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What is pink eye and how is it treated?

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<em>Answered by Dr. Diana Koelliker</em>
Answer by Dr. Koelliker

Conjunctivitis (commonly referred to as pink eye) is a term that indicates inflammation of the Conjunctiva.  The conjunctiva consists of two parts, one that covers the inside surface of the eyelids, and one that covers the white surface of the eye (sclera).  Conjunctivitis is most commonly caused by a viral infection, but can be caused by bacteria, allergies or inflammation from irritants.

Symptoms of conjunctivitis are redness of the eye, especially the conjunctiva over the white of the eye.  Hence the common name pink eye.  Drainage or weeping of fluid from the eye is common.  Irritation and sometimes pain are common and light sensitivity can happen in more severe cases.  The infection may involve one or both eyes and can be readily transmitted from one to the other if careful hygiene is not used.  Lymph nodes may become inflamed, particularly in front of the ear and may be felt as slightly painful, round objects about the size of a pea under the skin.  Viral conjunctivitis frequently occurs with symptoms of an upper respiratory infection or a cold.
Treatment for conjunctivitis consists of supportive care and frequently antibiotic drops or ointment.  Contacts should be removed during the time of the infection, and should be discarded if disposable.  Drainage from the eye will often mat the eyelids together, especially in the morning.  A washcloth with warm water can be used to gently remove the discharge.
The wash cloth should be viewed as contaminated and needs to be sufficiently washed after use.  Infections with thick drainage, and patients with conjunctivitis under age six have a higher incidence of bacterial infections and are more often treated with antibiotics.  Conjunctivitis with thin discharge and upper respiratory symptoms is commonly viral and will not respond to antibiotics.  That said, cases of viral conjunctivitis are frequently placed on antibiotics to prevent a secondary bacterial infection.  Patients who have medical conditions that impair their ability to fight infections or who take immunosuppressive medications (like steroids or chemo) are at higher risk for complications and should seek care sooner.  Recent visual corrective surgery (LASIK and others) is another indication for more aggressive treatment.

Antibiotic drops or ointments are frequently prescribed for conjunctivitis.  They are applied to the eye and are minimally absorbed.  They therefore have less complications than oral antibiotics.  Children in school and daycare are frequently referred for treatment so they can return to school.  Despite treatment, they may still be contagious.  Avoidance of touching the eyes with careful hand washing is the best way to avoid becoming infected.  Conjunctivitis is rarely an emergency and can usually be taken care of in the primary care setting.