Oh my gosh! Don’t touch Timmy–he’s got pinkeye! We’ve all heard this warning a dozen times, if not more. What is pinkeye, and why is it so bad? Why do you need magical drops after pinkeye in order to go back to school? Pinkeye is a poor description of three roughly related conditions called conjunctivitis. Most cases are completely harmless.
Viral conjunctivitis, or pinkeye, is the most common cause of pinkeye. It is caused by the same types of viruses that cause the common cold. It is usually associated with a sore throat, runny nose and stuffy nose, and a cough. One way to think about it is that the same virus that can infect so many disparate types of skin tissues – that is the lining of the throat, lungs, and nose–can occasionally infect the lining and skin of your eyes, causing redness and irritation and yellow discharge. The discharge is your body attempting attack the infection with antibodies and other inflammatory cells. The treatment for a viral conjunctivitis is mostly symptomatic. That is, saline rinses of the eye, and occasionally Visine or other types of redeye drops to help the appearance. But there is no cure. It will run its course within 2 to 4 days as the other symptoms of a cold virus also improve.
The second most common cause of conjunctivitis, or pinkeye, is allergic. We notice this when the pollen counts get high during spring time, or the mold counts get high during autumn. This type of pinkeye looks exactly like the other type of pinkeye. However the discharge is typically watery, and you likely won’t have a sore throat, but you may have a runny nose as most people do with allergies. Treatment-wise, there are several avenues to help with the symptoms. The first avenue of treatment are oral antihistamines (Benadryl, Claritin, etc) that will help with the release of histamine all throughout the body and will help with the itching and tearing of eyes. They may have side effects such as sedation and dry mouth. There are prescription antihistamine eyedrops as well, that will target the inflammatory effects of histamine locally right at the eyes. These include drops such as Azalastine.
The final cause of conjunctivitis is the most dangerous and feared, giving all the rest the bad rap. This is bacterial conjunctivitis. This is often caused by bacteria found on the skin such a “staph” (staphylococcus species) and “strep” (streptococcus species), as well as other nastier bacteria. These types of conjunctivitis appear typically as a nasty “beefy red” eye, with copious cloudy discharge every 15 to 20 minutes, so most of the vision is constantly obscured and the patient has to frequently wipe away discharge. These are the only type of pinkeye that require emergent and necessary treatment with antibiotic eyedrops. If not treated, the infection could spread to inside the eyeball causing a vitreitis, an eye-threatening infection. Throughout my decade-plus of emergency medicine practice, I would estimate less than 5% of all pink eyes are truly bacterial. However, I would estimate that in over 75% of pinkeye presentations I feel coerced to prescribing antibiotics drops because “the school needs to see that Timmy is treated before he can go back to school.” So yes, we are vastly over-treating most causes of conjunctivitis inappropriately, due to society’s misunderstanding of the causes and treatments required.
Now, there are other causes of conjunctival injection (redness) that mimic conjunctivitis or pinkeye. A notable ones include acute angle closure glaucoma, which is a sudden increase in the intraocular pressure in the front of the eye, which is typically sudden in onset after going into a dark room, and intensely painful, and the pupil typically becomes fixed and immobile and does not react to light. There is no discharge except for perhaps tears with this type of redeye, but it is not considered a conjunctivitis. This is an absolute emergency and requires immediate action to lower the pressures of the eye with medicated drops, and shortly after with surgery.
However, if your eye is a little pink but painless, don’t reach for the local ER, but first reach for over-the-counter saline drops to relieve the irritation, and Visine red-eye to help with the appearance. If you develop any pain or change in your vision, however, do seek medical attention.
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