If you don’t get pink eye at least a few times in life, you probably don’t get out enough. Pink eye is common, highly contagious, but rarely a serious condition. However, there are a few things to look out for, so we’ll go over them here.
What causes pink eye? Pink eye, or “conjunctivitis,” is usually caused by a virus or bacteria that infects the outside of the eye. These infections are spread by contact with another person, whether directly, or indirectly via shared toys or doorknobs, etc. There are other common causes of pink eye too, including allergies, a scratch to the surface of the eye, or a foreign object stuck in the eye. These are worth considering, and will be discussed later.
What are the symptoms? Classic infectious pink eye tends to include redness of the whites of the eye (“bloodshot”) as well as pus-like discharge often matting up the eyelashes. Patients may have the sensation of something being stuck in their eye. It is common to find the eyelids stuck shut by all the discharge upon waking from sleep. It may be accompanied by upper respiratory symptoms as well, and can involve one or both eyes.
Treatment. Because many of the causes of pink eye have overlapping symptoms, it is difficult to tell them apart and know which to focus treatment on. The thing you don't want to miss is a bacterial infection, so we usually prescribe antibiotic drops to be safe: bacterial infections are common and there’s no way to be sure it isn’t a bacteria. Vision is kind of important and all, and in the grand scheme of things, a few drops of antibiotic in the eye on a rare occasion isn’t going to do much harm. But if I take a look at an eye and I’m pretty convinced it's a virus or an allergy, I may skip the antibiotics and watch closely. If your child develops pink eye of any kind, you should call my office so we can treat appropriately; see the guide below to determine how urgent this is.
Calling in a prescription: If we’re purely dealing with bloodshot eyes and/or discharge without fever or cold symptoms, and none of the circumstances in the box below apply to your child, I may feel comfortable prescribing drops for you over the phone. Call our clinic during the day or page me during the day if we're not in clinic that day. This is not urgent, so if it's late at night please just leave us a message or email, or call once the day begins.
Things that need attention
- Newborns and infants under 3 months of age need to be seen as soon as possible; emergently if they have fever and cough.
- Children with fever, cough or ear pain need to be seen within 24 hours.
- If there is significant redness or swelling of the skin outside of the eye, you need to be seen urgently--this could be a very serious condition called periorbital cellulitis (see photo below).
- Any bulging of the eye out of the socket is, of course, a medical emergency.
- Children with foreign objects or scratches to their eyes should be seen as soon as possible, within less than 24 hours.
- If your child uses contact lenses and develops an associated redness and discharge of the eye, this could be either a sensitivity to the contact lens or worse, a corneal ulcer, which is a vision-threatening, serious condition requiring urgent referral to an ophthalmologist.
Different causes of pink eye.
For kicks, here’s a basic list of how some different types of pink eye may present. But remember, we can’t always tell them apart because the symptoms overlap quite a bit, so it’s best that I take a look in the office.
Bacteria. Heavy, thick discharge, bloodshot eye(s). Frequently starts in one eye and then spreads to the other. Not terribly itchy, but can be very uncomfortable. This is treated with antibiotic eye drops.
Viruses. Tends to be more on the watery side and very red with heavy tearing, but can involve thick discharge. It can start in both eyes or start in one and spread to the other. Not terribly itchy, but can be very uncomfortable. Sometimes the eyelids may be slightly puffy, sometimes a bit of redness under the eyes from rubbing and irritation, but there should not be any significant redness or swelling circling the eyes. It is highly contagious, but resolves on its own. The only problem is you can't tell it apart from bacteria in most cases.
Allergies. Usually watery, bloodshot and very itchy, follows exposure to an allergen (i.e. grass, pollen, cats, etc). Best treated by avoiding the allergen, but will respond to antihistamines (either orally or in eye drop form). Another great tip is to wash the hands and face frequently during times of exposure, kids are often contaminating their eyes by rubbing allergens into them.
Foreign objects in the eye or scratches. Think dramatic tearing from a single bloodshot eye with extreme discomfort but without thickened discharge. We need to make sure to remove any foreign object from the eye, and then I will use a special dye to see if there are any scratches to the cornea. If so, I will prescribe an antibiotic drop to prevent the now vulnerable cornea from developing a vision-threatening infection.
Corneal ulcer. Associated with contact lens use. Bloodshot eye(s), +/- discharge, and significant discomfort. There may be blurry vision. Again, this requires urgent referral to an ophthalmologist.
Other. There are a few rare autoimmune and other diseases that can cause redness and drainage from the eye. I won’t go into detail about them here, but if your child has any other unusual symptoms, such as cracked lips, rash, fever, etc, you’ll want to come in so I can take a look.
For urgent needs, same-day appointments are available Monday through Friday. Please call as early in the day as possible, the more notice we have the easier it is to fit everyone in.
Need help outside of office hours?
Firstly, if your child has an emergency, please call 911 or go directly to the ER - they will contact us if needed once your child has been evaluated.
Urgent Care centers can also be helpful when something needs to be seen outside of office hours but it's not an emergency.
For our list of preferred Urgent Cares and ERs, see our resources page.
And if you have something that might need urgent attention but you're not sure/don't know what to do, we can help: