Pink eye, also known as Conjunctivitis, is more common during the cold and flu season due to an increased risk of direct contact. You can get pink eye by touching any surface, touching your eye, and having close contact with someone else who has pink eye. In this blog, Dr. Bornstein discusses the different types of pink eye, its symptoms, and treatment.

baby with pink eye, conjunctivitis

PINK EYE DEFINITION:

Inflammation or infection of the area inside the upper and lower eyelid

PINK EYE SYMPTOMS:

  • Discharge from the eye
  • Pain
  • Itching
  • Redness
  • Crusting around the eye

PINK EYE CAUSES:

  • Bacteria, including Haemophilus, streptococcus (strep) and staphylococcus (staph). In newborns, chlamydia, gonococcus, staph, or silver nitrate induced
  • Viruses in all age groups, including adenovirus, echovirus, coxsackievirus
  • Allergies
  • Foreign body in the eye
  • Chemicals in the eye

PINK EYE TREATMENT:

It depends on the cause:

  • Eye drops are used to cover any bacterial cause
  • Foreign bodies should be removed
  • Allergy eye drops and antihistamines for allergic causes
  • Intravenous or intramuscular antibiotics are necessary for neonatal conjunctivitis, otherwise known as ophthalmia neonatorum
  • Steroid eye drops can help somewhat in viral conjunctivitis

OUTCOME:

Excellent for typical bacterial causes. Allergic causes need long-term therapy but are generally more of a nuisance. Neonatal conjunctivitis can advance to more serious infections needing intravenous antibiotics for seven to ten days, but this is very rare. Viral causes will resolve spontaneously after about two weeks.

DISCUSSION:

Conjunctivitis, more commonly, “pink eye,” is generally a harmless but irritating illness affecting the inside of the eyelids. It has become known as pink eye because sometimes the white part of the eye (the sclera) turns red, although that is not necessary for the diagnosis. In newborns, conjunctivitis can be caused by exposure to a sexually transmitted disease of the mother during birth. As the baby is born, chlamydia or gonococcus can enter the eye. Within a few days after birth, the child can become ill-appearing with a thick, crusted discharge from the eye. This needs to be treated aggressively with intravenous or intramuscular antibiotics. A mild form of irritation conjunctivitis can be caused in newborn babies by the installation of silver nitrate in the eyes. Silver nitrate is sometimes used in newborns to prevent the baby from contracting the more serious newborn conjunctivitis caused by sexually transmitted diseases. More often now, erythromycin ointment is used in newborns to prevent both sexually transmitted disease-induced conjunctivitis and irritation conjunctivitis from silver nitrate. Most of the time when infants have discharge from the eye, it is simply a blockage of the infant’s tear duct, which will resolve with time. Good prenatal care can prevent more serious sexually transmitted disease form.

Bacterial conjunctivitis is the most common type. The eye crusting related to this type generates most visits to the physician. There are generally two ways to contract this type of pink eye. One way is by exposure to someone else with the illness. If the bacteria are transmitted from the eye of an infected person to the eye of a healthy person, then the healthy person will catch the illness. Also, a child can catch a cold and get a stuffy, congested nose. The congestion can clog the tear duct that normally allows tears to drain from the eye, down the back of the nose, and to the throat. If the tear duct is clogged, tears can sit in the eye, allowing bacteria to set in. This type of pink eye is treated with antibiotic eye drops. Children will be contagious until they have been on the eye drops for 24 hours.

Viral conjunctivitis is another type of pink eye. This type typically causes a watery discharge and very red eye. This type resolves without treatment after about two weeks, and it is contagious until it resolves.

Allergic conjunctivitis usually causes itching, watering, and swelling of the lower eyelid. It is commonly a seasonal illness. Eye antihistamine drops and oral antihistamines can be used for this. This type of conjunctivitis is not contagious.

Chemical conjunctivitis occurs when a chemical, such as a household cleaning substance, cigarette smoke, smog, or any toxic substance, enters the eye. The most important response to this is to irrigate the eye for at least ten minutes with water.

Foreign body-induced conjunctivitis is treated by removal of the foreign body followed by eye drops and sometimes patching of the eye if there is a cut on the eye surface, called a corneal abrasion.

ONE DOCTOR’S OPINION:

I usually assume the cause of pink eye is bacterial, and treat it with antibiotic eye drops. If the condition doesn’t resolve, it is most likely viral. In that case, I wait for about two weeks, and if the symptoms haven’t resolved, I get an ophthalmologist involved. Sometimes, steroid eye drops can be used, but this should be done only after ophthalmologic evaluation because of the possibility of steroid eye drops increasing the chances of glaucoma. If the eye is particularly itchy and watery but not crusting, I will assume allergy and try antihistamine eye drops and/or oral antihistamines. It’s always important to be sure there is no foreign body in the eye. Sometimes an eyelash or piece of dust needs to be removed for the infection to resolve. Overall, this is a generally irritating, but harmless, illness.

Written by Dr. Michael Bornstein, who has 30 years of experience as a pediatrician. 

Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.