A red eye that waters, itches or is stuck shut when you wake up: conjunctivitis, often called pink eye, is one of the most common causes of a red eye, in children and adults alike. It is usually harmless and clears up in a few days — provided it is not confused with the rare red eyes that are urgent.
What is conjunctivitis?
Conjunctivitis is an inflammation of the conjunctiva, the thin, clear membrane that covers the white of the eye and the inside of the eyelids. When it becomes inflamed, its tiny blood vessels widen: the eye turns red, waters and feels gritty or uncomfortable.
There are three main causes: a virus, a bacterium or an allergy. In its usual form, it does not really hurt and it does not affect your vision.
Viral, bacterial or allergic conjunctivitis: how to tell them apart
A few clues point the way, without replacing a doctor's opinion:
- viral conjunctivitis: the most common type in adults. The eye waters a lot, with clear, watery discharge and a gritty feeling. It often starts in one eye and spreads to the other within a few days, sometimes together with a cold;
- bacterial conjunctivitis: more common in children. The discharge is thick, yellow or greenish, and the eyelids are stuck together on waking. It affects one eye or both;
- allergic conjunctivitis: itching is the main symptom. It affects both eyes at the same time, with clear tears, often with sneezing and a runny nose, especially in spring.
A bright red, clearly outlined patch, with no pain and no discharge, is not conjunctivitis: it is usually a small bleed under the conjunctiva. It is harmless and fades on its own. If it follows an injury or keeps coming back, mention it to a doctor.
Is conjunctivitis contagious?
Viral and bacterial conjunctivitis are contagious, especially in the first days and as long as the eye is watering. They spread mainly through hands and shared towels or bedding. Allergic conjunctivitis, on the other hand, is not contagious.
A few simple steps limit the spread within the family:
- wash your hands often, especially after cleaning or touching the eye;
- use your own towels and face cloths, and change pillowcases often;
- throw away each cotton pad or tissue after use;
- do not share eye make-up, and throw away any make-up used during the infection.
Pink eye in children: daycare and school
Pink eye spreads easily in daycare and schools. There is no single rule on keeping children at home: many daycares ask parents to keep the child at home as long as the eye is discharging, or until treatment has started.
In a child, a swollen, red, warm eyelid with a fever needs medical advice without delay. And in a newborn, in the first month of life, any red or discharging eye must be seen by a doctor the same day.
Treating conjunctivitis
The first step is the same whatever the cause: rinse the eye with sterile saline several times a day, using a clean cotton pad for each eye. Wipe from the inner corner, near the nose, outwards.
The rest depends on the cause, and is decided with a doctor:
- viral conjunctivitis clears up on its own in one to two weeks; antibiotics have no effect on a virus. Cool compresses ease the discomfort;
- bacterial conjunctivitis may call for antibiotic eye drops, especially in children or when there is a lot of discharge;
- allergic conjunctivitis is eased by rinsing, cool compresses and antihistamine eye drops or tablets.
If you wear contact lenses, take them out as soon as the eye turns red, and do not put them back in until the infection has cleared. Then switch to a new pair and a new case. Never use eye drops left over from another prescription on your own initiative: drops that contain a steroid can make some eye infections worse.
Red eye: when is it an emergency?
Some red eyes are NOT simple conjunctivitis. Go without delay to a hospital's eye emergency department if you notice any of these signs:
- real pain in the eye, not just discomfort or a gritty feeling;
- reduced vision or blurred vision that does not clear when you blink;
- marked sensitivity to light, making you want to keep the eye closed;
- a red, painful eye in someone who wears contact lenses;
- a red eye after an injury, a splash of a chemical or something getting into the eye;
- an abnormal pupil: larger or smaller than the other one, or misshapen;
- a red eye in a newborn;
- a red eye with a severe headache, nausea or coloured halos around lights.
If a chemical splashes into the eye, rinse it straight away under running water, for a long time, before going anywhere. Call 101 (Magen David Adom) for a serious injury: a wound to the eye, an object stuck in it, or a hard blow to the face.
Conjunctivitis and video consultation
Conjunctivitis is one of the problems that lends itself very well to a remote consultation: on video, the doctor can see the redness, the discharge, the eyelids, one eye or both. Questions fill in the rest — itching, a cold, allergies, other cases around you. This is usually enough to tell a viral, bacterial or allergic form apart, and to prescribe treatment straight away.
On the other hand, eye pain, reduced vision, marked sensitivity to light or wearing contact lenses all call for an eye examination. The video consultation then helps direct you to the right place.
Seeing Dr Nathalie Gozlan
Dr Nathalie Gozlan, a general practitioner, sees patients for a red eye or conjunctivitis, in adults and children alike — as a home visit in the Sharon region (Netanya, Kfar Saba, Raanana, Kadima-Tzoran, as well as the moshavim and kibbutzim of the area), or by video consultation anywhere in Israel, in English, Hebrew and French.
A painful red eye, or a red eye with reduced vision, is not ordinary pink eye: it needs to be examined the same day.
Frequently asked questions
How long is conjunctivitis contagious?
Viral conjunctivitis stays contagious as long as the eye is red and watering, often for about ten days. Bacterial conjunctivitis is much less contagious once treatment has started. Throughout this time, washing your hands and using your own towels remain the best protection.
Do you always need antibiotic eye drops?
No. Viral conjunctivitis does not respond to antibiotics and clears up on its own, with rinsing and artificial tears. Allergic conjunctivitis is treated with an antihistamine. Antibiotic eye drops are kept for bacterial forms, on a doctor's advice.
My child has pink eye: can they go to daycare?
Pink eye does not automatically mean staying at home, but many daycares and schools ask for the child to be kept at home as long as the eye is discharging, or until treatment has started. Check with the daycare or school. A baby under one month old with a red eye must be seen by a doctor the same day.
Can conjunctivitis be diagnosed by video consultation?
Yes, in most cases: on video, the doctor can see the eye, the discharge and the eyelids, and questions complete the picture. Treatment can be prescribed during the consultation. If there is pain, reduced vision, marked sensitivity to light, or if you wear contact lenses, an eye examination is needed.
