Pink Eye: Which Kind It Is, and Whether Your Child Can Go to School

Two questions bring people to this page, and they are almost never the medical one. What is this, and can they go to school tomorrow?

The short version: most pink eye is viral, most viral pink eye does not need antibiotic drops, and the school answer depends on your school rather than on us. Everything below is how to tell which kind you are looking at, and the handful of situations where a red eye is not a minor problem at all.

Four red eyes that need seeing the same day

• A baby under one month old with a red or discharging eye. Newborn conjunctivitis is a different problem with different causes and it is assessed urgently.
• Anyone who wears contact lenses. Take the lenses out, do not put them back in, and call today. A red eye in a lens wearer can be a corneal infection, which threatens sight.
• Real pain, light sensitivity, or any change in vision. Ordinary pink eye is gritty and irritating. It does not hurt deeply, and it does not blur vision beyond what a blink clears.
• An eye injury, or anything chemical splashed in the eye. Rinse with plenty of clean water for several minutes first, then get seen.

Telling the three kinds apart

	Viral	Bacterial	Allergic
Discharge	watery	thick, yellow or green	watery, stringy
Eyes stuck shut in the morning	sometimes	classically, yes	no
Itch	some	some	intense — the main complaint
One eye or both	starts in one, often spreads	often one	almost always both
Company it keeps	a cold, sore throat, recent fever	sometimes an ear infection	sneezing, runny nose, a season
Usual treatment	none needed	drops, sometimes	allergy treatment, not antibiotics

Viral is the common one, and it travels with a cold. It often starts in one eye and reaches the other a day or two later, which alarms parents and is completely expected. It gets better on its own over a week or two, and antibiotic drops do nothing to it.

Bacterial is the one with genuinely thick discharge that keeps coming back through the day and glues the lashes overnight. It sometimes needs drops and sometimes clears on its own. It is worth being looked at rather than guessed at.

Allergic is badly under-diagnosed, and in this state that matters. The tell is the itch — not irritation, but a child who wants to rub their eyes constantly — in both eyes, with no fever and no illness, often alongside sneezing and a runny nose. It is not contagious at all, it does not keep anyone off school, and it is the kind most often treated with antibiotic drops that cannot possibly help.

The school question, honestly

Policies differ, and the school’s policy is the one that decides. Ask them directly rather than relying on any page, including this one. What we can do is give you the note or the assessment they ask for.

What is generally true: allergic pink eye is not contagious and is not a reason to stay home. Viral and bacterial pink eye are contagious, and many schools and child care centres ask that a child stays home until the discharge has settled or until they have been on treatment for a day. Some ask for a clinician’s note before a child returns, which is a common reason families come in for something that would otherwise get better by itself — and that is a completely reasonable use of a visit.

If you need the note, say so when you call. It changes nothing clinically and it saves everyone a second appointment.

What helps at home

Cool compresses for comfort — a clean cloth, a fresh one each time. Warm compresses help loosen crusting if the lashes are stuck.

Wipe from the inner corner outwards, with something clean each time, and use a separate cloth for each eye.

Handwashing, relentlessly. This is how the whole household avoids it. Change pillowcases and towels, and do not share either.

Take contact lenses out and leave them out until you have been told otherwise. Throw away the pair that was in when it started, and the case.

Bin any eye makeup in use when it started.

Artificial tears are safe and help the grittiness.

Sunglasses outdoors if light is bothering them, which in Phoenix is not a small thing.

Three things not to do

Do not use leftover antibiotic drops from a previous illness, or somebody else’s. They expire, they may be the wrong thing, and a bottle already used in an infected eye is contaminated.

Do not use steroid eye drops unless a clinician has examined the eye and prescribed them. If the cause is a herpes infection of the eye, steroids can make it considerably worse and can damage sight. This is the single most important sentence on this page and the reason a red eye should not be self-treated from a medicine cabinet.

Do not use redness-reducing drops. They constrict blood vessels to hide the appearance and treat nothing.

Call us if

• The four same-day situations in the box above
• Symptoms getting worse after three or four days, or no improvement in a week
• Thick discharge that keeps rebuilding through the day
• Swelling or redness of the eyelid or the skin around the eye, or any fever with it — spreading redness around the eye and into the lid is a different and more serious infection
• Pink eye with an earache, which often means a bacterial cause worth treating
• Your child is rubbing enough to worry you about the eye itself
• It keeps coming back
• You need a note for school — a real and legitimate reason to be seen

The Arizona part

Most of the year, an itchy red eye here is more likely allergy than infection, and that is genuinely different from the national picture. Our allergy calendar does not match the one everyone reprints: spring runs early, there is a second run in autumn, and dust and wind put particulate in the air on days when nothing is blooming at all. Add haboob season and the air conditioning running for eight months, drying every eye in the house.

The practical consequence is a common and avoidable mistake: a child with allergic conjunctivitis gets antibiotic drops, gets no better, and stays home from school for a condition that was never contagious. If both eyes itch, there is no fever, nobody else is ill, and it happens around the same time each year, say that when you call. It points somewhere different, and the treatment that works is on our allergy page.

Sources

8. Conjunctivitis or pink eye — MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/001010.htm

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