symptoms at home?
• How do I use my prescription medication?
• How can I keep pink eye from spreading?
• What new or worsening symptoms should I contact you about?
• Are there any requirements my child must meet before returning to school/daycare?