The Essential Guide

Pink Eye: Its Many Causes and Treatments, and How to Prevent Its Spread

Redness, swelling, and discharge are common signs of pink eye, also known as conjunctivitis. The Epoch Times/Shutterstock
checkCircleIconMedically ReviewedJimmy Almond, M.D.
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Ever woken up with your eyes red, itchy, or with crusty eyelids stuck together? That’s a sign of pink eye—a common eye infection caused by a virus or bacteria.

Pink eye, or conjunctivitis, occurs when the conjunctiva—the thin, clear tissue that lines the inside of the eyelids and covers the white part of the eye—becomes inflamed or infected, causing the eye to appear red or pink.

Most cases are mild and clear up on their own, but symptoms can worsen over time. Natural approaches and lifestyle changes—such as practicing good hygiene and certain teas with antimicrobial properties—may help ease symptoms and support recovery.

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Pink eye happens when the conjunctiva becomes inflamed due to infection, allergens, or irritants. The Epoch Times/Shutterstock

What Are the Types of Pink Eye?

There are several main types of conjunctivitis, each with its own symptoms, causes, and treatments.
  1. Infectious conjunctivitis: Infectious conjunctivitis is the highly contagious form of viral conjunctivitis—the most common type of pink eye—often caused by common cold viruses, and spreads easily through direct contact or contaminated surfaces. Similarly contagious, bacterial conjunctivitis is more common in winter and can be either acute or chronic.
  2. Allergic conjunctivitis: Allergic conjunctivitis occurs when airborne allergens—such as pollen, pet dander, dust mites, smoke, or fragrances—irritate the eyes. It is not infectious or contagious and is often associated with nasal congestion and sneezing.
  3. Chemical conjunctivitis: Chemical conjunctivitis is caused by irritants such as air pollution, chlorine, or noxious chemicals. A rare example occurs in newborns when preventive eye drops lead to redness and inflammation within hours.
  4. Nonspecific conjunctivitis: Nonspecific conjunctivitis is a red eye with discharge that is not caused by infection, allergy, or chemicals.

What Are the Symptoms and Signs of Pink Eye?

Recognizing pink eye early can help reduce discomfort, speed up recovery, and prevent spreading it to others. Symptoms vary by type, but there are a few common signs to watch for.

Early Signs

Early recognition of pink eye allows for quick management and prevention.
Initial symptoms of pink eye are mild but can worsen quickly. Early signs include a gritty sensation in the eye, mild redness, watery or mucus-like discharge, light itching or irritation, and slight swelling or tenderness around the eyes.

Common Symptoms

Different types of conjunctivitis share some common symptoms, including red or pink eyes, eyelid swelling, excessive tearing, and eye discharge that can be clear, yellow, white, or green. Crusty eyelids or lashes—especially in the morning—are also common. Additionally, people who wear contact lenses may experience discomfort or difficulty keeping lenses in place.

Type-Specific Symptoms:

While pink eye typically involves redness and discharge, the symptoms can vary depending on the cause. Here’s how to tell the difference between each type.
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Pink eye can be caused by viruses, bacteria, or allergens—each with slightly different symptoms and treatments. The Epoch Times/Shutterstock
  • Viral conjunctivitis: Viral conjunctivitis typically starts in one eye with watery discharge and spreads to the other within 48 hours. It is often accompanied by cold-like symptoms such as swollen lymph nodes and fever.
  • Bacterial conjunctivitis: Bacterial conjunctivitis produces thick, pus-like discharge and may cause severe eyelid swelling, intense redness, and a thin film over the eye.
  • Allergic conjunctivitis: Allergic conjunctivitis typically affects both eyes and causes intense itching, tearing, and a velvety texture inside the eyelids. Severe cases may lead to corneal damage that affects vision.
  • Chemical conjunctivitis: Chemical conjunctivitis usually results in severe pain, decreased vision, redness, and significant swelling.
  • Nonspecific conjunctivitis: Nonspecific conjunctivitis presents with redness and discharge that typically improve on their own within 24 hours.

What Causes Pink Eye?

The underlying cause of pink eye depends on the type, ranging from viral or bacterial infections to allergens and chemical irritants. Some forms are highly contagious, while others are not.
In the United States, the most common cause of conjunctivitis in adults is viral infection. In children, most cases are bacterial. Fewer than half of all cases are allergic, and only a small number are chemical or other types.

Infectious Conjunctivitis

Infectious conjunctivitis is caused by viruses or bacteria and spreads easily through contact with infected surfaces, secretions, or hands.
Viral conjunctivitis: Viral conjunctivitis is often linked to viruses that cause the common cold. Viral conjunctivitis can also occur alongside infections such as measles, chickenpox, rubella, and mumps. Severe cases—including those caused by Ebola or SARS-CoV-2—may result in conjunctival hyperemia, which is increased blood flow that causes redness, along with systemic symptoms.
Bacterial conjunctivitis: Bacterial conjunctivitis is caused by bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria gonorrhoeae. Risk factors include exposure to irritants and overuse of contact lenses. Certain bacteria, such as Chlamydia trachomatis and Neisseria gonorrhoeae, may be transmitted from mother to baby during childbirth.

Allergic Conjunctivitis

Allergic conjunctivitis may be caused by exposure to allergens—such as pollen, dust mites, mold, animal dander, or contact lens solutions—triggers the release of histamines, leading to swollen blood vessels, redness, itching, and tearing. Symptoms tend to worsen with high pollen counts, especially on hot, dry, windy days, and often improve in cool, damp weather. Allergic conjunctivitis often occurs alongside nasal congestion and sneezing.

Chemical Conjunctivitis

Chemical conjunctivitis happens when the eyes are exposed to irritants like smoke, fumes, air pollution, chlorine from swimming pools, or harsh ingredients found in makeup or eye drops. Newborns may also develop chemical conjunctivitis after receiving eye drops at birth. Chemical conjunctivitis is not contagious and can affect one or both eyes.

Nonspecific Conjunctivitis

Common causes of nonspecific conjunctivitis include dry eye, irritation following chemical exposure, or temporary redness and discharge after removing a foreign object, like dust or an eyelash. In infants, a blocked tear duct is a frequent cause of nonspecific conjunctivitis.

Risk Factors for Conjunctivitis

Several conditions and situations can increase the risk of developing pink eye:
  • Recent upper respiratory infection: Having a recent cold or flu can raise the risk of viral conjunctivitis.
  • Weakened immune system: People with diabetes or other conditions that compromise the immune system are more susceptible to infectious conjunctivitis.
  • Age and time of year: Children ages 0 to 4 have the highest rates of conjunctivitis in March. Other age groups tend to experience a peak in May.
  • Exposure in health care or child care settings: People who work in health care or with young children have higher exposure to contagious viruses that cause conjunctivitis.
  • Use of contact lenses: Contact lenses can introduce bacteria, viruses, or fungi to the eye, especially if hands aren’t properly washed before handling lenses.
  • Underlying medical conditions: Autoimmune disorders, preexisting eye disease, and recent eye surgery can raise the risk of developing pink eye.
  • Risk factors in infants: Infants may develop conjunctivitis from infection during childbirth, premature rupture of membranes, exposure to silver nitrate, unsanitary delivery conditions, or being born prematurely.

How Is Pink Eye Diagnosed?

Diagnosing conjunctivitis requires a thorough history and comprehensive eye exam to identify the cause and guide treatment. Key history points include symptom onset, affected eye(s), associated symptoms, past episodes, treatment history, discharge type, pain or itching, eyelid, vision changes, light sensitivity, and corneal opacity.
The examinations and tests may include:
  • Ocular examination: Assesses visual acuity, eye movements, visual fields, type of discharge, pupil shape, size, and light response. It also checks for abnormal bulging of the eye, corneal opacity, foreign bodies, intraocular pressure (tonometry), and eyelid swelling.
  • Visual acuity test: Measures how well a person can read letters or symbols from a distance of 20 feet. A near-vision card may be used if space is limited, with one eye covered at a time.
  • Slit lamp test: Uses a microscope with a high-energy light beam to examine the conjunctiva, sclera, iris, and cornea. Fluorescein dye may be applied to assess surface damage. While not necessary in most cases, this test can help confirm a diagnosis.
  • Eye culture: Performed when conjunctivitis lasts longer than two to three weeks despite home treatment. A sample is collected from the inner eyelid with a cotton swab and examined under a microscope to determine if the cause of conjunctivitis is viral or bacterial. An eye culture exam is especially useful for treatment-resistant or chronic cases.
  • Allergy testing: Identifies potential triggers, such as pollen or pet dander, especially when symptoms don’t improve with standard treatment.

What Are the Treatments for Pink Eye?

Most cases of conjunctivitis are mild and resolve on their own. For those that require treatment, the approach depends on the specific type of conjunctivitis.

Infectious Conjunctivitis

When treating infectious conjunctivitis, it’s important to educate the patient on how to prevent spreading the infection.

Wash your hands often—especially after touching your eyes or applying eye drops. Avoid rubbing your eyes and clean any discharge with a fresh cloth each time, and wash the area two to three times a day. Refrain from sharing any personal items such as towels, makeup, or glasses. If you wear contact lenses, avoid wearing them until fully healed. Wear glasses in the meantime and clean them regularly. Replace contact lenses and makeup after recovery. Also, change pillowcases and towels daily.

Home care includes over-the-counter pain relievers such as ibuprofen and lubricating eye drops (artificial tears). If your eyelids are stuck together, you can apply a warm, damp washcloth to loosen dried mucus.

Viral conjunctivitis: Viral conjunctivitis usually clears up on its own within one to two weeks, although some cases last two to three weeks or longer. The body’s immune system typically fights off the viruses. While most cases don’t require medical intervention, more serious forms may need antiviral medication. Viral conjunctivitis caused by adenoviruses is treated with cold compresses and artificial tears. If the conjunctivitis is caused by the herpes simplex virus, topical antivirals are usually used, but sometimes oral medication is needed. Herpes zoster conjunctivitis is usually treated with oral antivirals. Due to potential complications, ophthalmologist referral is usually recommended, as is management with steroids, which may be indicated in some cases.

Bacterial conjunctivitis: Mild bacterial conjunctivitis often improves without antibiotic treatment, typically improving within two to five days, although it may take up to two weeks to resolve completely. Antibiotics—usually in the form of eye drops or ointments—may shorten recovery time, reduce complications, and prevent spreading. Antibiotics are especially needed for those with discharge, a weakened immune system, or suspected high-risk bacteria. Treatment improves symptoms within three to four days, but it’s important to complete the full course to avoid recurrence. For children, antibiotic ointments are often preferred over drops and should be applied inside the lower eyelid.

Allergic Conjunctivitis

The best way to manage allergic conjunctivitis is to avoid allergens whenever possible. To ease symptoms, you can use lubricating eye drops, apply cool compresses, and refrain from smoking and exposure to secondhand smoke. Antihistamine and mast cell stabilizer eye drops may help. Decongestant eye drops can be used for short periods, but long-term use can cause rebound congestion. Avoid contact lenses during flare-ups to prevent irritation and protein buildup on lenses.

Chemical Conjunctivitis

The best treatment for chemical conjunctivitis is to eliminate the source of the irritation, while the treatment options depend on the severity of the exposure. For mild exposure—such as chlorine—rinse the eyes carefully. Severe exposure, such as alkali burns, requires emergency care to prevent permanent eye damage. Over-the-counter or prescription eye drops may help in less serious cases. Saline flushing is also a standard treatment. In some cases, topical corticosteroids may be prescribed to reduce inflammation, ideally only under the care of an ophthalmologist, but are limited to short-term use due to potential side effects. If a chemical substance gets into the eye, it’s crucial to flush the eye with water for several minutes before seeking medical care.

Nonspecific Conjunctivitis

Nonspecific conjunctivitis typically resolves on its own within a few days, but using lubricating eye drops or ointments can provide faster relief. Preservative-free lubricants are ideal for people with severe dry eye or sensitivities and can be used frequently. Regular eye drops with preservatives should be used no more than six times daily. Ointments may offer longer-lasting relief but can blur vision and are best used at night.

What Are the Natural and Lifestyle Approaches to Pink Eye?

If you have pink eye, some foods and herbal teas may help manage symptoms.
Consult a health care professional before using natural remedies, especially for bacterial or severe cases. These options are not substitutes for antibiotics and should not delay medical evaluation when needed.

Natural Medicine

Natural remedies may offer gentle relief for pink eye symptoms, especially when the condition is mild. While not a replacement for medical treatment, certain foods and herbs may support healing and soothe irritation.
  • Honey has antibacterial and antimicrobial properties.
  • Echinacea and elderberry supplements or teas have shown antimicrobial and anti-inflammatory effects, especially for respiratory infections.
  • Ginkgo biloba has anti-inflammatory properties and may help treat allergic conjunctivitis. In one study, a combination of Ginkgo biloba extract and hyaluronic acid eye drops reduced redness, discharge, and swelling more effectively than eye drops alone.
  • Chamomile compresses have traditionally been used for anti-inflammatory, antimicrobial, and soothing benefits.
  • Calendula or pot marigold tea, cooled and applied as a compress, has been used to reduce inflammation and irritation.

Lifestyle Approaches

Healthy lifestyle practices can complement other approaches, but are not a substitute for severe bacterial cases.
  • Engaging in physical activity may improve immune function and reduce the risk of infections.
  • Avoiding smoking and secondhand smoke may lower the risk of developing conjunctivitis.
  • Eating a nutritious diet supports overall eye health. Diets rich in antioxidants such as berries and leafy greens and omega-3 fatty acids like flaxseed and walnuts may help reduce inflammation.
  • Vitamin A supports the health of the conjunctiva and other parts of the eyes.
  • Anti-inflammatory foods, such as turmeric and ginger, may aid recovery by reducing systemic inflammation. In one study, curcumin—a natural compound in turmeric—reduced allergic eye inflammation in mice by calming immune responses.

Traditional Medicine

Traditional healing systems have long used herbs, teas, and practices to ease eye discomfort.
  • Traditional Chinese medicine (TCM): Drinking chrysanthemum tea is believed to reduce inflammation and support vision. Acupuncture may also be used for allergic symptoms, but evidence for conjunctivitis is limited.
  • Traditional Japanese medicine (Kampo): Applying topical glycyrrhizinate—derived from licorice root—may reduce allergic conjunctivitis symptoms.
  • Ayurveda: Eating “cooling” foods, such as cucumber, is thought to balance “pitta,” or inflammation.
Always consult a trained practitioner before trying traditional remedies.

Mind-Body Practices

Mind-body approaches may complement other treatments by supporting overall well-being and helping the body recover more effectively.
  • Yoga or meditation: May reduce stress and support immune health, potentially decreasing susceptibility to infections or allergy flares.
  • Cold compresses: May relieve discomfort, itching, and redness associated with viral or allergic conjunctivitis.
  • Naturopathy: May support overall health through detoxification practices such as fasting or hydration.
  • Gentle facial massage (avoiding the eyes): May improve circulation and reduce stress-related inflammation, though evidence for its use in conjunctivitis is limited.

How Can I Prevent Pink Eye?

You cannot completely prevent pink eye, but you can lower your risk by following good hygiene practices and taking precautions in different situations.
Hygiene practices:
  • Wash your hands frequently with soap and water for 15 to 30 seconds
  • Avoid touching or rubbing your eyes
  • Do not share personal items such as towels or makeup
  • Clean glasses and storage cases thoroughly
  • Disinfect commonly touched surfaces
  • Discard and replace makeup and contact lenses after an infection
Environmental controls:
  • Avoid known allergens whenever possible
  • Stay away from smoke and environmental pollutants
  • Use air purifiers if allergic conjunctivitis is a concern
Special considerations:
  • Get tested for sexually transmitted diseases before childbirth if pregnant
  • Resume wearing contact lenses only after conjunctivitis is fully resolved
  • Consider vaccines for diseases that may lead to conjunctivitis
  • Avoid crowded environments during pink eye outbreaks

What Are the Possible Complications of Pink Eye?

While adenoviruses account for up to 90 percent of viral conjunctivitis cases, other viruses—including enteroviruses, herpes simplex, and varicella-zoster—can also cause pink eye. The latter two can lead to serious complications and even vision loss if not properly treated.
Although most pink eye cases are mild and resolve on their own, untreated or improperly managed conjunctivitis can result in more severe outcomes. Potential complications include:
  • Secondary bacterial infection: A bacterial infection that can occur during or after viral or allergic conjunctivitis, worsening symptoms and prolonging recovery.
  • Corneal ulceration: Sores that develop on the cornea and may increase the risk of vision complications.
  • Eye scarring and blindness: Herpes-related conjunctivitis, particularly in children, can cause eye scarring and permanent vision loss if left untreated.
  • Corneal perforation: A hole or tear in the cornea, which is a rare but serious complication.
Mercura Wang
Mercura Wang
Author
Mercura Wang is a health reporter for The Epoch Times. Have a tip? Email her at: mercura.w@epochtimes.nyc
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