In this article:
- A condition where the eye turns pink (red), often accompanied by itchiness, discharge, and sometimes pain is known as conjunctivitis or pink eye.
- Conjunctivitis can be caused by an infection, allergy, or exposure to chemical agents, which produce inflammation on the eye surface, the conjunctiva.
- Allergic and chemical conjunctivitis is not contagious, but viral or bacterial conjunctivitis can be highly contagious.
- Maintaining proper hygiene and taking steps toward prevention can help inhibit its spread.
- Applying a warm or cold compress can be comforting.
- Topical antihistamines, antivirals, or antibiotics may be needed.
What is Conjunctivitis?
Inflammation of the conjunctiva, the thin translucent tissue that covers the inner surface of the eyelids and the outer surface of the sclera (the white portion of the eye), is known as conjunctivitis.
Conjunctivitis is a common eye infection among adults and children. It can cause redness in the surface of the eye, discharge, sensitivity toward the light, ocular discomfort (burning, itching, or gritty sensation), and excessive tear formation.
Conjunctivitis can occur due to infectious and noninfectious agents. The inflammation caused by conjunctivitis may be hyperacute, acute, or chronic.
Types of Conjunctivitis
Conjunctivitis can be viral, bacterial, allergic, or vernal.
- Viral Conjunctivitis: The most common cause of infectious conjunctivitis is viruses. Viral conjunctivitis is usually spread through hand-eye contact. An estimated 50% of the cases become bilateral due to self-inoculation.
Depending on the strain, the infection can spread quite easily in public places. Symptoms that accompany viral conjunctivitis include a burning sensation in the eye, itch, redness, and clear watery discharge. (1)
- Bacterial Conjunctivitis: A bacterial infection in the eye may cause conjunctivitis, producing redness and soreness in the eyes and discharge of sticky pus. Bacterial conjunctivitis is contagious and generally affects both eyes at once.
The use of contact lenses makes you susceptible to being infected with gram-negative bacteria that cause conjunctivitis. (2)
- Allergic Conjunctivitis: This noncontagious form of conjunctivitis occurs due to an allergic reaction, which causes itchiness in the eye. It also makes the eye watery and red and may produce puffiness in the eyelids. (3)
- Vernal Conjunctivitis: Persistent conjunctivitis in people with chronic allergies or asthma is known as vernal conjunctivitis. It occurs mostly during spring and summer weather in boys and young men. (4)
What Are the Causes of Conjunctivitis?
Conjunctivitis can result from a bacterial or viral infection or exposure to an allergen. The common agents responsible for conjunctivitis include:
- Some viruses that cause the common cold
- Bacteria or viruses responsible for sore throat, sinusitis, and ear infections
- Bacteria that generally cause sexually transmitted diseases (STDs) such as gonorrhea and chlamydia
- Bacteria or viruses present in the excreta (stool and urine)
Noninfectious agents (allergens/irritants):
- Polluting agents such as dust, chemical vapors, smoke, or fumes
- Chlorine in swimming pools
- Chemicals present in cosmetics
- Contact lenses
- Foreign bodies in the eye, such as a loose eyelash
- Amoeba and parasites
Symptoms of Conjunctivitis
The common symptoms of conjunctivitis include:
- Grittiness in the affected eye
- Redness in the eye
- Excessive tearing
- Swollen eyelids
- Itchiness or burning sensation in the eye
- Sensitivity toward light
- Watery eyes
- Puffiness in the eyes
- Crust formation on the eyelids or lashes
- Blurred vision in some cases
- Runny nose and sneezing (allergic conjunctivitis)
- Stringy discharge (allergic conjunctivitis)
- Clear, thin discharge (viral and allergic conjunctivitis)
- Green, thick discharge (bacterial conjunctivitis)
These symptoms usually appear after 24-72 hours of infection and may last from a couple of days up to 3 weeks.
Different types of viral conjunctivitis may present additional symptoms, including:
- Pharyngoconjunctival fever: A syndrome that causes both conjunctivitis and pharyngitis, producing fever and sore throat along with conjunctivitis.
- Acute hemorrhagic conjunctivitis: A rare type of conjunctivitis that is highly contagious and can cause worldwide epidemics. Its symptoms are sudden in onset.
- Herpetic keratoconjunctivitis: A type of conjunctivitis caused by an infection with herpes simplex virus and may affect only one eye. Symptoms include the formation of blister-like lesions on the skin.
- Rubella and rubeola (measles): These viral illnesses may cause conjunctivitis, usually accompanied by a fever, rash, and cough.
Diagnosis of Conjunctivitis
Conjunctivitis and its cause can be diagnosed with an eye examination and analysis of symptoms and patient history. Bacterial, viral, and allergic conjunctivitis produce varying symptoms along with redness and swelling in the eye.
These symptoms may help in diagnosing the cause of conjunctivitis. However, in some instances, the symptoms are nearly identical irrespective of the cause. In such cases, laboratory testing may be required for a firm diagnosis.
Your doctor may collect the discharge from the infected eye as a sample and direct it to the laboratory for testing. The results help in determining the cause of conjunctivitis and in providing suitable treatment. (5)
Treatment options for conjunctivitis depend on its cause.
Antibiotic eye drops or ointments can be used to treat the underlying bacterial infection. The symptoms may subside after 3-4 days of treatment.
A high index of suspicion for bacterial infection should be considered in patients who use contacts. It is important to complete the prescribed course of antibiotics to prevent a recurrence.
Antibiotics are not effective for viral conjunctivitis. The viral infection will usually resolve on its own and run its course for 2-3 weeks, like a common cold. A cold compress or artificial tear solutions may provide relief from the symptoms.
Severe cases may require a prescription of topical steroids to help subside inflammation. Any of these medications will not shorten the duration of the infection.
Conjunctivitis caused by a varicella-zoster virus or herpes simplex virus requires the use of antiviral medications. Conjunctivitis caused by shingles will be accompanied by the typical zoster-type lesion on one side of the face.
Treating allergic conjunctivitis requires getting rid of the source of the allergy or irritation. Examples include using swimming goggles to prevent irritation from the chlorine present in pool water and avoiding contact with animals if you are allergic.
Over-the-counter or prescription eye drops may provide comfort. In severe cases, the doctor may prescribe eye drops containing antihistamines or steroids. (5)
Home Treatment for Conjunctivitis
Here are some measures you can do to prevent and get relief from conjunctivitis:
Note: Home remedies should only be used as an adjunct for alleviating the symptoms. It is recommended to get proper medical treatment.
1. Preventive Self-Care Measures
- Use fresh tissues or towels to wipe your face.
- Avoid sharing items such as hand towels, tissue, or washcloths.
- Keep your hands clean. Wash them before and after meals, after sneezing or coughing, and when going to the bathroom.
- Avoid touching your eyes, especially without cleaning your hands.
- Use swim goggles during swimming to prevent irritation from chlorine or infection from the microbes present in the water.
- Avoid allergens and substances that may irritate your eyes:
- Pollen allergies can be avoided by limiting outdoor activity and closing windows and doors if a high pollen level in the air is reported.
- If you are allergic to animals, avoid contact with pets. In case of contact, make sure not to touch your eyes with your hands.
- On exposure to allergens, wash your hand and body properly.
- Your makeup may harbor bacteria. Avoid using makeup if you are already infected and discard it if used during conjunctivitis. Do not share your eye makeup with others.
- Change pillow cases frequently. The drainage from infected eyes is contagious for up to 48 hours after the start of treatment.
- Complete the course of prescribed medications and discard them after use.
- Remove your contact lenses before showering to prevent entrapment of bacteria between the lens and the eye.
2. Apply Warm/Cold Compress
a. Cold Compress
For allergic conjunctivitis, using a cold compress may help to reduce the swelling and itching in the eye and prevent crust formation on the eyelashes from the dried-up discharge.
How to use:
- Take a fresh cloth and dip it in cold water.
- Wring out excess water and place the cloth on the affected eye.
- Leave it for 5-10 minutes.
- Apply a cold compress 3-4 times a day.
You may also use commercial gel eye masks that you keep in the fridge.
Note: Do not use the same cloth for both eyes. If only one eye is infected, avoid contact of the cloth with the other eye.
b. Warm Compress
Applying a warm compress can help when your eyelids are sticking together. The warm compress loosens the dried discharge and aids in separating your eyelids.
How to use:
- Soak a clean cloth in warm water and wring it out.
- Place the cloth on your eyes until it cools down.
- Repeat the procedure multiple times a day.
Make sure to use a clean cloth every time and use separate cloths for both eyes.
3. Avoiding Use of Contact Lenses
During infection, avoid wearing contact lenses without your doctor’s permission. If conjunctivitis results from the use of contacts, you may need to change your lenses or use a disinfecting solution.
The optometrist may ask you to use lenses that need frequent replacement to prevent the recurrence of the disease.
While the use of cold and warm compresses is widespread, no scientific experiments have been conducted to study their effects. Therefore, their usefulness or even harmful effects cannot be concluded. (6)
It is recommended that you do not put anything in your eye without prescription. The use of foods or herbal extracts is strictly prohibited as they are not sterile and may worsen the infection.
Risk Factors for Conjunctivitis
Conjunctivitis has a common incidence among children. Certain factors may increase the risk of contracting conjunctivitis and include the following:
- Close contact with a person having an infectious pink eye
- Exposure to environmental or chemical irritants
- Use of contact lenses, especially due to improper storage or poor hygiene
- Seasonal allergies or exposure to allergens
- Sharing linens, towels, or other objects with infected individuals
Some General Queries
Is conjunctivitis contagious?
Allergic conjunctivitis is not infectious. However, conjunctivitis caused by bacterial or viral infections is highly contagious and can spread through:
- Direct contact with an eye by hands
- Skin to skin contact (hugs and handshakes)
- Touching objects contaminated with the causative microbes
- Respiratory tract/airborne droplets
Can newborns get a pink eye?
Neonatal conjunctivitis, or the development of the pink eye in newborns, is possible and may occur due to:
- Blocked tear duct
- From the mother during childbirth (the mother may not be experiencing any symptoms but be carrying the causative virus or bacteria in the birth canal)
- Cold and flu viruses
Neonatal conjunctivitis may occur within 1 day to 2 weeks after birth and is characterized by drainage from the eyes and red, puffy, and tender eyelids.
Infectious conjunctivitis can cause severe complications in newborns. Newborns need immediate help from medical professionals if significant redness in the eyes with discharge is present.
It is recommended to distance babies from people with the flu or a cold.
What is the difference between a pink eye and a stye?
Inflammation and redness in the conjunctiva are known as conjunctivitis or pink eye. This condition may occur due to bacterial or viral infections or allergen exposure, including chemicals and smoke.
A stye is characterized by the presence of a pimple or abscess in either of the eyelids. It may cause mild redness in some cases. The inflammation occurs as a result of a blockage in an oil or sebaceous duct due to the accumulation of dust or microbes.
When to See a Doctor
It is recommended to seek medical help if you suspect a pink eye and undergo treatment before the symptoms become severe. Remove your contact lenses at once.
Immediate medical attention is required if the pink eye is accompanied by:
- Eye pain
- Changes in vision
- Use of contact lenses
- Any medical problem
- Ear infection in young children
What you may ask your doctor:
- What measures should I take to prevent conjunctivitis?
- How do I prevent it from spreading to others?
- Can an infected person go to public places?
What your doctor may ask you:
- Do you have any allergies?
- How long have you had the symptoms?
- Have you come in contact with anyone suffering from conjunctivitis in the recent past?