Pinkeye Panic

There’s been a surge of pinkeye in my small world this week.  First, my nephew and his wife called from their ski vacation with complaints of redness, swelling, and crusty goo that glued their eyelids together overnight. The next day Ellen’s youngest missed school with the same set of symptoms.

In the days since I’ve gotten several calls from moms with one basic question: what do I do?

Keep in mind, I’m a pediatrician who’s a health writer.  I don’t officially see patients or run a practice anymore, so why all the calls?  Pinkeye (medical name: conjunctivitis) is such a common, annoying scourge that sufferers look for information as much as cure. So I thought you’d like to know what I know.

Pinkeye is an inflammation of the membrane that covers the white part of the eye and the inner surface of the eyelids (the conjunctiva). Viruses and bacteria are the most common culprits, though allergies and some other conditions can cause a more chronic variety.  For our purposes let’s focus on how to tackle the sudden onset of red, itchy, painful eyes caused by infection without pulling your hair out.

When you or your kiddo wake up with the telltale signs, where do you start?  Is it a virus or bacteria?  Do you need a doctor’s visit?  Will warm compresses do the job or do you need antibiotics?  Is it contagious?

The short, frustrating answer is yes to all of the above. Lots of common viruses and bacteria cause pinkeye, and it’s exceedingly difficult to tell the difference.  There are also some nasty actors that can be in the game, like some of the bugs that cause STDs (this is particularly true for newborns). Even your doctor may find it hard to pinpoint the cause, so it’s best to take a trip to the office for a look-see.

Chances are, your child’s school won’t want him around until he’s been treated with antibiotic drops for 24 hours, so you may as well get an early start.

There are some typical subtle differences in the symptoms of viral vs. bacterial pinkeye, but take note: these vary greatly between individuals and can’t be counted on to make a diagnosis.

Bacteria will often cause angry, red and swollen eyelids along with red eyes.  They tend to affect both eyes simultaneously and produce lots of sticky, crusty greenish discharge.

Viral pinkeye is more likely to start in one eye and then spread to the other after a day or two.  Clear, watery tearing is more typical here, and common cold or respiratory symptoms may show up at the same time.

But whether it be viral or bacterial, the cause of a given case of pinkeye is so difficult to nail accurately that your doctor is likely to prescribe antibiotic eyedrops to be used in both eyes (even if symptoms haven’t shown up in the other) for 5-7 days.  Be sure to finish the course, or the infection may return with a vengeance.

In the meantime, warm compresses with sterile gauze or a clean washcloth will help. Some patients find camomile tea compresses soothing. Be sure to replace the gauze or cloth before moving from one eye to the other, and place directly in the trash or laundry after use.

And yes, pinkeye is very contagious. I’ll repeat my mantra here … wash your hands, wash your hands, wash your hands. Keep towels and linens isolated and be careful with close contact until symptoms resolve.

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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