Pink Eye (Conjunctivitis)
Types of Pink Eye and How to Tell Them Apart
Viral conjunctivitis is the most common type of pink eye, according to the AAO. It is caused by adenovirus or common cold viruses. You may notice burning, redness, and a watery discharge that starts in one eye and spreads to the other within a few days.
No antiviral treatment exists for most viral conjunctivitis. According to the NEI, the infection resolves on its own in 1 to 2 weeks. Cold compresses and preservative-free artificial tears can ease discomfort while your body fights off the virus.
Bacterial pink eye produces a thick, yellow-green discharge that causes your eyelids to stick together, in the morning. According to the NEI, the most common bacteria in adults are Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. Bacterial conjunctivitis can start in one eye and spread to the other.
Your eye doctor prescribes antibiotic eye drops or ointment to treat bacterial conjunctivitis. Symptoms improve within 24 to 48 hours of starting antibiotics. The AAO notes that most pink eye cases are viral, and over-prescription of antibiotics for viral cases is a documented problem in clinical practice.
Allergic conjunctivitis causes intense itching in both eyes along with watery discharge and eyelid swelling. According to the NEI, it is triggered by allergens such as pollen, pet dander, and dust mites. Unlike viral and bacterial forms, allergic pink eye is not contagious and cannot spread to other people.
Your eye doctor treats allergic conjunctivitis with antihistamine and mast-cell stabilizer eye drops, available both over the counter and by prescription. Identifying and avoiding your specific allergen triggers helps prevent future episodes. If allergic conjunctivitis recurs every season, starting drops before symptoms appear provides better control.
Symptoms and When to See a Doctor
All types of pink eye share some overlapping symptoms: redness in the white of the eye, tearing, a feeling of grittiness or irritation, and mild light sensitivity. The type of discharge helps distinguish between causes. Watery discharge points to viral or allergic, while thick yellow-green discharge points to bacterial.
Pink eye may cause your eyelids to swell and your conjunctiva (the clear tissue over the white of your eye) to look puffy or swollen. You may also notice crusting on your eyelashes after sleep. These symptoms can affect one or both eyes depending on the type.
See your eye doctor the same day if you have significant eye pain (not just irritation), sensitivity to light, blurred vision that does not clear with blinking, or a large amount of thick discharge. These symptoms can indicate a more serious infection or a different eye condition that mimics pink eye.
Newborns with red or discharge-producing eyes need urgent medical evaluation, as neonatal conjunctivitis from bacteria picked up during birth can damage the cornea without prompt treatment. Contact lens wearers with pink eye symptoms should remove their lenses and see their eye doctor, since contact lens-related infections can progress fast.
Your eye doctor examines your eyes with a slit lamp and evaluates the type of discharge, the pattern of redness, and which structures are affected. In most cases, the clinical appearance is enough to determine whether your pink eye is viral, bacterial, or allergic.
If your symptoms are severe, do not improve with treatment, or keep coming back, your doctor may take a swab of the discharge for culture to identify the specific organism. This helps your doctor choose the most targeted antibiotic. For suspected allergic cases, your doctor may refer you to an allergist for trigger testing.
Treatment and Prevention
Viral conjunctivitis does not respond to antibiotics because antibiotics only work against bacteria. Your immune system clears the virus on its own over 1 to 2 weeks. During that time, cold compresses, artificial tears, and good hygiene help manage symptoms and prevent spreading.
Your eyes may look and feel worse during the first 3 to 5 days before symptoms start to improve. If your symptoms have not started improving after 2 weeks, or if they get worse at any point, return to your eye doctor for reassessment. A secondary bacterial infection can develop on top of a viral case.
Your eye doctor prescribes antibiotic drops or ointment based on the suspected bacteria. Apply the medication as directed, even if your symptoms improve before you finish the course. Stopping early can allow resistant bacteria to survive and cause a recurrence.
You can return to work or school once you have been on antibiotics for 24 to 48 hours and your discharge has improved, according to the NEI. Children should stay home from school or daycare until they meet these criteria to protect their classmates from infection.
Viral and bacterial conjunctivitis are contagious through direct contact, according to the NEI. Wash your hands often, after touching your eyes or applying drops. Do not share towels, pillowcases, eye drops, or makeup with anyone while you have symptoms.
Replace any eye makeup you used before or during the infection, since bacteria and viruses can survive on applicators and in liquid products. Wash pillowcases and towels in hot water daily while you have symptoms. Clean your eyeglasses with soap and water to remove discharge and reduce reinfection risk.
According to the NEI, you should not wear contact lenses while you have pink eye. Discard any lenses you wore during the infection, even if they are monthly or biweekly lenses that still have wear time left. The lenses may harbor the organism that caused your infection.
Also discard your contact lens case and any opened solution bottles. Start fresh with a new case and new solution once your eye doctor confirms the infection has resolved and clears you to resume lens wear. Wearing contaminated lenses or using contaminated solution can restart the infection.
Pink Eye Questions and Answers
Viral pink eye is contagious for as long as your eyes are red and producing discharge, which can last up to 2 weeks. Bacterial pink eye becomes much less contagious within 24 to 48 hours of starting antibiotic drops. Allergic pink eye is not contagious at all.
For viral pink eye, you may spread the infection as long as symptoms last. For bacterial pink eye, most workplaces and schools allow return after 24 to 48 hours on antibiotics. Check your employer's or school's specific policy. Practice strict hand hygiene if you must be around others while symptomatic.
Most cases of pink eye resolve without any lasting effects on your vision. Certain severe bacterial infections (such as gonococcal conjunctivitis) can damage the cornea if not treated promptly. Seek same-day care if you have severe pain, large amounts of discharge, or vision changes.
Only bacterial pink eye benefits from antibiotics. Since most pink eye is viral, antibiotics are unnecessary in the majority of cases. Your eye doctor examines your eyes and determines the type before recommending treatment. Taking antibiotics for viral pink eye does not speed recovery and contributes to antibiotic resistance.
Preservative-free artificial tears can soothe irritation from any type of pink eye. Redness-reducing drops may make your eyes look better temporarily but can mask symptoms your doctor needs to see. Do not use allergy drops for infectious pink eye unless your doctor confirms the cause is allergic.
Recurrent pink eye may indicate allergic conjunctivitis that flares with seasonal allergens, a chronic eyelid condition like blepharitis, or reinfection from contaminated makeup or contact lens supplies. Talk with your eye doctor if you get pink eye more than once a year so they can identify and address the underlying cause.
Get the Right Treatment for Pink Eye
Pink eye is common and resolves within 1 to 2 weeks. See your eye doctor if you have severe symptoms, vision changes, or symptoms that do not improve, so you receive the right treatment for your specific type of conjunctivitis.