Understanding Contagion Risk
The contagiousness of pink eye depends entirely on its underlying cause. Viral and bacterial conjunctivitis are highly contagious, while allergic conjunctivitis poses no transmission risk.
Viral
Highly contagious for 10-14 days. Spreads through direct contact and respiratory droplets.
Bacterial
Contagious until 24 hours after antibiotic treatment begins. Spreads via contaminated surfaces.
Allergic
Not contagious. Caused by environmental allergens and immune response.
Clinical Detection and Differentiation
Viral Conjunctivitis
- Watery discharge with minimal mucus
- Affects one eye initially, often spreads to both
- Associated with upper respiratory infection symptoms
- Preauricular lymph node enlargement
- Photophobia and foreign body sensation
Bacterial Conjunctivitis
- Thick, purulent yellow or green discharge
- Eyelids stuck together upon waking
- Rapid onset, typically unilateral initially
- Conjunctival injection and chemosis
- No significant itching or systemic symptoms
Allergic Conjunctivitis
- Intense bilateral itching and tearing
- Stringy mucoid discharge
- Seasonal pattern or exposure-related onset
- Associated with rhinitis and sneezing
- Conjunctival edema and papillary reaction
Immediate Care Protocols
Viral Conjunctivitis Treatment
- • Apply cool sterile compresses for 10-15 minutes, 4-6 times daily
- • Artificial tears without preservatives every 2-3 hours
- • Avoid topical antihistamines or vasoconstrictors
- • Self-limiting condition: resolves in 7-14 days
Bacterial Conjunctivitis Treatment
- • Topical antibiotic therapy: fluoroquinolones or aminoglycosides
- • Apply medication 4 times daily for 5-7 days
- • Warm compresses to facilitate drainage
- • Gentle eyelid hygiene with sterile saline solution
Allergic Conjunctivitis Treatment
- • Topical antihistamine-mast cell stabilizer combination
- • Cold compresses to reduce inflammation and itching
- • Allergen avoidance and environmental control measures
- • Oral antihistamines for systemic allergic symptoms
Prevention Protocols
Household Transmission Prevention
Personal Hygiene
- • Wash hands with soap for 20 seconds after eye contact
- • Avoid touching or rubbing eyes
- • Use disposable tissues for discharge removal
- • Change pillowcases daily during active infection
Item Isolation
- • Do not share towels, washcloths, or linens
- • Discard eye cosmetics used during infection
- • Clean eyeglasses with alcohol-based solution
- • Disinfect contact lens cases or discard
Workplace and School Guidelines
- 1. Exclusion Period: Remain home until discharge ceases or 24 hours after antibiotic initiation
- 2. Surface Disinfection: Clean high-touch surfaces with EPA-registered disinfectants
- 3. Hand Hygiene Stations: Ensure accessible handwashing facilities and alcohol-based sanitizers
- 4. Contact Lens Prohibition: Discontinue lens wear until complete resolution
- 5. Swimming Pool Avoidance: Refrain from pool use during active infection period
⚠️ When to Consult a Specialist
Seek immediate ophthalmological evaluation if you experience any of the following:
- • Moderate to severe eye pain
- • Significant photophobia or light sensitivity
- • Blurred vision or visual acuity changes
- • Corneal opacity or infiltrate
- • Severe headache with ocular symptoms
- • Immunocompromised status
- • Contact lens-related infection
- • No improvement after 3-5 days of treatment
Neonatal conjunctivitis requires immediate medical attention due to risk of gonococcal or chlamydial infection with potential for systemic complications.
Clinical Considerations
Differential Diagnosis
Conjunctivitis must be differentiated from more serious conditions including:
- Acute angle-closure glaucoma
- Keratitis or corneal ulceration
- Uveitis or iritis
- Scleritis or episcleritis
- Foreign body or corneal abrasion
Epidemiology
Conjunctivitis accounts for approximately 1-4% of primary care visits. Viral etiology represents 65-90% of infectious cases, with adenovirus being the most common pathogen. Bacterial conjunctivitis occurs more frequently in children, while allergic conjunctivitis affects up to 40% of the population seasonally.
Prognosis
Most cases of conjunctivitis are self-limiting with excellent prognosis. Viral conjunctivitis typically resolves within 2-3 weeks without sequelae. Bacterial conjunctivitis responds rapidly to appropriate antibiotic therapy. Complications are rare but may include corneal involvement, chronic inflammation, or secondary infection.