When to Wait and See, When to Call the Doctor

Pink eye… the name perfectly describes it. You wake up with crusty eyelids, maybe an uncomfortable itch in your eye, tearing and possibly some light sensitivity. When you look in the mirror, you see that the white of your eye is now bright pink. You assume it’s “pink eye” and you are probably right. However, you are likely wrong if you assume that the cause is bacterial and antibiotic eye drops are in order. There are many non-bacterial causes for pink eye, including viruses, says David Shu-Chih Chu, MD, assistant professor of ophthalmology at New Jersey Medical School, at the University of Medicine & Dentistry of New Jersey in Newark. Hence the name “viral conjunctivitis” since conjunctivitis is an umbrella term for any condition that causes inflammation of the eye-lid lining membrane. In non-bacterial conjunctivitis, the discharge is typically watery or ropy, while with bacterial pink eye it tends to be thicker, of a yellow or greenish hue, and crusty.


I called Dr. Chu to discuss the best ways to treat pink eye. Since viruses have to run their course, treatment for viral conjunctivitis — most commonly caused by adenovirus, similar to the virus that causes the common cold — is primarily focused on relieving symptoms, he says. Dr. Chu advises lubricating the eye with artificial tear drops as often as needed for relief of the discomfort. He also recommends putting cold compresses on the eye to reduce swelling and inflammation, cautioning that it is important to use a fresh face cloth or towel for each compress. Some people find that antihistamine eye drops can relieve the uncomfortable itchiness but most versions, including olopatadine ophthalmic drops (Patanol) and epinastine (Elestat), require a prescription. There is one kind, ketotifen fumarate ophthalmic (Zaditor), that is available over the counter.

Viral pink eye generally takes from one to three weeks to completely clear up, but Dr. Chu recommends visiting the doctor if symptoms don’t start to abate after the first few days. That’s because, in rare cases, there could be other causes, such as herpes simplex (the cause of cold sores) or varicella (the cause of chicken pox) or uveitis, an inflammation of the uvea (the middle of the eye) that left untreated can lead to blindness. For wearers of contact lens, another possible cause is a corneal infection from bacteria or fungi, such as the recent ones associated with cleansing solutions. These infections are vision-threatening, so if contact lens users develop a “pink eye” it is important to seek help from an eye doctor immediately.

Also, says Dr. Chu, pink eye can occasionally become severe and even affect the corneas. If your symptoms grow worse or you notice vision changes, such as blurring, get medical care immediately. Though steroid drops treat severe cases, there are potentially risky side effects including glaucoma or cataracts, so doctors prescribe them judiciously.

Because pink eye can remain contagious for more than a week, it is crucial to practice careful hygiene. No sharing of towels, pillows or blankets, says Dr. Chu. Frequent hand washing is a must, as is keeping your hands away from your eyes. Also avoid antibiotics unless the doctor confirms a bacterial basis — by taking a culture.

Allergic conjunctivitis, which is usually seasonal, will cause both eyes to be watery and itchy. This condition is not contagious. An evaluation by an allergist in addition to an ophthalmologist may be beneficial.