A Patient’s Guide to Conjunctivitis (Pink Eye)

Conjunctivitis, or pinkeye, irritates the clear layer that covers the front of the eye called the conjunctiva, causing inflammation or swelling in that mucus membrane. That can lead to the characteristic color change that gives this condition its informal name. "Conjunctivitis is called pinkeye because the white of the eye takes on this very pink, sometimes even red color," says Karen Hoffmann, immediate past president of the Association of Professionals in Infection Control and Epidemiology.

For most who get this typically acute, or short-term, infection, it doesn't last beyond a couple weeks. And sometimes it resolves in a matter of days. So many never see a health provider – or need to. Given that, the exact figures on how many develop conjunctivitis annually are lacking. But it's estimated that between 3 million and 6 million people, many children, develop conjunctivitis each year. According to the Centers for Disease Control and Prevention, kids in the U.S. miss 3 million school days as a result of pinkeye.

Depending on the cause, it can be highly contagious and easily transmitted in places like schools, and day care and health care facilities. The infection may also be spread among athletes, especially those who participate in contact sports, and where athletes come in close contact or share equipment like locker rooms.

Types

Conjunctivitis is often put into three or four categories.

Viral and bacterial conjunctivitis are both considered forms of infectious pinkeye and are therefore highly contagious.

Most frequently, viruses cause pinkeye. Viral conjunctivitis is commonly linked with the viruses that cause the common cold like adenovirus. "It can also develop through exposure to the coughing or sneezing of someone with an upper respiratory tract infection," says Barbara L. Horn, president of the American Optometric Association.

"Viral conjunctivitis can also occur as the virus spreads along the body's own mucous membranes, which connect the lungs, throat, nose, tear ducts and conjunctiva," Horn says. "Since the tears drain into the nasal passageway, forceful nose blowing can cause a virus to move from your respiratory system to your eyes."

Another cause of conjunctivitis is bacteria, such as staph (staphylococcal bacteria) or strep (streptococcal bacteria), says Dr. Sharon Lehman, division chief of pediatric ophthalmology at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

Then there's allergic conjunctivitis, which is caused by an allergic reaction to pollen or another substance that's a trigger. "That's most often a seasonal problem," Lehman says. "Or if you're allergic to cats or dogs, your eyes may get red," Lehman says.

Chemical conjunctivitis can be caused by air irritants such as smoke, fumes or chlorine in swimming pools – as well as by ingredients in cosmetics or other products that come in contact with the eyes like contact lens solutions.

Causes

Infectious conjunctivitis – viral and bacterial – are spread in the same way a common cold is spread. For example, Lehman says, a child with conjunctivitis touches a toy or they sneeze on a toy, and then the next child grabs a toy and touches their eye or their mucus membrane, transmitting the bacteria or the virus.

Particularly in the case of infectious conjunctivitis – but also in some other instances such as applying makeup – hand-to-eye contact frequently precipitates pinkeye. For example, a person can get pinkeye after coming in contact with someone who has conjunctivitis and, without first washing their hands, touching their eye.

Touching contaminated surfaces, sports equipment (like a basketball) or even towels that an infected person has touched are other ways conjunctivitis may be contracted, Hoffmann says.

Being exposed to irritants in the environment, like air pollution, can trigger the chemical form of pinkeye. Similarly, being exposed to allergens can cause some with allergies to develop conjunctivitis.

Symptoms

Pinkeye symptoms, which may affect one or both eyes, include:

Diagnosis

Frequently pinkeye resolves on its own without treatment. But especially if symptoms persist or if more serious symptoms occur, such as difficulty seeing, becoming especially sensitive to light or if you develop a fever with the infection, see a health provider.

In particular, eye doctors – ophthalmologists and optometrists – are able to distinguish between causes of pink eye, which can ensure proper treatment. A diagnosis can typically be made based on a patient's health history, symptoms and an eye exam.

Far less commonly, a health provider may take a culture of the liquid draining from the eye. If there's a lot of pus, or purulent drainage, like with pinkeye that causes the eye to crust over, that may be suggestive of conjunctivitis that's caused by bacteria. "Bacterial infections typically have more purulent drainage than viral infections," Hoffmann says.

Treatment

In the majority of cases, conjunctivitis will resolve on its own without treatment.

"If it's a viral conjunctivitis, there's really no treatment needed because it's just like the common cold," Lehman says. Viral pinkeye is highly infectious, and often both eyes are affected.

Horn notes that "for the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation." She adds, however, "these drops will not shorten the infection."

However, antibiotics, which treat bacteria, don't treat viruses.

"There is a strong pressure to put all kids who get conjunctivitis on topical antibiotics, and some schools and day care centers require children to not come back until they're treated" or the infection is fully resolved, Lehman says. "That puts a lot of pressure on the parents, and they put a lot of pressure on the doctors to provide topical antibiotics. But in most cases viral conjunctivitis will resolve itself."

For bacterial conjunctivitis, topical antibiotics may help shorten the course of the infection. Horn says, "Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments. Bacterial conjunctivitis may improve after three or four days of treatment, but patients need to take the entire course of antibiotics to prevent recurrence."

"For allergic conjunctivitis, the first step is to remove or avoid the irritant, if possible," Horn says. "Cool compresses and artificial tears sometimes relieve discomfort in mild cases." In more severe cases, nonsteroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen may be used to ease inflammation and relieve pain; and antihistamines may also be prescribed. "People with persistent allergic conjunctivitis may also require topical steroid eye drops," Horn notes.

No matter the type of pinkeye, you can provide some relief for symptoms like inflammation and dryness by using:

Health Care Providers That Treat Conjunctivitis

Complications

Persistent symptoms and any concerns with pain, vision or otherwise should be discussed with a health provider. And treatment, when delivered, should be specific to the type of pinkeye a person has.

"While conjunctivitis is usually a minor eye infection, sometimes it can develop into a more serious problem if left untreated," Horn says.

Rarely, pink eye can lead to inflammation of the cornea, impacting vision. If you or a child have any issues with vision or light sensitivity, make sure to see prompt medical attention. For instance, a rare bacterial conjunctivitis that's caused by gonorrhea may threaten a person's sight if not treated properly.

In addition, special care is warranted for infants – and in particular newborns under 1 month of age – who develop pinkeye. Bacterial conjunctivitis in infants can, in rare cases, lead to life-threatening issues such as meningitis or blood poisoning if the bacteria gets into the blood. For that reason, any form of pinkeye in babies should be promptly evaluated.

Prevention

As is true for avoiding any communicable disease, keeping your hands clean is the No. 1 way to protect yourself against developing pinkeye. "Hand hygiene is really the key to prevention," says Hoffmann, who is an infection preventionist, a nurse who specializes in preventing infections.

To avoid getting pink eye from someone else:

"Wash your hands often with soap and water," Horn says. "If you don't have soap and water, you can use hand sanitizer with alcohol in it." Also, wash your hands if you come into contact with something an infected person touched, and avoid touching your eyes as well, she says.

If you have pinkeye, make sure to clean your glasses regularly. "If you wear contact lenses, follow your eye doctor's instructions for cleaning, storing, and replacing them," Horn says.

Also, if you have conjunctivitis, keep washing your hands regularly and avoiding rubbing your eyes, which can spread pinkeye from one eye to the other. Clean any discharge off eyes several times daily with a fresh cotton ball (discarding it after use) or washcloth that you wash with hot water and detergent, and then wash your hands again, the CDC advises. And don't swim in any swimming pools.

To keep from getting pink eye again, Horn advises:

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