Conjunctivitis (Pink Eye): Symptoms, Causes & Treatment
📊 Quick Facts About Conjunctivitis
💡 Key Takeaways About Conjunctivitis
- Most cases heal without antibiotics: Viral conjunctivitis (80% of cases) resolves on its own within 1-2 weeks - antibiotics don't help
- Highly contagious: Viral and bacterial conjunctivitis spread easily through direct contact, shared items, and contaminated hands
- Three main types: Viral (most common, watery discharge), bacterial (thick yellow-green discharge), and allergic (itchy, watery, not contagious)
- Proper eye cleaning is essential: Wipe from outer to inner corner with a clean, damp cloth to prevent spreading infection
- See a doctor for severe symptoms: Vision changes, severe pain, light sensitivity, or symptoms lasting more than 5 days require medical evaluation
- Contact lens wearers need extra caution: Stop wearing lenses immediately and seek medical advice to prevent serious complications
What Is Conjunctivitis (Pink Eye)?
Conjunctivitis is an inflammation of the conjunctiva, the thin transparent membrane covering the white of the eye and lining the inner eyelids. It causes red, irritated eyes with discharge and is commonly called "pink eye." Most cases are caused by viral or bacterial infections, or allergic reactions.
The conjunctiva is a delicate, transparent mucous membrane that serves two important functions: it protects the eye from foreign particles and keeps the eye moist by producing mucus and tears. When this membrane becomes inflamed, the tiny blood vessels within it become more visible, giving the eye its characteristic pink or red appearance.
Conjunctivitis is one of the most common eye conditions worldwide, affecting millions of people each year. In the United States alone, approximately 6 million cases occur annually, resulting in significant healthcare visits and lost productivity. The condition is particularly prevalent in children due to their close contact in schools and daycare settings, though it can affect people of all ages.
Understanding the type of conjunctivitis you have is crucial because it determines both the treatment approach and whether you can spread the condition to others. While the symptoms may appear similar across different types, the underlying causes and management strategies vary significantly.
The Three Main Types of Conjunctivitis
Medical professionals classify conjunctivitis into three primary categories based on the underlying cause. Each type has distinct characteristics that help guide diagnosis and treatment:
Viral conjunctivitis is the most common form, accounting for approximately 80% of all acute conjunctivitis cases. It is typically caused by adenoviruses, the same family of viruses responsible for the common cold. This explains why viral conjunctivitis often accompanies upper respiratory infections. The condition usually starts in one eye and spreads to the other within 24-48 hours. Viral conjunctivitis produces a watery, clear discharge and may cause swollen lymph nodes near the ear.
Bacterial conjunctivitis represents about 15-20% of cases and is caused by various bacteria, most commonly Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. This form produces a thicker, more purulent (pus-like) discharge that is often yellow or green in color. The discharge may cause eyelids to stick together, particularly after sleeping. Bacterial conjunctivitis responds to antibiotic treatment, which can shorten the duration of symptoms.
Allergic conjunctivitis occurs when the conjunctiva reacts to allergens such as pollen, dust mites, pet dander, or certain chemicals. Unlike infectious forms, allergic conjunctivitis is not contagious. It typically affects both eyes simultaneously and is characterized by intense itching, watery discharge, and often accompanies other allergic symptoms like sneezing and nasal congestion. Seasonal allergic conjunctivitis (hay fever) occurs during specific times of year, while perennial allergic conjunctivitis persists year-round.
Conjunctivitis can also result from other causes including chemical irritation (such as chlorine in swimming pools), foreign objects in the eye, or underlying medical conditions. In newborns, conjunctivitis may indicate a serious infection acquired during birth, such as chlamydia or gonorrhea, which requires immediate medical treatment.
What Are the Symptoms of Conjunctivitis?
The hallmark symptoms of conjunctivitis include red or pink coloration of the eye, discharge (watery or thick), itching or burning sensation, gritty feeling, swollen eyelids, and crusting of eyelids especially in the morning. The specific symptoms often help distinguish between viral, bacterial, and allergic forms.
Recognizing the symptoms of conjunctivitis is essential for proper self-care and knowing when to seek medical attention. While some symptoms are common to all types of conjunctivitis, others are more specific to particular forms and can help identify the underlying cause.
The most universally recognized symptom is the redness or pinkish hue of the eye, which gives the condition its common name "pink eye." This discoloration occurs because inflammation causes the tiny blood vessels in the conjunctiva to dilate and become more visible against the white sclera of the eye.
Eye discharge is another common symptom, though its character varies significantly between types. Understanding the nature of your eye discharge can provide valuable clues about the cause of your conjunctivitis and help guide appropriate treatment decisions.
Symptoms by Type of Conjunctivitis
| Type | Discharge | Key Symptoms | Contagious |
|---|---|---|---|
| Viral | Watery, clear | Often with cold symptoms, swollen lymph nodes, starts in one eye | Yes, highly |
| Bacterial | Thick, yellow-green pus | Eyelids stuck together in morning, can affect one or both eyes | Yes |
| Allergic | Watery, stringy mucus | Intense itching, affects both eyes, sneezing, runny nose | No |
Beyond discharge and redness, patients commonly experience a gritty or sandy sensation in the affected eye, as if something foreign is present. This feeling results from the inflamed conjunctiva and any accumulated discharge irritating the eye's surface. The sensation is often more pronounced when blinking.
Swelling of the eyelids is another frequent symptom, ranging from mild puffiness to more pronounced swelling that can partially obscure vision. The swelling typically develops gradually and may be more noticeable in the morning after lying flat during sleep.
Light sensitivity (photophobia) can occur with conjunctivitis, though severe photophobia may indicate a more serious condition affecting deeper structures of the eye. Mild discomfort in bright light is common, but intense light sensitivity should prompt medical evaluation.
Symptoms in Newborns and Infants
Newborns can develop a mild, sticky discharge from their eyes within the first few weeks of life due to narrow tear ducts - this is usually not conjunctivitis and resolves on its own. However, if a newborn develops truly red or swollen eyes, significant discharge, or these symptoms appear alongside blisters around the eyes, immediate medical attention is essential.
Neonatal conjunctivitis can indicate infection acquired during birth, including potentially serious conditions like chlamydial or gonococcal conjunctivitis that require urgent antibiotic treatment to prevent vision-threatening complications.
When Should You See a Doctor for Pink Eye?
Seek immediate medical care if you experience severe eye pain, vision changes, intense light sensitivity, symptoms that worsen after 5 days, thick discharge with severe inflammation, eye redness with facial blisters, or if a newborn has eye symptoms. Contact lens wearers should see a doctor promptly for any eye infection.
While most cases of conjunctivitis are mild and self-limiting, certain symptoms and circumstances warrant prompt medical evaluation. Understanding these warning signs can help you make informed decisions about seeking care and potentially prevent serious complications.
The general rule is that straightforward conjunctivitis typically improves within 5 days. If your symptoms are getting worse rather than better, or if they persist beyond this timeframe without improvement, it's time to consult a healthcare professional. This is particularly important if you've been attempting home treatment without success.
- Severe eye pain (not just irritation or discomfort)
- Changes in vision or blurred vision
- Intense sensitivity to light
- Symptoms that worsen after 5 days of home treatment
- Very heavy, purulent discharge with severe inflammation
- Redness in only one eye with significant pain and grittiness
- Eye redness accompanied by blisters or rash on the face
- Any eye symptoms in a newborn under 1 month old
Certain populations require more urgent evaluation. Contact lens wearers should seek prompt medical attention for any eye infection, as they face increased risk of serious complications including corneal ulcers. The warm, moist environment under contact lenses can harbor bacteria, and continuing to wear lenses during an infection can lead to severe, potentially vision-threatening problems.
People with weakened immune systems, whether from medical conditions or medications, should also seek earlier evaluation, as they may develop more severe infections or unusual complications.
What to Expect at the Doctor
When you visit a healthcare provider for suspected conjunctivitis, they will typically perform a thorough eye examination. This usually involves visual inspection of the eye and surrounding structures, assessment of visual acuity, and examination of the conjunctiva and other eye structures.
In most cases, doctors can diagnose conjunctivitis based on clinical examination alone. However, if symptoms are severe, atypical, or not responding to initial treatment, they may collect a sample of eye discharge for laboratory analysis to identify the specific organism causing the infection.
How Can You Treat Pink Eye at Home?
Home treatment for conjunctivitis involves regular eye cleaning with warm water and soft cloths, applying cool compresses for allergic conjunctivitis or warm compresses for infectious types, using artificial tears for comfort, and practicing strict hygiene to prevent spread. Most viral conjunctivitis resolves within 1-2 weeks with supportive care alone.
Many cases of conjunctivitis can be effectively managed at home with proper self-care measures. The foundation of home treatment is keeping the eyes clean and comfortable while preventing the spread of infection to others or to your unaffected eye.
Proper eye cleaning is perhaps the most important aspect of home care. When conjunctivitis produces discharge, regular cleaning helps remove the irritating material, improves comfort, and may help speed recovery. The technique matters - always wipe from the outer corner of the eye toward the inner corner (toward the nose) to avoid pushing discharge and bacteria deeper into the eye.
Step-by-Step Eye Cleaning Guide
- Wash your hands thoroughly: Use soap and water for at least 20 seconds before touching your eyes
- Prepare your materials: Use a clean, soft cloth, cotton ball, or tissue moistened with lukewarm water
- Clean gently: Wipe from the outer corner toward the inner corner (toward the nose)
- For crusted eyelids: Hold a warm, moist compress over closed eyes for 1-2 minutes to soften the crust
- Dispose properly: Throw away the used cloth or cotton ball immediately to prevent recontamination
- Wash hands again: Clean your hands thoroughly after touching your eyes
Compresses can provide significant relief. For allergic conjunctivitis, cool compresses help reduce itching and swelling. For viral or bacterial conjunctivitis, warm compresses can help loosen crusted discharge and soothe discomfort. Apply the compress for 5-10 minutes several times daily, using a fresh, clean cloth each time.
Artificial tears or lubricating eye drops can help wash away irritants and keep the eye comfortable. These are available over-the-counter and are generally safe to use frequently. Choose preservative-free formulations if you'll be using them more than four times daily, as preservatives can cause additional irritation with frequent use.
Comfort Measures and Recovery
During recovery, consider avoiding eye makeup and contact lenses until symptoms completely resolve. If you were wearing contact lenses when symptoms began, discard that pair and start fresh with new lenses once your eyes have fully healed. Also discard any eye makeup that may have been contaminated.
While recovering, avoid touching or rubbing your eyes as much as possible. This can worsen irritation and, in the case of infectious conjunctivitis, spread the infection to your other eye or to others. If you must touch your eyes (such as when applying eye drops), wash your hands before and after.
How Can You Prevent Spreading Conjunctivitis?
Prevent spreading conjunctivitis by washing hands frequently, using your own towels and washcloths, changing pillowcases daily, avoiding sharing eye makeup or contact lens supplies, and staying home from school or work when symptoms are active. Viral conjunctivitis remains contagious for up to 2 weeks.
Infectious conjunctivitis spreads remarkably easily through direct and indirect contact. Understanding how transmission occurs is key to implementing effective prevention strategies, both for protecting yourself from infection and preventing spread to others if you're already infected.
The primary transmission route is hand-to-eye contact. Touching an infected eye transfers viral or bacterial particles to the hands, which can then contaminate surfaces, objects, or other people through touch. The pathogens can survive on surfaces for hours to days, making indirect transmission through shared objects a significant concern.
Hand Hygiene - Your Best Defense
Frequent, thorough handwashing is the single most effective measure for preventing conjunctivitis spread. This is especially important during cold and flu season when viral conjunctivitis is more common, and in environments where many people are in close contact.
Wash your hands with soap and water for at least 20 seconds, particularly after touching your face or eyes, after blowing your nose, before and after caring for someone with conjunctivitis, and before handling contact lenses. When soap and water aren't available, alcohol-based hand sanitizer (at least 60% alcohol) provides a reasonable alternative.
Preventing Spread at Home
When someone in your household has infectious conjunctivitis, implementing careful hygiene measures can help protect other family members:
- Assign the infected person their own towels, washcloths, and pillowcases
- Change pillowcases daily during active infection
- Wash linens and towels in hot water separately from other household items
- Clean frequently touched surfaces (doorknobs, light switches, phones) regularly
- Avoid sharing personal items like eye drops, makeup, or glasses
Eye makeup deserves special attention. Never share mascara, eyeliner, eye shadow, or makeup brushes. If you develop conjunctivitis, discard any eye makeup you used in the days before symptoms appeared, as it may be contaminated. After recovery, start fresh with new products.
Guidelines for School and Childcare
Children with significant eye discharge should stay home from school or childcare until the heavy discharge clears. This typically takes 2-3 days for most cases. If treated with antibiotic drops for bacterial conjunctivitis, children can usually return after 24-48 hours of treatment.
Children with mild redness and minimal discharge, who feel otherwise well and can avoid touching their eyes, may be able to attend school. Children with allergic conjunctivitis don't need to stay home since this form is not contagious.
Older children and adults generally pose less transmission risk than young children because they're less likely to rub their eyes and share close physical contact. However, they should still practice good hygiene and may need to stay home from work if symptoms are severe or if their job involves close contact with others or food handling.
How Is Conjunctivitis Treated Medically?
Most conjunctivitis doesn't require prescription treatment. Viral conjunctivitis is self-limiting and treated with supportive care. Bacterial conjunctivitis may receive antibiotic eye drops or ointment, which can shorten symptom duration. Allergic conjunctivitis responds to antihistamine eye drops and allergen avoidance. Severe cases may require additional medications.
The treatment approach for conjunctivitis depends primarily on identifying the underlying cause. This is why healthcare providers assess your symptoms, history, and examination findings before recommending treatment - what works for one type may be ineffective or even unnecessary for another.
Treatment for Viral Conjunctivitis
Since viral conjunctivitis is caused by viruses rather than bacteria, antibiotics are completely ineffective and should not be prescribed. The condition typically resolves on its own within 1-2 weeks as the body's immune system clears the infection.
Treatment focuses on supportive care: artificial tears for comfort, cool compresses to reduce swelling and itching, and proper eye hygiene. In some cases, particularly with adenoviral conjunctivitis, your doctor may recommend a mild anti-inflammatory eye drop to help manage symptoms, though this doesn't speed viral clearance.
One exception is herpetic conjunctivitis, caused by herpes simplex virus. This form requires specific antiviral treatment to prevent serious complications including corneal involvement. If your doctor suspects herpes-related eye disease, they will prescribe appropriate antiviral medications.
Treatment for Bacterial Conjunctivitis
Bacterial conjunctivitis often improves without antibiotic treatment, but antibiotics can shorten the duration of symptoms and reduce the period of contagiousness. Your doctor may prescribe antibiotic eye drops or ointment to be used several times daily for about one week.
Common antibiotic options include fluoroquinolone drops (such as moxifloxacin or ciprofloxacin), aminoglycoside drops (such as tobramycin), or combination antibiotic-corticosteroid preparations for more severe inflammation. Ointments are sometimes preferred for children or for nighttime use, as they provide longer contact time with the eye surface.
It's crucial to complete the full course of antibiotic treatment as prescribed, even if symptoms improve quickly. Stopping early can allow resistant bacteria to survive and potentially cause recurrent infection.
Treatment for Allergic Conjunctivitis
Managing allergic conjunctivitis involves two main strategies: reducing exposure to the triggering allergen and controlling symptoms with appropriate medications.
Antihistamine eye drops provide rapid relief of itching and redness. These are available both over-the-counter and by prescription, with newer formulations combining antihistamine and mast cell stabilizing properties for more comprehensive control. For severe or persistent allergic conjunctivitis, your doctor may prescribe short-term topical corticosteroid drops to reduce inflammation.
Oral antihistamines can help, particularly when eye symptoms occur alongside other allergic symptoms like nasal congestion and sneezing. Cool compresses and artificial tears provide additional comfort. For people with chronic allergic conjunctivitis, identifying and minimizing allergen exposure is essential for long-term management.
What Are the Potential Complications?
While most conjunctivitis resolves without complications, untreated or severe cases can occasionally lead to corneal involvement (keratitis), chronic conjunctivitis, or spread of infection to surrounding structures. Newborns with untreated bacterial conjunctivitis face risk of serious eye damage. Contact lens-related infections carry higher complication risks.
The vast majority of conjunctivitis cases resolve completely without any lasting effects on vision or eye health. However, understanding potential complications helps you recognize when to seek prompt medical care and underscores the importance of appropriate treatment when indicated.
Corneal involvement represents the most concerning potential complication. The cornea is the clear dome-shaped surface covering the front of the eye, and infection or inflammation affecting this structure (keratitis) can potentially impact vision. Signs of corneal involvement include severe pain, significant light sensitivity, decreased vision, and a visible white spot on the cornea.
Adenoviral conjunctivitis, the most common cause of viral pink eye, can occasionally cause subepithelial infiltrates - small inflammatory deposits beneath the corneal surface that may temporarily affect vision. These usually resolve over weeks to months but occasionally require treatment with anti-inflammatory drops.
Newborns face particular risks from untreated bacterial conjunctivitis. Gonococcal conjunctivitis can rapidly progress to corneal ulceration and perforation if not treated promptly, potentially resulting in permanent vision loss. This is why newborn eye symptoms always warrant immediate medical evaluation.
Frequently Asked Questions
Most cases of conjunctivitis resolve within 5 to 7 days without specific treatment. Viral conjunctivitis typically lasts 1-2 weeks and is self-limiting - it will resolve on its own as your immune system clears the virus. Bacterial conjunctivitis may last 7-10 days without treatment but can resolve faster with antibiotic eye drops, typically within 2-4 days of starting treatment. Allergic conjunctivitis persists as long as you're exposed to the triggering allergen and may be seasonal or year-round depending on the cause.
Viral and bacterial conjunctivitis are highly contagious and spread easily through direct contact with infected eye secretions, contaminated hands, or shared items like towels, pillows, and makeup. Viral conjunctivitis can remain contagious for up to 2 weeks from when symptoms begin. The infection spreads when you touch an infected eye and then touch objects or other people before washing your hands. Importantly, allergic conjunctivitis is NOT contagious because it's caused by an allergic reaction rather than an infection.
Seek medical care immediately if you experience: severe eye pain (not just irritation), vision changes or blurred vision, intense light sensitivity, symptoms that worsen after 5 days, thick yellow or green discharge with severe inflammation, eye redness with blisters around the eye, or any eye symptoms in a newborn under 1 month old. Contact lens wearers should see a doctor promptly for any eye infection to prevent serious complications. If symptoms don't improve with home care within a week, schedule an appointment with your healthcare provider.
Mild conjunctivitis can often be managed effectively at home. Clean your eyelids gently with a soft cloth moistened with warm water, wiping from the outer corner toward the nose. Apply cool compresses for allergic conjunctivitis or warm compresses for infectious types. Use preservative-free artificial tears to soothe irritation. Stop wearing contact lenses until symptoms completely resolve. Most viral conjunctivitis heals on its own within 1-2 weeks with supportive care. However, if symptoms are severe or don't improve within 5-7 days, seek medical evaluation.
Viral conjunctivitis typically produces watery, clear discharge, often starts in one eye and spreads to the other within a day or two, and frequently accompanies cold symptoms. It accounts for about 80% of acute conjunctivitis cases. Bacterial conjunctivitis produces thick, yellow-green discharge that may cause eyelids to stick together, especially in the morning. The key difference in treatment is that viral conjunctivitis doesn't respond to antibiotics and must run its course (1-2 weeks), while bacterial conjunctivitis can be treated with antibiotic eye drops to shorten duration and reduce contagiousness.
Children with significant eye discharge should stay home until the heavy discharge clears, typically 2-3 days. This is because the discharge indicates active, highly contagious infection, and children in daycare or school often share close contact. If treated with antibiotic drops for bacterial conjunctivitis, children can usually return after 24-48 hours of treatment. Children with mild redness and minimal discharge who feel well and can avoid touching their eyes may attend. Children with allergic conjunctivitis don't need to stay home since it's not contagious.
References and Sources
This article is based on current clinical guidelines and peer-reviewed medical literature. All medical claims are supported by Level 1A evidence where available.
- American Academy of Ophthalmology. Conjunctivitis Preferred Practice Pattern. AAO PPP Guidelines 2024
- Centers for Disease Control and Prevention. Conjunctivitis (Pink Eye). CDC Conjunctivitis Guidelines
- Sheikh A, Hurwitz B, van Schayck CP, McLean S, Nurmatov U. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD001211. DOI: 10.1002/14651858.CD001211.pub3
- World Health Organization. WHO Model List of Essential Medicines - Ophthalmic Preparations. 23rd List, 2023.
- Azari AA, Barney NP. Conjunctivitis: A Systematic Review of Diagnosis and Treatment. JAMA. 2013;310(16):1721-1729. DOI: 10.1001/jama.2013.280318
- Rietveld RP, ter Riet G, Bindels PJ, Sloos JH, van Weert HC. Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms. BMJ. 2004;329(7459):206-210.
Medical Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, which includes board-certified specialists in ophthalmology, infectious disease, and family medicine. Our editorial process follows international medical standards for accuracy, objectivity, and evidence-based content.
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