Conjunctivitis (Pink Eye)

Understand conjunctivitis (pink eye) – causes, symptoms, red‑flags and treatment. Learn when to seek urgent care and how Doctors365 telemedicine can help.

Written by Din Karahodza, and medically reviewed by Dr. Diellza Rabushaj, medical writer and researcher.

Disclaimer

This article is for general information only and does not replace an in‑person examination. Doctors365 is a telemedicine platform and is not an emergency service. If you develop severe pain, vision loss, eye injury, chemical exposure, or other alarming symptoms, call your local emergency number or visit the nearest urgent eye clinic immediately.

What is conjunctivitis?

The conjunctiva is a transparent mucous membrane covering the white of your eye (sclera) and the inner surfaces of your eyelids. It keeps the eye lubricated and protected. Conjunctivitis (sometimes called “pink eye”) occurs when this membrane becomes inflamed or infected. The inflammation causes redness, irritation and discharge. According to evidence‑based sources, conjunctivitis is the most common cause of eye redness encountered in primary care and emergency settings, and more than 80 % of acute cases are diagnosed by non‑ophthalmologists[1].

Types of conjunctivitis

Infectious conjunctivitis – can be viral or bacterial. Viruses (especially adenoviruses) cause about 80 % of cases[1]. Bacterial infections are more common in children and contact lens wearers; common pathogens include Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae[1]. Rare causes include sexually transmitted bacteria such as Chlamydia trachomatis and Neisseria gonorrhoeae[1].

Non‑infectious conjunctivitis – caused by allergies, toxins (e.g., smoke, chlorine), foreign bodies or systemic conditions. Allergic conjunctivitis is the most frequent non‑infectious type and affects up to 15–40 % of the population[1].

How does conjunctivitis develop?

Inflammation occurs when pathogens or allergens trigger an immune response, causing dilation of conjunctival blood vessels and increased mucus production. In viral and allergic forms the discharge is typically watery, while bacterial infections produce thicker, yellow‑white (purulent) or mucopurulent secretions[1]. The incubation period ranges from one day (bacterial) to several days (viral)[4].

Epidemiology and risk factors

Conjunctivitis can occur at any age. A nationwide emergency‑department study found a bimodal age distribution: peak incidence in children under 7 years (highest between 0–4 years) and a second peak in young adults (early 20s)[1]. Allergic conjunctivitis peaks in spring and summer[1].

Key risk factors include:

Risk factorEvidenceExposure to infected individuals or contaminated objectsViral conjunctivitis spreads easily through hand‑to‑eye contact or contaminated items; transmission risk is estimated at 10–50 %[4]. Bacterial conjunctivitis can result from contaminated fingers, oculogenital spread or fomites[4].Contact lens useContact lens wearers have higher risk of bacterial keratitis and should remove lenses if conjunctivitis develops[2].Allergies and atopyAllergic conjunctivitis occurs in people with hay fever, asthma or eczema[2].Environmental irritantsSmoke, chlorine, dust and wind can irritate the conjunctiva.Compromised tear film or ocular surface injuryDisruption of the natural epithelial barrier, abnormal eyelid anatomy, trauma or immunosuppression predispose to bacterial infection[4].Sexual activity/newborn exposureChlamydial and gonococcal conjunctivitis are often acquired through oculogenital spread or during childbirth[1].

Signs, symptoms and red‑flags

Conjunctivitis commonly causes:

• redness of the white part of the eye and inner lids;
• a gritty or burning sensation;
• excessive tearing (watering);
• discharge – watery in viral and allergic forms, thick or purulent in bacterial infection[1];
• itching (hallmark of allergic conjunctivitis);
• crusting and “matting” of eyelashes upon waking[4].

Seek urgent care now if you notice:

• Severe eye pain, decreased vision or light sensitivity. These can indicate keratitis, iritis or angle‑closure glaucoma and require immediate assessment[1].
• Copious purulent discharge, swelling or difficulty opening the eye. Hyperacute bacterial conjunctivitis (often due to Neisseria gonorrhoeae) may cause corneal perforation[4].
• Blisters or vesicular rash around the eye or on the nose. This suggests herpes simplex or herpes zoster infection and needs urgent antiviral treatment[4].
• History of recent eye surgery, trauma or contact with caustic chemicals. Chemical injuries and postoperative infections are emergencies.
• Symptoms that do not improve after 7–10 days of care or worsen despite treatment[4].

How conjunctivitis is diagnosed

Clinicians usually diagnose conjunctivitis through a detailed history and physical exam. They will ask about symptom onset, exposure history, contact lens use, past episodes, type of discharge and associated systemic symptoms[1]. The eye examination focuses on visual acuity, pupillary responses, eyelid swelling, discharge type, corneal clarity and preauricular lymph nodes[1]. Important differentials such as iritis, keratitis and glaucoma must be excluded if there is focal redness, ciliary flush, vision loss or severe pain[1].

Most cases do not require laboratory testing. Cultures or rapid adenoviral antigen tests are reserved for severe, recurrent, neonatal, sexually transmitted or treatment‑resistant cases[1]. Contact lens wearers with suspected bacterial conjunctivitis need evaluation to rule out keratitis[2]. In neonates, ophthalmia neonatorum can cause serious ocular and systemic infection and warrants urgent specialist care[1].

Treatment options

General measures

Most cases of conjunctivitis resolve without medication. Supportive care includes:

• Frequent handwashing and avoiding eye rubbing to prevent spread[3];
• Cold compresses or artificial tears to relieve irritation[2];
• Cleaning eyelids with a clean cloth to remove discharge[5];
• Discontinuing contact lenses and discarding used lenses and cases until healing occurs[5];
• Avoiding eye makeup and sharing towels[3].

Viral conjunctivitis

Viral conjunctivitis, often caused by adenoviruses, is highly contagious and usually self‑limiting; symptoms resolve over 1–2 weeks. There is no effective antiviral treatment for common viral forms[4]. Supportive care (cold compresses, artificial tears and antihistamine drops) relieves discomfort[4]. Patients should avoid work or school until systemic symptoms resolve and practise strict hygiene to limit transmission[2]. Herpes simplex or herpes zoster conjunctivitis requires oral or topical antivirals (acyclovir, famciclovir or valacyclovir) and ophthalmology referral[1].

Bacterial conjunctivitis

Uncomplicated bacterial conjunctivitis resolves spontaneously in up to 60 % of cases within 1–2 weeks[4]. Randomised trials show topical antibiotics shorten symptom duration by about 1 day and reduce transmissibility[4]. However, they should be reserved for situations such as:

• Purulent or severe mucopurulent discharge or marked discomfort[4];
• Contact lens wearers, who are at risk of corneal infection[4];
• Immunocompromised patients or those with systemic illnesses[4];
• Suspected chlamydial or gonococcal infection, where systemic antibiotics are essential[4].

Common topical options include polymyxin B/trimethoprim, fluoroquinolones (e.g., ciprofloxacin, ofloxacin), macrolides and aminoglycosides[1]. Eye ointments last longer but may blur vision. Contact lens users should be treated with fluoroquinolones for Pseudomonas coverage and avoid lens use during treatment[1]. Systemic ceftriaxone and azithromycin are recommended for gonococcal conjunctivitis; dosing must be determined by a clinician[1].

Allergic conjunctivitis

Management focuses on avoiding triggers, using artificial tears, cold compresses and topical antihistamines (with or without vasoconstrictors)[1]. Mast‑cell stabilisers, dual‑action antihistamine/mast‑cell inhibitors and short courses of topical steroids may be used for moderate–severe disease under specialist supervision[1]. Oral antihistamines can help control systemic allergy symptoms[1].

Safety considerations and contraindications

• Avoid unnecessary antibiotics. Overuse can cause allergic reactions, antimicrobial resistance and may prolong or worsen viral conjunctivitis[4]. Patient education about watch‑and‑wait strategies is important.
• Use corticosteroids only under ophthalmologist guidance. Topical steroids may slow healing and increase the risk of corneal thinning or glaucoma[1].
• Contact lens wearers should stop lens use during infection. Resuming lenses too soon can lead to keratitis or ulceration[2].
• Pregnant or breastfeeding women and young children should consult a clinician before using any eye medication.
• Drug interactions: Some oral antihistamines can cause drowsiness or interact with other sedatives. Inform your clinician about all medicines you take.

Lifestyle and prevention tips

Adopting healthy habits helps prevent conjunctivitis and limit its spread:

• Wash hands frequently with soap and water, especially after touching your eyes[3]. Use alcohol‑based sanitizer when soap is unavailable.
• Avoid touching or rubbing your eyes, and teach children to do the same[3].
• Use clean towels, washcloths and pillowcases and avoid sharing them[3].
• Discard or replace eye cosmetics and contact lens accessories used before infection[5].
• Wear protective eyewear when swimming or in dusty or windy environments. Chlorinated pools and contaminated water can transmit viruses[4].
• Manage allergies by limiting exposure to pollen and allergens, keeping windows closed during high‑pollen seasons and taking allergy medicines as prescribed.
• Maintain general health – balanced diet, adequate sleep and regular exercise support immune function.

Telemedicine and Doctors365: how we can help

Conjunctivitis is well suited for a telemedicine first approach. Our medical team at Doctors365 can:

• Evaluate symptoms via video consultation to distinguish between viral, bacterial and allergic conjunctivitis.
• Provide self‑care advice and recommend over‑the‑counter treatments.
• Issue prescriptions for topical or systemic medicines when appropriate and safe.
• Advise when to seek in‑person care and arrange referral to ophthalmologists for red‑flag symptoms or complications.
• Offer follow‑up visits to monitor progress and adjust treatment if necessary.

Remember, telemedicine cannot perform visual acuity testing, slit‑lamp examination or culture sampling. If you experience severe pain, vision loss, trauma, chemical injury, or symptoms in a newborn, please seek immediate in‑person care.

Ready to get personalised advice? Book an online consultation with a Doctors365 clinician today. You can also explore our Specialties or learn about Common eye conditions through our health library. For tips on lens hygiene, see our Contact lens care tips.

Evidence at a glance

• High prevalence and economic burden: Conjunctivitis is the most common cause of red eye; over 80 % of acute cases are diagnosed outside ophthalmology clinics, costing an estimated US $857 million annually[1].
• Viral dominance: Around 80 % of acute conjunctivitis cases are viral; adenoviruses account for 65–90 %[1].
• Age and season patterns: Peaks occur in children under 7 years and again in young adults; allergic cases are more frequent in spring and summer[1].
• Transmission risk: Adenoviral conjunctivitis spreads easily, with a transmission rate of 10–50 % via contaminated hands or objects[4].
• Self‑limiting nature: At least 60 % of bacterial conjunctivitis resolves without treatment within 1–2 weeks, and antibiotics only modestly shorten symptom duration[4].
• Red‑flags require referral: Severe pain, vision loss, hyperacute discharge, vesicular rash or lack of response after a week demand urgent ophthalmology review[1][4].

What you can do now

1. Identify your symptoms: Note when symptoms started, the type of discharge and any triggers (e.g., new cosmetics, allergies, recent illness).
2. Practise excellent hygiene: Wash hands regularly, avoid touching your eyes and use separate towels and pillowcases.
3. Remove contact lenses and eye makeup: Do not wear contact lenses until symptoms clear and discard any used lenses or eye cosmetics[5].
4. Use supportive care: Apply cold or warm compresses, clean eyelids gently and use preservative‑free artificial tears for comfort[2].
5. Book a teleconsultation: If symptoms persist, worsen or you are unsure of the cause, schedule a telemedicine appointment with Doctors365 for personalised guidance.
6. Seek emergency help: If you develop red‑flag symptoms such as severe pain, vision loss or copious discharge, visit an emergency eye clinic immediately[1].

Frequently asked questions (FAQs)

1. What causes conjunctivitis?

Conjunctivitis occurs when the conjunctiva becomes inflamed due to infection or irritation. Viral infections (usually adenoviruses) cause about 80 % of cases[1]. Bacterial infections, allergies, foreign bodies, chemical exposure and systemic diseases are other causes[1].

2. How long does pink eye last?

Viral conjunctivitis typically resolves within 1–2 weeks without treatment[4]. Uncomplicated bacterial conjunctivitis usually clears in 7–10 days, although antibiotics may reduce symptoms by about a day[4]. Allergic conjunctivitis may persist or recur as long as you are exposed to the allergen and improves with trigger avoidance and antihistamines[1].

3. Is pink eye contagious?

Viral and bacterial conjunctivitis are contagious. Adenoviral conjunctivitis has a transmission rate estimated at 10–50 %[4]. It spreads through direct contact with tears, discharge or contaminated objects. Strict hand hygiene, avoiding sharing towels and staying home when symptomatic help reduce spread[3]. Allergic conjunctivitis is not contagious[2].

4. Do I need antibiotics for conjunctivitis?

Most viral and mild bacterial conjunctivitis cases resolve without antibiotics. A meta‑analysis showed only about a 10 % improvement in symptom resolution with antibiotic eye drops[4]. Antibiotics are recommended for contact lens wearers, immunocompromised patients, severe purulent discharge, or suspected chlamydial/gonococcal infection[4]. Always consult a clinician before starting antibiotics.

5. How can I tell viral from bacterial pink eye?

Differentiating can be difficult because symptoms overlap. Viral and allergic forms usually cause watery discharge, itching and tender preauricular lymph nodes[1]. Bacterial conjunctivitis more often produces thick, yellow‑white discharge, glued eyelids and less itching[4]. A clinician will assess your history, discharge characteristics and may test for specific organisms when needed.

6. Can I go to work or school with conjunctivitis?

You should stay home if you have viral or bacterial conjunctivitis with systemic symptoms or if you cannot avoid close contact with others[2]. If work or school involves close proximity to others (e.g., healthcare, childcare), it is best to remain off until symptoms and discharge have resolved.

7. What can I do to relieve itching and redness?

Use cold compresses, preservative‑free artificial tears and over‑the‑counter antihistamine eye drops for itching[1]. Avoid rubbing your eyes. If symptoms persist or vision changes occur, seek medical advice.

8. When should I see an eye specialist?

Seek urgent specialist care if you experience severe pain, vision loss, intense photophobia, a vesicular rash, persistent symptoms beyond 7–10 days or if conjunctivitis occurs in a newborn[1][3]. Contact lens wearers and people with chronic eye disease should consult an ophthalmologist early.

References

1. Hashmi MF, Gurnani B, Benson S. Conjunctivitis. StatPearls. Updated Jan 26 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541034/.
2. Centers for Disease Control and Prevention. Clinical overview of pink eye (conjunctivitis). 2024 Apr 15. Available from: https://www.cdc.gov/conjunctivitis/hcp/clinical-overview/index.html.
3. Mayo Clinic. Pink eye (conjunctivitis): symptoms & causes. 2025 Jan 10. Available from: https://www.mayoclinic.org/diseases-conditions/pink-eye/symptoms-causes/syc-20376355.
4. Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013;310(16):1721–1729.
5. Mayo Clinic. Pink eye (conjunctivitis): diagnosis & treatment. 2025 Jan 10. Available from: https://www.mayoclinic.org/diseases-conditions/pink-eye/diagnosis-treatment/drc-20376360.
6. American Academy of Ophthalmology. Conjunctivitis: what is pink eye? 2024. Available from: https://www.aao.org/eye-health/diseases/pink-eye-conjunctivitis. Accessed Aug 2025.