How to treat—and avoid—pink eye in children

Endless coughs and sneezes, runny noses, and unexplained itchy bumps—kids seem to be a magnet for germs. In our parent’s guide to childhood illnesses, we talk about the symptoms and treatments for the most common conditions. Read the full series here.

What is pink eye? | Causes of pink eye in children | Contagiousness | Symptoms | Diagnosis | Treatments | How to administer eye drops | Prevention

When I was a daycare provider, the sight of a goopy eye stopped me in my tracks. The sticky gunk in the corner of a child’s eye was a good indication of the dreaded pink eye—a common (and usually contagious) eye infection, especially in children. It meant phone calls to parents, letters home informing families to be on the lookout, and often the knowledge that I would be wrestling eye drops into a reluctant toddler within the week when they returned to class. As a parent, the crusty eyes of my own children meant time off work, and the same pint-sized wrestling match.

The good news is, while pink eye is an inconvenient annoyance, it is rarely serious and usually goes away quickly on its own or with treatment.

What is pink eye (conjunctivitis)?

Conjunctivitis, commonly known as “pink eye,” is an inflammation of the conjunctiva (tissue covering the inside of the eyelids and white part of the eye.) Pink eye is a very common condition in both children and adults. Some types of pink eye spread easily from person to person, especially in settings like daycare centers and schools.

What causes pink eye in children?

There are three main types of childhood pink eye. Each has different causes.

1. Viral pink eye is caused by common viruses such as adenoviruses and herpes virus.
2. Bacterial pink eye is caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella. “Eighty percent of the time a child’s pink eye is due to a bacterial cause,” says Ashanti Woods, MD, a pediatrician at Mercy Medical Center in Baltimore.
3. Allergic pink eye (also called irritant conjunctivitis) is a symptom of seasonal allergies or an allergic reaction (such as to animal dander), or caused by an eye-irritant such as pool water.

Conjunctivitis in newborns and infants can be very serious and your child should see their provider promptly.

Is pink eye contagious?

Although allergic pink eye is not contagious, viral and bacterial pink eye are highly contagious and spread easily from one eye to the other, and between people.

Viral pink eye is usually contagious before symptoms appear, and stays contagious for the duration of the symptoms.

Bacterial pink eye begins being contagious when symptoms appear and stays contagious until eye discharge is no longer present, or until 24 hours after beginning antibiotics.

Pink eye symptoms in children

Symptoms of pink eye can occur in one or both eyes. The symptoms vary from child to child, but include:

• Watery eye(s)
• Pink/red eye(s)
• Swollen eyelid(s)
• White, green, or yellow discharge (fluid) coming from the eye(s)
• Crust along eyelids or eyelashes—may cause eyelids to stick together, especially in the morning
• A lump in front of the ear
• Sensitivity to bright light
• Blurry vision
• A sensation of a foreign body in the eye/something stuck in the eye

Pink eye is usually a mild illness and does not cause a fever. If pink eye is accompanied by a fever, seek medical attention as this is a sign the infection has spread beyond the conjunctiva.

Pink eye symptoms are usually fairly obvious, but visiting a healthcare provider is the only way to determine the type of pink eye and course of treatment.

What to expect at a doctor’s appointment

Because pink eye can be similar to other conditions, children should see a healthcare provider for a diagnosis. A pediatrician, family practitioner, nurse physician, or physician assistant can diagnose pink eye, but complicated cases may need to be treated by an ophthalmologist.

At the appointment, the child’s doctor will do a physical exam and ask questions about the child’s symptoms, general health, and possibly family history. The provider may use a special light to look in the child’s eye to inspect for injury or foreign body. The healthcare provider may choose to do lab tests by collecting a sample of the discharge coming from the eye(s).

Treatments for pink eye in children

The treatment for pink eye depends on the cause.

Viral pink eye treatment

Viral pink eye tends to clear up on its own in one to three weeks, according to the Centers for Disease Control and Prevention (CDC). Viral eye infections are contagious for at least seven days. Occasionally, antibiotic eye drops are prescribed to prevent a secondary bacterial infection. For a serious viral infection, such as cases caused by herpes simplex virus (herpes) or varicella-zoster virus (chicken pox), it is crucial your child have an examination by an ophthalmologist or eye specialist who may prescribe antiviral medication.

“Viral pink eye or viral conjunctivitis is typically treated conservatively,” says Soma Mandal, MD, a board-certified internist at Summit Medical Group. “You can use an [over-the-counter] eye drop to help clear up the redness and congestion. Typically, viral pink eye can last for up to two weeks and can be accompanied by other eye symptoms.” 

Bacterial pink eye treatment

Bacterial pink eye often improves within two to five days without treatment, but can take up to two weeks to completely go away. Antibiotic drops or ointment are often prescribed to prevent spread, lessen complications, and shorten the length of infection—particularly if discharge is present, or the child is immunocompromised.

Common medications used to treat bacterial pink eye include.

The prescribing provider will determine dosage and treatment plans for these medications. “While most pediatric medicines are in fact doses based off of a child’s weight, eye drops are traditionally dosed in standard drops and by age,” Dr. Woods says. 

Do not share medications between children or adults as this can be dangerous and also spread germs.

Ibuprofen, such as Children’s Advil or Children’s Motrin, can be given to reduce pain. Warm compresses (using a clean washcloth and warm water) can be applied to the eyes for a few minutes at a time several times a day to help reduce symptoms and loosen crusty discharge. Make sure to use a different cloth for each eye and between applications. Do not rub eyes or attempt to dig out secretions.

While over-the-counter eye drops (such as artificial tears) and ointment are available, always check with a healthcare provider before administering them to children. Return to the healthcare provider if symptoms persist more than two to three days with treatment, or one week without treatment.

Allergic pink eye treatment

Allergic pink eye is best treated by removing the irritant or allergen from the child’s environment. Allergy medications such as antihistamines, either oral or eye drop form or nasal steroids (or a combination) or vasoconstrictor drops (which narrow swollen blood vessels in the eyes) may be suggested by a healthcare provider to manage allergic pink eye symptoms. Consult your child’s provider before using these treatments.

How to administer eye drops or ointment

Some children will tolerate the administration of eye drops well—many will fight it, particularly younger children.

Kidshealth.org gives a detailed guide to administering eye medication to children. The basics steps are:

1. Wash your hands.
2. Clean your child’s eyes.
3. Lay your child on his or her back on a flat surface.
4. Tell your child to look up and to the side so that the drops flow away from the nose.
5. Rest the wrist of your administering hand on your child’s forehead.
6. (For drops) Hold dropper within one inch of the eye, and drop the medicine in the lower eyelid, away from the tear ducts, which are located in the lower inner corner of the eye.
7. (For ointment) Pull down slightly and gently on the skin below the eye, just above the cheekbone. Bring the tube within one inch of your child’s eye, and apply a thin layer along the bottom eyelid
8. Have your child close or blink eyes for a minute to disperse medicine throughout the eye.
9. Repeat on the other infected eye, if necessary.
10. Rinse or wipe dropper or tube.
11. Wash your hands.

How to prevent pink eye in children

Infectious (viral or bacterial) pink eye is contagious like the common cold and usually spreads through contact with respiratory secretions or direct contact with the eyes. Most children touch common surfaces—such as toys, furniture, or food—that have respiratory droplets or bacteria on them and then touch or rub their eyes and infect them. 

Prevention of pink eye is similar to preventing the common cold by practicing good hand hygiene: wash hands before handling food, after using the restroom, after changing diapers, after touching eyes, nose, and mouth) and sanitation of common objects (phones, tables, door handles, toys, bottles/dishes/cups, blankets, car seats, carriers, and strollers). Don’t share personal items like pillowcases or pillows, makeup, or towels.

Other ways to help prevent the spread and/or recurrence of pink eye in children include:

• Wash items that come into contact with someone who has pink eye, such as bedding and stuffed animals.
• Clean glasses and their cases often, if your child wears them.
• Throw away any products that have been used around the eyes of an infected person, such as make-up, make-up brushes, medications (once treatment is finished), contact lenses, contact solution, and contact cases.

Also, it is important household contacts not share towels, washcloths, or eye drops or ointments. Once a child shows signs of pink eye, she or he should stay away from other children until it is resolved or they have been cleared by a medical provider.

When your child can return to school or child care

“[When a child can return to school or daycare] depends on the cause of the pink eye,” says Dr. Mandal. “Children with viral conjunctivitis can be infectious for up to two weeks, similar to when a child has the common cold.”

Bacterial conjunctivitis usually resolves without treatment, but when treated with antibiotics, children may be able to return to school sooner. “Most kids are started on an eyedrop to reduce inflammation, and can return to school when the eyes are no longer injected (red). Children with bacterial conjunctivitis can return to school 24 hours after starting an antibiotic eye drop [or ointment],” explains Dr. Mandal. “Children with allergic conjunctivitis are not contagious and can return to school or daycare.”

Since schools and child care programs are concerned about conjunctivitis outbreaks, it is important that your child’s provider write a letter stating when your child can safely return and specify if they do not have an infectious type of pink eye.

And once more for anyone who needs to hear it again, wash your hands frequently. That goes for adults and children.