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Viruses Most Common Cause of Pinkeye

By Dr. Jamie Lien

Pinkeye, or conjunctivitis, is redness and swelling of the conjunctiva, the thin, clear lining inside the eyelid and on the surface of the eyeball. Irritation or infection can cause this lining to become red and swollen. Pinkeye is a very common problem in children and adults and can have many different causes, including infections caused by viruses or bacteria, allergies and exposure to irritants.

Viruses are the most common cause of infectious pinkeye. Viral pinkeye is most common in the late fall and early spring. Symptoms include redness in the white of the eye, eyelid swelling, itchy eyes, tearing and watery or slightly thick whitish drainage. Both eyes are usually affected. Viruses that cause pinkeye usually cause other symptoms as well, including sore throat and runny nose and are not usually treatable with medication. Viral pinkeye symptoms usually last between five and seven days, but can last up to three weeks.

Symptoms of bacterial pinkeye can be slightly worse than those of viral pinkeye, including moderate to large amounts of gray or yellow eye discharge which cause the eyelashes to stick together, eye pain, sensitivity to light, and swelling of the lymph nodes in front of the ears. Sometimes the bacteria that cause pinkeye can also cause an ear infection. Bacterial pinkeye symptoms usually last between seven and 10 days without antibiotic treatment and two to four days with antibiotic treatment. Prescription antibiotic eyedrops usually kill the bacteria that cause pinkeye.

The eye discharge in both viral and bacterial pinkeye is usually most pronounced in the morning, when the child first wakes up. Because the eyes have been closed all night, the discharge builds up during sleep, and can even crust the eye shut. The discharge can be removed by gently dabbing the area with a damp washcloth. Eyelid swelling may also be more prominent in the morning, and should improve throughout the day.

Children may return to day care or school when symptoms begin to improve, usually in three to five days for viral pinkeye, and 24 hours after starting antibiotics for bacterial pinkeye if symptoms have improved.

Infectious pinkeye is highly contagious, and is spread through contact with the eye drainage, which contains the virus or bacteria that caused the pinkeye. If you touch an infected eye, and then touch your other eye or an object while you have drainage on your hand, the virus or bacteria can be spread. The main cause of the spread of pinkeye is poor hand washing. Sharing objects such as towels, washcloths, contact lens equipment, eye makeup or eye medicine with a person who has pinkeye can also spread the infection.

Do not use antibiotic eyedrops prescribed for someone else or from a previous infection. These medications may have been contaminated or may be inappropriate for your current infection.

If you feel that your child might have bacterial pinkeye, you should see your pediatrician. He or she can prescribe antibiotic treatment as well as check for other conditions such as ear infections or more serious eye infections.

Allergic conjunctivitis affects both eyes and is caused by the body’s response to an allergy-inducing substance such as pollen or pet dander. Symptoms include itching, tearing and redness and swelling of the eyes. Your child may also have sneezing and watery nasal discharge. Most allergic conjunctivitis can be controlled with allergy eyedrops.

Dr. Jamie Lien is a pediatrician in the Emergency Department at Rady Children’s Hospital-San Diego, and an assistant clinical professor of pediatrics at UC San Diego. She can be reached at