By Bryan Phillips, M.D. for Lee’s Summit Physicians Group

What is pink eye?

In medical lingo it’s called Conjunctivitis. Pink eye is a broad term – pretty much anything that turns your eye pink. It could be viral, bacterial, allergic, chemical or mechanical (getting poked in the eye). Today we’ll focus on allergic, viral & bacterial causes.

Allergic

Allergic is more common in the warmer months. It will cause a pink to red eye with watery to mucousy discharge. The hallmark of allergic conjunctivitis is that it’s itchy! It can be treated with oral antihistamines (Claritin, Zyrtec), nasal steroids (Flonase) and/or eye drops (patanol, zaditor). Trying to avoid the thing you’re allergic to is useful too, if possible.

Viral

Viral conjunctivitis looks a lot like allergic but is not itchy. It is usually without other eye symptoms or maybe a gritty sensation in the eye. A clue to this type of Conjunctivitis is that it often accompanies uri (cold) symptoms (runny nose, cough, maybe a fever). It can be one or both eyes. You may have a fair bit of dried discharge gluing the lashes together in the morning. The watery discharge can also cause chapping around the eye from being wet all day. Both of these problems can be helped by putting Vaseline on the eyes a couple times a day. This will protect the surrounding skin and stop the discharge from gluing the lashes together – a quick wipe with a wet cloth in the morning and you’re good to go.

Bacterial

Bacterial conjunctivitis is often isolated (no cold symptoms) and the discharge will tend to be more purulent (green or yellow, thicker) – sometimes it looks like the child is crying pus. It can look bad but doesn’t cause the child much discomfort. The eye may be glued shut in the morning as in the viral description above. In spite of the daycare & schools being alarmed, this is not very worrisome outside of the newborn period. There really aren’t any common complications and the symptoms will tend to resolve spontaneously in a few days (no more than 5-7 days). You can treat as viral above.

The role of eye drops for pink eye is a lot more fraught than years ago.

There really isn’t much evidence that antibiotic drops do much – either shortening the course of the illness or making it less contagious. The downside to the drops is expense (they aren’t cheap!), they can actually cause irritation to the eye, and even more worrisome, they have been linked to the increase of MRSA (methicillin resistant staph) in the community. Apparently a round of antibiotic eye drops increases the risk of your nose being colonized with MRSA for a few weeks.

With weak evidence of any benefit but definite downsides to treatment for a mild self-limited illness, it is not wise to prescribe antibiotic eye drops for routine pink eye.

Good handwashing & some Vaseline on the eyes before bed is really all that’s required. I would only recommend an office visit if you are worried about other symptoms – like ruling out an ear infection or pneumonia, especially in light of the COVID-19 situation. I often still have to write a note for daycare or school to avoid the child being excluded – basically explaining pink eye is generally part of a simple cold and can be treated as such.

Reference: 2013 AAP managing infectious ds in child care & schools, quick referral guide, 3rd edition