Pink Eye in Children: Conjunctivitis Symptoms & Treatment

What Is Pink Eye (Conjunctivitis)?

Pink eye, medically known as conjunctivitis, is an inflammation of the conjunctiva—the thin, clear membrane that covers the white part of the eye and lines the inside of the eyelids. It causes the eye to appear pink or red due to swollen blood vessels and is one of the most common eye conditions affecting children worldwide.

The conjunctiva normally acts as a protective barrier for the eye, producing mucus and tears that help keep the eye moist and defend against infections. When this membrane becomes inflamed, either from infection, allergies, or irritation, the characteristic symptoms of pink eye develop. The condition affects millions of children each year, particularly those in daycare settings where close contact facilitates transmission.

Understanding what causes pink eye is essential for proper treatment and prevention. The inflammation occurs when viruses, bacteria, allergens, or irritants trigger an immune response in the conjunctiva. This response causes blood vessels to dilate and become more visible, producing the distinctive pink or red appearance that gives the condition its common name. The conjunctiva also produces additional discharge as it attempts to flush out the irritant or infection.

While pink eye can affect children of any age, it is particularly common in infants and toddlers who frequently touch their eyes and share toys with other children. The condition typically affects one eye first but often spreads to the other eye within a day or two. Despite its alarming appearance, pink eye is usually a mild condition that resolves without complications, though it requires careful hygiene to prevent spreading to family members and classmates.

Viral Conjunctivitis

Viral conjunctivitis is the most common type of pink eye in children and is often associated with upper respiratory infections like the common cold. The same viruses that cause runny noses, sore throats, and coughs can infect the conjunctiva when children rub their eyes with contaminated hands. Adenoviruses are the most frequent culprits, though other viruses including those causing measles, chickenpox, and herpes can also cause conjunctivitis.

Viral pink eye typically produces a watery, clear discharge rather than the thick yellow-green discharge seen in bacterial infections. The eyes may feel gritty or sandy, and children often experience sensitivity to light. Because viruses cannot be treated with antibiotics, viral conjunctivitis must run its course, typically resolving within 7-14 days. However, proper eye hygiene and comfort measures can help manage symptoms during recovery.

Bacterial Conjunctivitis

Bacterial conjunctivitis occurs when bacteria colonize the conjunctiva, often introduced through direct contact with contaminated hands or objects. Common bacterial causes include Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. Bacterial pink eye produces more significant discharge that is typically thick, yellow, or greenish in color and may cause eyelids to stick together, especially after sleep.

While bacterial conjunctivitis can sometimes resolve on its own, antibiotic eye drops or ointments may be prescribed to speed recovery and reduce the contagious period. With antibiotic treatment, symptoms typically improve within 24-48 hours, and children can usually return to daycare or school after 24 hours of treatment. Even without antibiotics, bacterial conjunctivitis generally clears within 7-10 days with good hygiene practices.

Allergic Conjunctivitis

Allergic conjunctivitis develops when the immune system overreacts to allergens such as pollen, dust mites, pet dander, or mold. Unlike infectious forms of pink eye, allergic conjunctivitis is not contagious and typically affects both eyes simultaneously. The hallmark symptom is intense itching, accompanied by watery discharge, red eyes, and often associated symptoms like sneezing and nasal congestion.

Children with allergic conjunctivitis often have a history of other allergic conditions such as eczema, asthma, or hay fever. Symptoms tend to be seasonal if caused by outdoor allergens or year-round if triggered by indoor allergens. Treatment focuses on avoiding the allergen when possible and using antihistamine eye drops or oral medications to control symptoms.

What Are the Symptoms of Pink Eye in Children?

The main symptoms of pink eye include red or pink coloration of the white part of the eye, discharge that may be watery or thick and yellow-green, eyes that stick together after sleeping, and a gritty or sandy sensation. Children may also experience eye swelling, light sensitivity, and increased tearing.

Recognizing the symptoms of pink eye helps parents determine when home care is sufficient and when medical attention may be needed. Symptoms typically develop gradually, often starting in one eye before spreading to the other. The severity of symptoms varies depending on the cause of the conjunctivitis and can range from mild discomfort to more significant irritation that affects daily activities.

One of the earliest signs parents notice is a change in the appearance of their child's eye. The white part of the eye (sclera) takes on a pink or red hue as blood vessels become inflamed and more visible. This redness may be mild or quite pronounced, sometimes extending to the inner eyelids. The eye may also appear swollen, with puffiness around the eyelids that can be more noticeable in the morning.

Eye discharge is another hallmark symptom that varies based on the underlying cause. Viral conjunctivitis typically produces a watery, clear discharge that may cause the eyes to tear excessively. Bacterial infections generate thicker, more purulent discharge that ranges from yellow to greenish in color. This discharge accumulates while children sleep, often causing eyelids to stick together upon waking—a symptom that can be distressing for both children and parents.

Common Symptoms to Watch For

• Red or pink eyes: Visible redness in the white part of one or both eyes due to inflamed blood vessels
• Eye discharge: Watery (viral) or thick yellow-green (bacterial) discharge from the affected eye
• Sticky eyelids: Eyelids stuck together with crusted discharge, especially noticeable in the morning
• Gritty sensation: Feeling like sand or a foreign object is in the eye
• Itching: Particularly prominent in allergic conjunctivitis but can occur in all types
• Tearing: Increased tear production as the eye tries to flush out the irritant
• Swollen eyelids: Puffiness of the upper or lower eyelids
• Light sensitivity: Discomfort when exposed to bright lights

Symptoms in Newborns

Newborn babies deserve special attention when it comes to eye symptoms. Infants under one month old can develop a condition called neonatal conjunctivitis, which may be acquired during birth from bacteria in the birth canal. While some sticky discharge in newborn eyes is normal due to narrow tear ducts, certain symptoms require immediate medical attention.

Parents should seek same-day medical care if their newborn develops red or swollen eyes, significant discharge (especially if yellow or green), or if the eyes appear to be bulging or painful. These symptoms could indicate a more serious infection that requires prompt treatment to prevent complications affecting vision.

When Should You See a Doctor for Pink Eye?

See a doctor if your child is under 1 month old with any eye symptoms, has eye pain or sensitivity to light, experiences vision changes, shows no improvement after 5 days, develops severe swelling around the eye, or has thick greenish discharge. Newborns with eye symptoms need immediate same-day evaluation.

While most cases of pink eye can be safely managed at home with proper eye cleaning, certain situations require professional medical evaluation. Knowing when to seek care helps ensure your child receives appropriate treatment while avoiding unnecessary medical visits for mild cases that will resolve on their own.

The age of your child is an important factor in determining when to seek care. Newborns and infants under one month old should be evaluated by a healthcare provider if they develop any eye redness, discharge, or swelling. In this age group, eye infections can potentially be more serious and may require specific antibiotic treatment. Older children with mild symptoms can typically be monitored at home initially, with medical care sought if symptoms worsen or persist.

The nature of symptoms also guides decision-making. Pink eye that remains mild with minimal discharge and no pain can usually be managed with home care and good hygiene. However, symptoms that suggest a more serious condition—such as significant eye pain, light sensitivity, vision changes, or severe swelling—warrant prompt medical attention. These symptoms could indicate involvement of deeper eye structures that require specific treatment.

Signs That Suggest Medical Evaluation

Beyond emergency situations, several scenarios indicate that your child should be seen by a healthcare provider. If symptoms persist beyond 5 days without improvement despite proper eye cleaning, bacterial infection may be present and antibiotic treatment could be beneficial. Similarly, if symptoms seem to be worsening rather than improving over time, medical evaluation is appropriate.

Children who develop pink eye along with high fever, significant illness, or symptoms affecting other parts of the body may need evaluation for more widespread infection. Additionally, recurrent episodes of conjunctivitis or symptoms that occur primarily in one eye may warrant investigation into underlying causes such as blocked tear ducts or other anatomical issues.

How Do You Treat Pink Eye at Home?

Home treatment for pink eye centers on regular eye cleaning to remove discharge and prevent spreading. Clean eyes several times daily using a cotton ball moistened with lukewarm water, wiping from the outer corner toward the nose. Use a fresh cotton ball for each wipe and wash hands thoroughly before and after. If eyelids are stuck, apply a warm compress for 1-2 minutes before cleaning.

Effective home care can help your child recover from pink eye more comfortably while reducing the risk of spreading the infection to others. The cornerstone of home treatment is keeping the eyes clean, which helps remove infectious discharge, reduces irritation, and promotes healing. Most cases of pink eye improve significantly within 3-5 days of consistent eye cleaning.

Before touching your child's face or eyes, always wash your hands thoroughly with soap and water for at least 20 seconds. This essential step protects both you and your child from spreading the infection. After cleaning your child's eyes, wash your hands again immediately to prevent transferring bacteria or viruses to other surfaces or family members.

The cleaning technique matters for both effectiveness and safety. Use a soft cotton ball or clean cloth moistened with lukewarm (not hot) water. Gently wipe from the outer corner of the eye toward the inner corner, following the natural direction of tear drainage. This technique helps move discharge away from the eye rather than pushing it back into the tear duct. Use a fresh cotton ball for each wipe, and never use the same cotton ball on both eyes if only one is affected.

Step-by-Step Eye Cleaning Guide

1. Wash your hands thoroughly with soap and water before starting
2. Moisten a cotton ball with lukewarm water—squeeze out excess water
3. If eyelids are stuck together, hold a warm, damp compress against the closed eye for 1-2 minutes to soften the crust
4. Gently wipe from the outer corner of the eye toward the inner corner (toward the nose)
5. Discard the cotton ball immediately after one wipe
6. Repeat with fresh cotton balls until the eye is clean
7. Use separate materials for each eye if both are affected
8. Wash your hands again after cleaning
9. Clean eyes 3-4 times daily or as needed when discharge accumulates

Additional Comfort Measures

Beyond eye cleaning, several measures can help your child feel more comfortable during recovery. Cool or warm compresses applied to closed eyelids for 5-10 minutes can soothe irritation—choose whichever temperature feels better to your child. Ensure the compress is clean and used only once before washing.

If your child wears contact lenses, they should switch to glasses until the pink eye has completely resolved and for at least 24 hours after finishing any prescribed treatment. Contact lenses can harbor bacteria and should not be worn during an active eye infection. Discard disposable lenses that were worn when symptoms began, and clean reusable lenses thoroughly according to manufacturer instructions.

Encourage your child not to rub their eyes, as this can worsen irritation and spread infection. Keeping children's fingernails trimmed short can help minimize damage from unconscious rubbing, especially during sleep. For older children, explain that while the eyes feel uncomfortable, rubbing will make them feel worse.

What Medical Treatments Are Available?

Medical treatment for pink eye depends on the cause. Bacterial conjunctivitis may be treated with antibiotic eye drops or ointment, which typically show improvement within 24-48 hours. Viral conjunctivitis has no specific treatment and must resolve on its own. Allergic conjunctivitis is treated with antihistamine eye drops and allergen avoidance.

Understanding the available medical treatments helps parents make informed decisions about their child's care. While many cases of pink eye resolve without prescription medications, certain situations benefit from specific treatments that can speed recovery, reduce symptoms, or prevent complications.

The decision to prescribe antibiotics for pink eye involves weighing several factors. Since most conjunctivitis in children is viral, antibiotics would not be effective and contribute to antibiotic resistance. However, when bacterial infection is suspected based on the nature of discharge, severity of symptoms, or lack of improvement with eye cleaning alone, antibiotic treatment may be recommended.

Antibiotic Eye Drops and Ointments

When a healthcare provider determines that antibiotic treatment is appropriate, they will prescribe eye drops or ointment containing antibiotics effective against common bacterial causes. Common prescriptions include erythromycin ointment, polymyxin-trimethoprim drops, or fluoroquinolone drops depending on the child's age and specific situation.

Eye drops are typically prescribed to be used 3-4 times daily, while ointments are often used at bedtime due to temporary blurring of vision. It is essential to complete the full course of antibiotics as prescribed, even if symptoms improve quickly. Stopping antibiotics early can allow surviving bacteria to regrow and potentially develop resistance.

When administering eye drops to children, have them lie down or tilt their head back, looking up at the ceiling. Gently pull down the lower eyelid to create a small pocket and place the prescribed number of drops into this pocket—avoid touching the dropper to the eye. Have your child close their eyes gently (not squeezing) for 1-2 minutes to help the medication absorb.

Treatment for Allergic Conjunctivitis

Allergic conjunctivitis is managed differently than infectious types. The primary approach involves identifying and avoiding the allergen when possible. For seasonal allergies, keeping windows closed during high pollen times and showering after outdoor activities can help reduce symptoms.

Over-the-counter or prescription antihistamine eye drops can provide significant relief from itching and redness. Oral antihistamines may also be recommended, especially if your child has other allergy symptoms like nasal congestion or sneezing. Cool compresses can provide additional comfort for itchy, irritated eyes.

How Can You Prevent Pink Eye from Spreading?

Prevent pink eye spread through rigorous hand washing, avoiding touching eyes, using separate towels and washcloths for the affected child, changing pillowcases daily, and keeping children home from daycare during the most contagious period with heavy discharge. Teach children to cover coughs and sneezes since pink eye often accompanies colds.

Pink eye, particularly viral and bacterial forms, is highly contagious and spreads easily among family members, classmates, and playmates. The infection transmits through direct contact with discharge from an infected eye, contaminated hands, or objects that have touched an infected eye. Understanding how pink eye spreads enables effective prevention strategies.

Hand hygiene represents the single most important measure for preventing pink eye transmission. Children and adults in the household should wash hands frequently with soap and water, especially after touching the face, before eating, and after contact with the affected child. When soap and water are not available, alcohol-based hand sanitizers provide an alternative, though soap and water are preferred.

Creating physical barriers to transmission within the home helps protect other family members. The affected child should have their own towel, washcloth, and pillowcase that are not shared with others and are washed frequently in hot water. Avoid sharing items that touch the face, such as makeup, eye drops, or contact lens solutions.

Practical Prevention Strategies

• Frequent hand washing: Wash hands before and after touching the face, especially the eye area
• Avoid touching eyes: Teach children to avoid rubbing or touching their eyes
• Separate towels and linens: Use individual towels and change pillowcases daily
• Clean surfaces: Regularly clean frequently touched surfaces like doorknobs and toys
• No sharing: Don't share eye makeup, drops, or items that touch the face
• Cover coughs and sneezes: Since viral pink eye often accompanies colds, respiratory hygiene helps
• Dispose of tissues: Throw away tissues used to wipe eyes immediately

Can Children Attend Daycare or School?

The decision about when a child with pink eye can return to daycare or school depends on the severity of symptoms and local policies. Children with significant discharge that requires frequent cleaning should stay home, both for their own comfort and to reduce transmission risk. The highly infectious period corresponds with the presence of active discharge from the eyes.

Many daycare centers and schools have specific policies about pink eye attendance. Some require children to be on antibiotic treatment for 24 hours before returning, while others allow attendance as long as symptoms are mild and good hygiene can be maintained. Contact your child's school or daycare for their specific requirements.

Children with mild symptoms—slight redness and minimal discharge that clears during the day—can often attend if they can avoid touching their eyes and practice good hand hygiene. Children with allergic conjunctivitis, which is not contagious, do not need to stay home unless symptoms are severe enough to affect their comfort and participation.

Are There Complications from Pink Eye?

Complications from pink eye are rare in children. Most cases resolve completely without affecting vision. Potential complications include spread of infection to other eye structures (rare), chronic conjunctivitis if untreated, and temporary blurred vision from discharge. Newborns with certain bacterial infections require prompt treatment to prevent serious complications.

Parents often worry about potential complications from pink eye, but serious problems are uncommon when the condition is properly managed. Understanding what complications can occur helps parents recognize warning signs while providing reassurance that most cases resolve without lasting effects.

The vast majority of children with pink eye experience a self-limited illness that resolves completely within one to two weeks. Vision is not affected in typical cases of conjunctivitis, though the discharge may cause temporary blurring until the eyes are cleaned. Once the infection clears, the eyes return to normal without any lasting changes.

In rare cases, infection can spread from the conjunctiva to involve other eye structures. Keratitis, an infection of the cornea, can develop particularly with certain viruses like herpes simplex or in cases of severe bacterial infection. This condition causes significant eye pain, light sensitivity, and potentially visible changes to the cornea. Prompt treatment is essential to prevent vision damage.

Special Considerations for Newborns

Newborn conjunctivitis deserves particular attention because certain bacterial causes can lead to serious complications if not treated promptly. Infections with Neisseria gonorrhoeae or Chlamydia trachomatis acquired during birth require specific antibiotic treatment and close monitoring. This is why eye symptoms in newborns should always prompt immediate medical evaluation.

In most developed countries, newborns receive preventive eye treatment (typically erythromycin ointment) shortly after birth to prevent gonococcal conjunctivitis, which historically was a significant cause of blindness. Despite this prevention, any concerning eye symptoms in newborns warrant medical attention.