Conjunctivitis (“pink eye”) is a common infection in children. It often occurs with a cold. It can be caused by cold viruses or by bacterial infections. Bacterial pink eye is usually treated with antibiotic drops; there is no treatment for viral pink eye. Pink eye can also be caused by allergies or irritants in the eyes. Pink eye in newborns is a separate, more serious illness.
Symptoms
- Redness in the whites of the eyes.
- Eyes may be watery and may itch or have mild pain.
- There is often a runny nose and other cold symptoms such as fever, cough, congestion or sore throat.
- Sometimes there is green-yellow discharge from the eye (indicating a bacterial infection is more likely).
- The eyelids may be mildly irritated or swollen.
- The eyelids may be stuck together in the mornings or after naps.
- Sometimes an earache or symptoms of an ear infection (there is a particular germ that causes pink eye and ear infection).
- Eye irritation usually starts suddenly and gets better after the eyes are washed out.
- Allergic pink eye has similar symptoms but with mild, watery, clear discharge and the eyes are not as red.
What causes conjunctivitis?
Upper respiratory viruses sometimes also infect the eyes causing redness and irritation and a clear discharge. Other viruses may just infect the eyes. Viral eye infections go away without any treatment just like other viral infections. Sometimes having a cold or viral eye infection makes a person prone to getting a bacterial eye infection. At other times, a bacterial infection just happens without a viral infection. Often this bacterial infection is caught from someone else with the same infection, especially if they live in the same house. Bacterial infections will also often go away without any treatment, but antibiotic drops will make it go away faster, make it less contagious, and make complications less likely. Other causes of eye redness are allergies, irritants (soap, shampoo, smoke, chlorine, dirty hands, etc.) or foreign bodies in the eye (dirt, sand, bits of grass, etc.) or eye trauma such as someone poking your child in the eye or a toy hitting them in the eye.
Normal Course
It may start with a runny nose or other respiratory symptoms. Your child may complain about eye itching or tenderness, then the whites of the eyes become red. A watery discharge appears with viral infections; a yellow-green thicker discharge appears with bacterial infections. The eyelids may be matted or stuck together in the morning; your child may not be able to open her eyes. Sometimes the eyelids are a little swollen. Bacterial pink eye may be accompanied by an ear infection. Viral pink eye usually lasts 3-7 days, about as long as the cold symptoms. Eye irritation from something in the eye usually lasts a few hours; washing out the eye can help.
Treatment
- Eye irritation from something in the eye is treated by washing the hands and then face and eyelids with soap and water, then rinsing the eyelids with water. You can use a cotton ball to drip water into the eye.
- For viral infections, there is no treatment. It will go away by itself. You can rinse the eyes with warm water (you can use a cotton ball) several times a day. This can help prevent a bacterial infection.
- Thick eye discharge or eyelids matted together can be cleaned with warm washcloth.
- For bacterial infections (with green-yellow discharge), prescription antibiotic drops or ointment are used.
- If there is an ear infection, an oral antibiotic is used to treat both infections, and eye drops are not necessary.
- Avoid wearing contacts or using eye makeup until the infection has improved.
Complications
- Certain viruses can cause more serious eye problems; watch for any problems with your child’s vision.
- Bacterial infections can spread to the tissues around or behind the eye. If your child starts to act sick, has redness or swelling of the skin around the eyelids, severe eye swelling or pain, then she needs further evaluation and treatment.
- Middle ear infections (otitis media) can occur with bacterial pink eye.
Prevention
Respiratory viruses and bacterial infections are spread from person to person through direct contact, and from doorknobs and other objects contaminated with mucous, saliva and secretions containing the germs. Bacterial germs also spread with the hands. Handwashing is the most effective means of preventing the spread of germs. Children should learn to avoid rubbing or touching their eyes, nose or mouth until they wash their hands first.
Returning to school or daycare
For bacterial pink eye, treated with antibiotic drops or ointment, your child can return to school 24 hours after treatment has begun. With viral infections, or irritants, your child can return to school immediately. (There is one particular form of epidemic viral pink eye that requires exclusion; you would be informed if this were the case).
When should I seek further care?
Seek immediate care if your child:
- Starts to feel or to act very ill.
- Has redness or swelling of the skin around the eyelids or severe swelling of the eyelids.
- Develops eyes that start to bulge outward or blurry vision.
Call your doctor for an appointment today or tomorrow if your child:
- Has been diagnosed with viral pink eye and a green-yellow discharge develops.
- Has a bacterial infection and is not better in 3-4 days.
- Develops an earache or a fever.
Resources
Choosing Wisely patient page on Antibiotics for Conjunctivitis
