Pink Eye: A Complete Guide to Conjunctivitis

A comprehensive look at the contagious eye condition called pink eye or conjunctivitis, including symptoms, causes, treatment, and prevention.

pink-eye

What is Pink Eye?

Pink eye, or Conjunctivitis, is a common eye ailment that has affected many of us. It is caused by an infection or inflammation of the conjunctiva (the outermost layer of the eyeball). Pink eye can be caused by bacterial infections, viruses, or allergies. If pink eye develops, the sclera (white part of the eye) may become red or pink in color. There may be discharge, which can irritate the eyes further. Often the condition appears in one eye and then spreads to the other. There are several types of pink eye, and most are contagious. Depending on which type of pink eye you have, symptoms may last between seven and fourteen days.

How Did I Get Pink Eye?

Picture of someone with pink eye or Conjunctivitis

Pink eye can be contracted numerous ways. Viral and bacterial conjunctivitis are the most common ways for pink eye to spread from person to person. You can contract it simply by touching your eye after touching an infected surface or object such as a doorknob or shopping cart, or by using infected mascara or eye drops. Other times, pink eye develops as a symptom of a disease. For example, if you contract Chlamydia you may experience a pink or red eye as a symptom. If you are subject to seasonal allergies, you may experience pink eye during times of the year when pollen and other allergens fill the air. Other factors can also increase your risk of developing pink eye, including:

  • Sharing items with or touching someone who has pink eye
  • Exposure to certain allergens
  • Exposure to certain viruses or bacteria
  • Lack of proper personal hygiene, such as infrequent hand washing
  • Using certain types of contact lenses such as extended-wear lenses
  • Not properly cleaning contact lenses (learn more about common care mistakes)

Is Pink Eye Contagious?

Bacterial and viral pink eye is contagious, but allergic pink eye is not. It can be hard to tell which type you are suffering from, but allergic pink eye usually goes away quickly on its own, or when the irritating agent is removed and the eyes are rinsed out. The infectious types of pink eye are the ones to be wary of, because they can spread very easily. People can contract pink eye just by touching or using an infected article that has been used by a person who has the eye infection. For a simple illustration, imagine a person who has pink eye and has rubbed his eyes and used that hand to open a door, or used eye makeup or eye drops. That person could end up infecting someone else who touches the same door or uses the same object in their eyes.

This is why people—especially kids—who are diagnosed with pink eye are encouraged to stay home until the infection is cured in order to avoid passing the infection to other people. While many people believe the herpes simplex form that causes most eye problems is contagious, the virus actually lives in our environment and over 90 percent of adults have been exposed to it. This means that most of us will not develop an eye problem because of it, even though it is constantly around us.

Other means of passing the infection include sharing items like pillowcases, towels, and bathroom washcloths. Most types of pink eye are contagious. If you are exhibiting symptoms of this condition it is very important to contact your doctor so that he or she can properly diagnose which type it is.

Types of Pink Eye

Inflammation turns the white part of the eye pink or red. Let’s go over the various types of pink eye:

  • Viral conjunctivitis
  • Bacterial conjunctivitis
  • Allergic conjunctivitis
  • Eye drop conjunctivitis
  • Herpes simplex conjunctivitis
  • Giant papillary conjunctivitis
  • Neonatal conjunctivitis
  • Vernal conjunctivitis
  • Epidemic keratoconjunctivitis
  • Non-infectious conjunctivitis

Viral and bacterial conjunctivitis are the most common types of pink eye. It is similar to the common cold and usually improves on its own over the course of several weeks. For the first ten to twelve days, viral conjunctivitis is very contagious. On rare occasions, it may cause cloudy spots in the cornea. The symptoms of bacterial conjunctivitis are worse than those of viral conjunctivitis. There are several types of bacteria that cause conjunctivitis including gonorrhea, staphylococci, and streptococci. Viral and bacterial conjunctivitis are very contagious, and can be contracted in numerous ways.

Allergic conjunctivitis is typically non-contagious and is caused by common allergies such as animal dander, pollen, and dust. Some people experience allergic conjunctivitis several times per year, such as during certain seasons, while others may only develop the condition when exposed to an environmental allergen, such as when visiting a different city. Those who use medicated eye drops regularly may develop eye-drop conjunctivitis. Eye-drop conjunctivitis is caused by the preservatives in certain types of eye drops. Most people can tolerate a moderate to high level of exposure to them, but others are more sensitive. Depending on the sensitivity of the subject, symptoms may be mild or severe. Typically, avoiding the use of such eye drops prevents the condition from recurring.

Herpes simplex conjunctivitis is also caused by a virus, but it differs slightly from normal viral conjunctivitis. Although viral conjunctivitis can cause a burning sensation and pain, with herpes simplex conjunctivitis, the pain and burning may be unbearable. Herpes simplex conjunctivitis is also known to cause additional symptoms such as blisters on the conjunctiva or eyelids.

Giant papillary conjunctivitis is a non-contagious conjunctivitis usually seen in people who wear soft contact lenses. It is caused by an immunological response to contact lens deposits. This type of conjunctivitis may compel a contact-lens wearer to switch to a different type of contact lens. Soft contact lenses may need to be replaced with rigid gas-permeable (RGP) lenses or daily disposable contact lenses.

Neonatal conjunctivitis is found in newborns whose mothers are infected with a sexually transmitted disease like chlamydia or gonorrhea. While other types of conjunctivitis heal on their own, this type needs to be treated immediately following delivery to prevent blindness. To prevent the spread from mother to newborn, a doctor will apply an antibiotic medication such as erythromycin ointment to the infant’s eyes. Expectant mothers who have gonorrhea or chlamydia should be treated for the disease before the birth of their baby. Untreated chlamydia and/or gonorrhea can increase the risk of transmission from mother to baby by 10 to 20 percent. If left untreated in a newborn, neonatal conjunctivitis can lead to blindness.

Vernal conjunctivitis is usually found in people and families with a history of allergies, asthma, and eczema. This type of conjunctivitis is defined as long-term swelling of the outer lining of the eyes due to an allergic reaction.

Epidemic keratoconjunctivitis is extremely contagious, and there are often large outbreaks in schools. It is an infectious form of the condition that derives from particular strains of adenovirus and is spread through contact with infected persons, instruments, and other items. Symptoms of this type of conjunctivitis typically last from one to three weeks. This form of conjunctivitis causes blurred vision, which sometimes lasts a few months.

Non-infectious conjunctivitis is typically the result of irritated eyes. Typical irritants are dust, smoke, perfume, and strong chemicals. This type of conjunctivitis can also develop if an irritant is ingested. Allergic conjunctivitis and giant papillary conjunctivitis belong to this category.

Causes of Pink Eye

Pink eye results in redness, irritation, or inflammation of the conjunctiva. The conjunctiva is the clear, thin membrane that covers the white portion of the eyes (sclera) as well as the inner surface of the eyelids. The conjunctiva usually reacts to bacteria, viruses, allergies, irritants, or diseases in other parts of the body. Here is a look at what causes pink eye:

  • Viral conjunctivitis is caused by various ailments such as common colds, sore throats, and respiratory infections.
  • Bacterial conjunctivitis is usually caused by bacteria that have made their way into the eye. The most common bacteria are staphylococci and streptococci.
  • Allergic conjunctivitis is caused by allergic reactions to specific substances such as dust, pollen, airborne chemicals, perfumes, and detergents.
  • Eye-drop conjunctivitis is caused by overexposure to the preservatives found in certain types of eye drops.
  • Herpes simplex conjunctivitis is caused by the sexually transmitted disease herpes simplex virus types 1 and 2. In type 1, eye herpes may develop and lead to pink eye. In type 2, pink eye may develop in infant eyes after birth.
  • Giant papillary conjunctivitis is an allergic response to deposits formed on soft contact lenses or ocular prosthetics.
  • Neonatal conjunctivitis is seen in infants whose mothers have either gonorrhea or chlamydia.
  • Vernal conjunctivitis is caused by allergens. Sufferers are mostly males, and the condition occurs most often in the spring and summer seasons.
  • Epidemic keratoconjunctivitis is caused by coming into contact with people or objects that are infected with the adenovirus.
  • Non-infectious conjunctivitis is caused by numerous factors, ranging from allergies to the wearing of a specific type of contact lens that irritates the eyes.

Pink Eye Symptoms

Some of the symptoms of pink eye are unique to certain types of pink eye. The most noticeable sign is the pink to reddish color of the eyes, which is due to inflammation of the conjunctiva. Irritation and itchiness are two other common symptoms of conjunctivitis. Tearing is another prevalent symptom, as the eyes naturally produce more tears in order to relieve the discomfort. Some types of pink eye cause discharge; this may be frequent in both viral and bacterial conjunctivitis. This discharge may be yellow or green, and it can cause the eyelids to stick together or it can flow out of the eyes. Let’s go over the specific symptoms of each form of conjunctivitis:

Viral Conjunctivitis Symptoms

  • Watery eyes accompanied by discharge
  • Discomfort
  • Itchiness
  • The infection usually affects one eye, but it can affect both

Bacterial Conjunctivitis Symptoms

  • Watery eyes followed with yellow or green discharge
  • Irritation and redness
  • The infection usually starts with one eye and spreads to the other

Allergic Conjunctivitis Symptoms

  • Heavy tearing
  • Itchiness affecting both eyes is especially likely
  • Swollen or puffy eyes and eyelids

Eye Drop Conjunctivitis Symptoms

Herpes Simplex Conjunctivitis Symptoms

Giant Papillary Conjunctivitis Symptoms

  • Inability to wear or tolerate contact lenses
  • Large amount of discharge
  • Excessive tearing
  • Red bumps on underside of eyelids

Neonatal Conjunctivitis Symptoms

  • Redness of eyes
  • Swollen or puffy eyelids
  • Discharge
  • One or both eyes may be affected

Vernal Conjunctivitis Symptoms

  • Burning and watery eyes
  • Itchiness
  • Photophobia (discomfort in bright light)
  • Bumps may appear on underside of eyelids
  • Area around cornea may become swollen and rough

Epidemic Keratoconjunctivitis Symptoms

  • Redness and irritation of the eyes
  • Light sensitivity (photophobia)
  • Thin, watery discharge
  • Swollen lymph nodes on affected side
  • Blurred vision

Non-infectious Conjunctivitis Symptoms

  • Itchiness of eyes and eyelids
  • Redness of sclera
  • Pain or burning sensation
  • Can be found in one or both eyes simultaneously or the condition can disappear in one eye and develop in the other separately
  • Recurrence of conjunctivitis several times per year

Diagnosing Pink Eye

Diagnosing pink eye usually begins with a complete history and physical examination. Infectious forms of conjunctivitis are diagnosed by their symptoms and appearance. In general, a slit lamp examination is performed. The slit lamp magnifies the surface of the eye and allows the eye doctor to see an inflamed conjunctiva, infected cornea, or infected anterior chamber (the front part of the eye). Viral conjunctivitis is harder to diagnose and distinguish from bacterial conjunctivitis solely by its appearance. Typically the pink eye is accompanied by an upper respiratory infection. Samples may be taken and sent to a laboratory to identify the infectious organism. In most cases, samples are taken when gonorrhea or chlamydia is suspected, pink eye is severe, or the condition is recurrent.

Preparing for Your Pink Eye Diagnosis

If you are experiencing symptoms of pink eye, it is very important to contact your eye doctor and make an appointment for a correct diagnosis. Before the appointment, it is always a good idea to write down your symptoms, make a list of all medications you are currently taking (including vitamin supplements and similar products), and questions you may want to ask. While you are on the phone making the appointment, ask if there is anything you need to do to prepare for the appointment. For example, you may need to discontinue wearing your contact lenses.

Tips on How to Avoid Pink Eye

Avoiding pink eye does not have to be difficult. There are several things you can do to avoid pink eye and prevent the spread of it. Here are some basic ways to prevent pink eye from spreading:

  • Wash your hands frequently
  • Use antibacterial hand sanitizer frequently, especially if you are unable to wash your hands with soap and water
  • If allergic conjunctivitis is the problem, remove yourself from the area in which the allergens are present
  • Use cold compresses on your eyes periodically to lessen symptoms if due to allergies; use warm compresses several times per day for all other types
  • Avoid touching your eyes directly
  • Avoid touching other people
  • Avoid swimming in pools or Jacuzzis
  • Avoid shaking hands with others
  • Avoid sharing towels, washcloths, make-up, goggles, sunglasses, eye drops, pillows
  • Keep your eyewear clean at all times
  • Get a diagnosis as soon as symptoms develop
  • If you are pregnant and have a sexually transmitted disease, get immediate treatment and notify health-care providers of the problem
  • Change pillowcases and towels frequently
  • Follow doctors’ instructions thoroughly
  • Disinfect common household items frequently, especially if a member of the household has pink eye
  • Discontinue using current contact lenses, make-up, and eye drops, and do not replace or resume using product until condition is gone
  • Parents should teach children the importance of preventing spread of pink eye

Pink Eye Treatment and Medication

Typically, treatment for pink eye is based on the type of pink eye you have. Pink eye is typically resolved with or without treatment within a week or two, and without serious complications, although symptoms may last up to six weeks. Other times, such as with allergic conjunctivitis, pink eye may disappear after removing the allergen. Pink eye medication can be a mix of prescribed and over-the-counter medicines. For bacterial infections, a doctor must prescribe an antibiotic to attack the bacteria. This medication can be delivered in eye drops or ointments that are applied to the eyes. Pink eye caused by allergies can be solved with anti-histamine allergy eye drops like Patanol®. Patanol has been proven effective in preventing pink eye caused by allergies with just two drops a day. It is safe (according to the manufacturer) for kids over the age of three. Other antihistamines may be recommended by a physician for allergic conjunctivitis.

Another Pink eye medication is Similasan® Allergy Eye Relief™ eye drops. These OTC medications may not be as impressive, but they provide some relief. Similasan also makes pink-eye-relief eye drops for viral conjunctivitis. Other companies also manufacture similar eye drops to alleviate viral pink eye. These over-the-counter medications are all that is required for most cases of viral pink eye—the virus just needs to run its course, and pink eye medication is used just to soothe the symptoms. Antibiotics do not work against viruses. For relieving discharge, warm compresses are great for removing the sticky residue as well as the crusty, dried portions around the eyes. If herpes simplex conjunctivitis is present, a doctor may prescribe anti-viral medicines. Sexually transmitted diseases may be treated by a means of systemic antibiotics (given by mouth or as an injection into a muscle). Some types of conjunctivitis require mild steroids to be applied directly to the surface of the eye. In general, steroids are only used in severe cases.

For persistent problems it is best to consult with your eye care professional. Use the chart below to learn more about various supplements that may be useful in relieving symptoms and treating pink eye:

Supplement Directions for Use
Vitamin A Take 2,500 IU daily
Vitamin C Take 1,000 to 3,000 mg daily; divide doses
Zinc and copper Take 25 mg of zinc and 2 mg of copper daily
An mian pian (Brion) Take 4 pills, 3 times per day
Chamomile Apply as a hot compress or use as an eyewash
Eyebright and fennel Apply as a hot compress or use as an eyewash
Long dan xie gan wan (Brion) Take 6 pills, 2 times per day
Ming mu di huang wan (Brion) Take 10 pills, 3 times per day
Ming mu shang qing pian (Brion) Take 4 pills, 2 times per day
Nei zhang ming yan wan (Brion) Take 8 pills, 3 times per day
Shi hu ye guang wan (Brion) Take 1 pill, 2 times per day
Xiao yao wan (Brion) Take 8 pills, 3 times per day

** Always consult with your doctor before using any of the products listed above. Benefits will depend on the type of conjunctivitis you have.

Complications of Pink Eye

There are several complications that can arise from pink eye. Treatment often involves relieving symptoms while the virus works its way through your system naturally. During this period, with or without treatment, pink eye complications may include:

  • Continued discomfort
  • Blurred and/or reduced vision
  • Scarring of the cornea or additional problems with cornea
  • Spreading the condition to others
  • Recurrence
  • Eye infections

Talking to Your Eye Doctor

Here are some questions to ask your eye doctor about pink eye:

  • How did I get pink eye?
  • What can I do to prevent the spread of pink eye?
  • How long will I need to stay away from work, school, public places, etc?
  • Which over-the-counter or natural supplements would work best on me?
  • Which type of pink eye do I have?
  • What should I expect during my diagnostic appointment?
  • Is there anything I need to do before my appointment?
  • If treatment is not working, how long should I wait to contact you again?
  • Based on my lifestyle, what can I do to reduce the risk of developing pink eye?
References:
  • J. Weizer, MD and J.D. Stein, MD, MS “Reader’s Digest Guide to Eye Care” (Quantum Publishing Ltd, 2009) 52-54
  • M. Beers, MD “The Merck Manual of Medical Information” 2nd Home Edition (Pocket Books, 2003) 1296-1297
  • J. Anshel, MD “Smart Medicine for Your Eyes – A Guide to Natural, Effective, and Safe Relief of Common Eye Disorders” (SquareOne Publishers, 2011) 294-295
This article was last updated on 01/2014