Red eyes = pink eye? Maybe, but there are also other causes of eye redness and even eye goop (discharge)! Lets take a look at pinkeye, also known as conjunctivitis, which is definitely common in daycare, school and beyond. And yes – adults can get it too.

Disclaimer: this is not medical advice nor should it be interpreted as such. This blog is for informational purposes only. Please seek medical advice from your trusted healthcare provider.

What is pinkeye and how do kids get it?

I have a lot of parents and friends ask if their child has pinkeye, actually pretty frequently. But the potential causes of redness in the eye are many, not just pinkeye.

Pinkeye (conjunctivitis) is inflammation of the conjunctiva – which covers the outside of the eye (the sclera) and the inside of the eyelids (in several places, click here to see an image from Cleveland Clinic). It is a mucous membrane. This thin layer helps to protect the eye and keep it lubricated, by playing a role in tear production. This is important to understand so that you can understand some of the symptoms below.

As you can imagine, different things can cause inflammation of the conjunctiva. Viruses, bacteria and even allergens (and more) can cause this inflammation. When it comes to kids, the most common cause if viruses.

Pinkeye is spread through direct contact (rubbing the eyes and touching someone else); indirect contact (touching a tissue or other item that has discharge on it or has come in contact with an infected eye); and through droplets (when it is viral and associated with cold symptoms, this is particularly common).

Symptoms of Pinkeye

So, we know the role of the conjunctiva in lubrication and eye protection. When they are inflamed, these functions are affected.

General pinkeye symptoms include:

• Red or “pink” eyes; sometimes there is some swelling
• Itchy eyes (related to the inflammation and lack of lubrication)
• Tearing excessively (since this process is being affected)
• Pus or discharge from the eyes – a common symptom seen in children is sticky eyelids (waking up with them stuck shut for example)

There are some differing symptoms when pinkeye is caused by a bacteria vs. a virus.

Viral:

• May be unilateral (affects only one eye)
• Light sensitivity may occur

Bacterial:

• May be painful
• A large amount of pus or discharge (may be green or yellow) – due to the increase in discharge, the crusty eye issue may be more common
• Can be unilateral or bilateral (both eyes)

As you can see, it can be hard to distinguish between the two at a glance. Many of the symptoms overlap. It is easier to tell when pinkeye is say, caused by an allergen – because there likely won’t be discharge or pain, just redness and itchiness with watery eyes.

Red and watery eyes due to conjunctival inflammation can occur also after swimming in a chlorinated pool (again, there wouldn’t be discharge). Neither this type or the one caused by allergens would be contagious or spread.

Home Management

Contrary to popular belief, most cases of pinkeye can actually be managed at home (especially viral types, which would not benefit from an antibiotic that works against bacteria) – but getting an assessment by a doctor for any eye issues is advised as pinkeye is sort of the “last option” diagnosis, meaning there are other potential causes of prolonged eye irritation and inflammation that should be ruled out first. Your doctor can also help to differentiate between the causes of pinkeye – which as you can see from the symptoms above can be difficult to the “naked eye” if you will.

Viral cases generally clear up sometime within one to two weeks without treatment. Things you can do to manage a viral pinkeye at home:

• Firstly – follow the guidance of your provider! They may give you specific guidance based on the type of pinkeye your child has
• Cool or lukewarm compresses can be used on the eye (use a clean washcloth for example – soak it in lukewarm or cool water, wring it out and apply to the eyelid with eyes closed) – this both relieves the discomforts and can help make crusty discharge easier to remove! Wipe away any excess discharge from inside corner to outside corner.
• For the itchiness and sensation of discomfort, artificial tears can be used in older children (who may be more willing to receive the drops!) and may be used in younger children after consulting with a doctor. Never use Visine – redness-relieving drops like this can make symptoms worse or may cause discomfort.
• Administration of acetaminophen or ibuprofen for pain (if needed)
• Prevent the spread to others through good hand hygiene and sanitation of any objects that may have come in contact with viral particles

If symptoms of a viral infection are particularly uncomfortable, sometimes a doctor might prescribe steroid drops, but this is not always the case and is for symptom relief not treatment.

The American Academy of Ophtalmology does not recommend administering breast milk to a baby or child with pinkeye. This is because it can introduce further bacteria to the eye and because the study that does exist where this was trialed did not show that it was effective.

When & Where To Seek Assistance

As I mentioned, it is a good idea to see your doctor if your child has pinkeye symptoms that are not relieved quickly (such as in the case of allergic conjunctivitis, which should resolve with removal of the allergen or chemical-related such as with chlorinated pools). They can help determine which type of pinkeye your child has and the best treatment (if any).

I will make note here that the use of antibiotics for pinkeye is not necessarily supported by evidence anymore. It is often prescribed automatically without knowing whether the pinkeye is actually caused by bacteria or not, contributing to antibiotic resistance.

Even in cases where pinkeye is caused by a bacteria, it is usually mild and most cases would resolve on their own without them, according to the American Academy of Ophthalmology and Choosing Wisely Canada.

Antibiotics can also cause further eye irritation, redness, discomfort and discharge.

Finally, from an accessibility point of view: they can be costly.

An assessment is still important – Choosing Wisely recommends pursuing antibiotics if the infection is severe or lasts longer than a week. As always – this is something you should discuss with your provider and make an informed choice regarding. An idea would be to take the script for antibiotics if they’re given and hold onto it if you find your symptoms are mild. This of course can be harder to determine in young children who can’t necessarily say “my eye really hurts”. All things to consider.

Other cases when it is a good idea to see a doctor:

• Your baby is less than 3 months old with pussy eye discharge
• If there is pain associated with the pinkeye symptoms
• If your child develops light sensitivity or vision difficulties
• If there are other symptoms such as a fever or rash associated with the pinkeye (this could be viral but it could be something else)
• See doctor for follow up – If the pinkeye is not resolving in about 2 weeks or so (or following the timeline given by your provider)
• You have concerns – this is always a valid reason to see your provider!

Prevention Tips

As always, we want to prevent these illnesses from happening as much as possible. Keep in mind that sometimes despite our best efforts, these things still happen. But what you might have seen from the pandemic is that hand-washing and things like staying home when you’re sick (or keeping a child home when they’re contagious) can actually be very effective at minimizing illnesses.

To prevent the spread of pinkeye, we have to look at the way its spread which we talked about earlier. Through direct and indirect contact, as well as droplets in viral cases.

To prevent the spread of pinkeye:

• Best protection: Wash your hands and your child’s hands after touching your child’s eyes (or after they rub their eyes) or face
• Don’t share towels or washcloths with anyone who has pinkeye in the home; change pillow cases and towels daily
• Sanitize objects that are “high touch” for anyone infected
• Encourage older children not to rub their eyes (but this of course won’t work with younger ones!)

If you get pinkeye and use makeup, it is also recommended to replace any eye makeup products by the American Academy of Ophthalmology. You also should not wear contact lenses until you have recovered.

Remember that pinkeye is generally very mild, but an assessment is still beneficial.

When can my child return to daycare/childcare/school?

With a viral case of pinkeye, children can usually return after seeing a doctor (likely to rule out other potential causes). If they have a bacterial case and/or are started on antibiotics, this may mean they need to wait 24 hours after starting the medication to return.

Each childcare/school will have different policies so it is best to consult them directly regarding return times.

Polysporin for Pink Eye?

This is one I see get tossed around a lot.

Based on current data and the lack of evidence behind antibiotics for pinkeye, using polysporin pinkeye which does have smaller amounts of antibiotics in it (see active ingredients here) seems not necessarily useful. Some people swear by it – but I do wonder about its contribution to antibiotic resistance and other issues. You also have to keep in mind that in other cases where antibiotics are prescribed, you’re either given broad spectrum (meaning they impact different bacteria more “broadly”) or narrow spectrum, which more specifically target certain bacteria. Using a broad spectrum without actually knowing the bacteria that is causing the infection (if it is a bacteria at all…) may therefore still be ineffective if its not targeted enough.

The product may also simply irritate the eyes of some. Even if you read the reviews on their product website, you will see some people saying it stings or hurts their eyes. This is something we talked about above too with antibiotics in general.

So verdict is: consult your doctor for an assessment before giving anything, even this over the counter (OTC) option. A chat with a pharmacist may be useful too, as they know a heck of a lot on these topics of course!

Additional Resources

Canadian Paediatric Society – Pinkeye (Conjunctivitis)

American Academy of Pediatrics – Pinkeye (Conjunctivitis)

Choosing Wisely – Antibiotics for Pinkeye