What To Do When Pink Eye Strikes

There are 6 million cases of pink eye (conjunctivitis) each year in the United States, costing the nation anywhere from 377-857 million dollars annually. For years, the accepted treatment was antibiotic eye drops for everyone, no matter the cause of the pink eye. In fact, some schools still require children to be placed on antibiotic eye drops before they are allowed to return.

However, most patients DO NOT need antibiotic eye drops. In fact, a recent study in the Journal of Ophthalmology showed that nearly 60% of patients with conjunctivitis filled prescriptions for antibiotic eye drops. This is quite a bit higher than the incidence of pink eye that actually requires antibiotics, 10-20%. This practice is not only costly, but can be harmful by promoting antibiotic resistance and disrupting the normal flora of the eye.

Let’s take a look at the most common causes of conjunctivitis, how you can identify these, and the best treatments options available.

Viral conjunctivitis

Viruses are by far the most common cause of pink eye. They account for at least 80% of cases, if not more. The most common virus to cause pink eye is adenovirus, which incidentally is a major cause of colds and flu-like symptoms throughout the world.

Generally speaking, if the symptoms start as an upper respiratory infection and then progress to pink eye, the likely culprit is a virus. There are a number of other ways to identify viral conjunctivitis. Though most conjunctivitis causes a “red eye,” viral conjunctivitis tends to cause a clear drainage (versus yellow or green colored mucous), it usually does not itch, and viral infections are more likely to cause lymph node swelling on the side of the face and neck where the conjunctivitis is present.

Viral pink eye is certainly contagious similar to other common viruses – and it can be spread by the bearer of the illness for 5-12 days. Once exposed, it can take 10-14 days before showing symptoms. But it is not dangerous and will generally improve within 7-10 days.

IMPORTANT THING TO REMEMBER

Viral conjunctivitis does NOT require any treatment with antibiotic eye drops. In fact, the eye drops can actually irritate the eye because of the chemicals in the solution. What may be beneficial to help with symptoms and perhaps decrease the duration of the conjunctivitis are saline eye drops that wash away the viral infection. Many ophthalmologists are now prescribing this and, from anecdotal experience, it seems to help.

There is a type of viral conjunctivitis that requires treatment but it is generally different than the typical pink eye. Shingles is the same viral infection that causes chicken pox but can reappear and travel along the nerves in the face. If this nerve innervates the eye, the eye can be affected and requires treatment with antiviral medication. Generally the shingles rash will also be present. If you are concerned about this condition, you need to see your doctor right away for treatment.

Bacterial conjunctivitis

This type of pink eye is much less common and also generally not dangerous. In fact, studies have shown that whether bacterial conjunctivitis is treated with antibiotic eye drops or not, the infection is likely to improve in about 7-14 days.

There are a few ways to identify bacterial conjunctivitis. First, bacterial conjunctivitis can cause crusting and adherence of the eyelids upon waking. So if it’s very difficult to open your eye when you wake up, it could be bacterial conjunctivitis. Unfortunately, viral conjunctivitis can occasionally cause this as well, but generally wipes away easily and is not present throughout the day. Bacterial conjunctivitis can also cause greenish and yellowish eye discharge, which is less common with viral pink eye. Like viral conjunctivitis, bacterial usually does not itch.

In my clinical practice, I rely heavily on the exam. If a patient has colored discharge and crusting of the eye, I am more likely to consider bacterial conjunctivitis, while clear drainage without crusting leads me toward a viral illness.

IMPORTANT THING TO REMEMBER

Bacterial conjunctivitis heals on its own at least 60% of the time within 7-14 days, even without antibiotic eye drops. Because of this, an approach of avoiding antibiotic eye drops in many cases of conjunctivitis is likely to work, and can prevent the adverse reaction that can occur from these drops. A wait and see approach is acceptable in patients who have mild cases of conjunctivitis, even if bacteria could be the culprit. However, I am likely to prescribe antibiotic eye drops in patients with more moderate to severe symptoms.

As always, there are a couple caveats to the treatment above. One of these is the case of conjunctivitis with what we call hyperpurulence. This refers to patients who have a large amount of whitish (milky) drainage pouring from their eyes. This is very rare but can be caused by a more severe type of bacteria, including the possibility of gonorrhea. If you have this condition, you should be seen immediately by a physician.

Finally, if you wear contact lenses and get conjunctivitis, there is a high chance you will need antibiotic eye drops because you could be harboring a more dangerous bacteria. You should stop wearing your contacts immediately and see your doctor to discuss the best treatment.

Allergic conjunctivitis

This condition is estimated to affect as much as 40% of the population in the United States. Most patients with this condition don’t actually seek care, so it’s less often that they are seen in a doctor’s office.

The main differentiator for allergic conjunctivitis is that it causes itching. Allergic conjunctivitis is also seasonal, occurring with other outdoor allergies like pollens and ragweed. Oral antihistamines and antihistamine eye drops are mainstays of treatment, but once again, saline eye drops may dilute out the allergen causing the irritation, and significantly help with symptoms.

Step-By-Step Guide

Now you know the 3 main causes of conjunctivitis, ways to identify each cause, and some possible treatment options. But it still may not be clear what to do when pink eye strikes. Here is a simple algorithm that I follow, which can help you understand the best treatment. If you go through the guide and nothing fits, or if you are still unsure, you should see your doctor to help you make the best treatment choice.

Conclusion

Pink eye is quite prevalent in our society. The historical treatment with antibiotic eye drops is not necessarily the best option based on a number of recent studies. With this information, you are now armed to make the best and most logical decision regarding treatment for your symptoms.

Does the guide above help you? Do you think doctors should be prescribing less antibiotic eye drops? Comment below.