Conjunctivitis: Online Diagnosis and Treatment

Conjunctivitis, commonly referred to as pinkeye, causes eye redness, itching, and drainage. In addition to the uncomfortable symptoms, having pink eye can put a dent in your income. Daycares and workplaces often won’t let people return to work unless their conjunctivitis is treated.¹ Because conjunctivitis has several causes, each requiring a different treatment, it is important to see a doctor to get an accurate diagnosis. Telehealth for conjunctivitis is a perfect solution, getting you back to work quickly.

Scheduling a consultation with a virtual doctor on the Telegra MD telehealth platform is simple and convenient. You will receive a diagnosis, a treatment protocol, and an appropriate online prescription to treat your conjunctivitis symptoms. Telehealth for conjunctivitis treatment makes it easy to consult with a virtual doctor and receive conjunctivitis treatment quickly and easily, even if you don’t have insurance.

Each year, approximately 6 million people get conjunctivitis.² About 1 in 3 visits to the emergency department for an eye-related condition is attributed to conjunctivitis. Treating bacterial conjunctivitis has an annual direct cost of $377 million to $857 million annually in the U.S.⁴ The indirect cost of bacterial conjunctivitis alone adds another $63 to $141 million due to school and work absenteeism. The total economic impact of conjunctivitis is estimated to exceed $1 billion annually.⁵

Telehealth is expected to decrease the costs of conjunctivitis because online doctors who treat conjunctivitis provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

What Is Conjunctivitis?

Conjunctivitis is inflammation of the conjunctiva, the clear membrane that covers the sclera (the white part of the eye) and the inner lining of the eyelids. A variety of bacterial and viral pathogens can cause conjunctivitis. Allergies, irritants, and medication side effects are other potential causes. Most of the time, conjunctivitis will resolve on its own, but some may progress and cause potentially serious complications.²

Can Conjunctivitis Be Treated Through Telehealth?

Absolutely, telehealth is an ideal platform for treating conjunctivitis. Conjunctivitis is a clinical diagnosis. The diagnosis is based on your symptoms. Your virtual doctor will diagnose conjunctivitis if you have symptoms consistent with conjunctivitis and do not have symptoms associated with other medical conditions. Consulting with a virtual doctor to discuss your conjunctivitis symptoms is a convenient way to get an accurate diagnosis, receive treatment for your conjunctivitis, and get a doctor’s note to return to school or work.

How Do You Get Conjunctivitis?

Viruses are the most common cause of infectious conjunctivitis. There are over 200 different viral strains that cause colds and viral conjunctivitis.⁶ Viral conjunctivitis is highly contagious, so it is very easy to get pink eye. The viruses that cause conjunctivitis spread via contaminated fingers, medical instruments, swimming pools, and sharing personal items.⁷ To prevent the spread of conjunctivitis, wash your hands frequently and avoid touching your eyes or nose.

Bacterial conjunctivitis can also spread from person to person. Touching contaminated objects and then touching your eyes is a common way to get conjunctivitis. It can also be spread when large, contaminated droplets are emitted when an infected person coughs or sneezes and the droplets land on your eyes.

Gonorrhea and chlamydia can also cause bacterial conjunctivitis. These bacteria can be transmitted from the genitals to the eye or vertically from an infected mother to her newborn.

What Are Common Symptoms of Conjunctivitis?

In addition to redness and swelling of the eyeball and eyelid coverings, other symptoms of conjunctivitis include:

• A feeling that there is something in your eye
• Pink or red eye
• Burning sensation
• Crusting of the eyelids and eyelashes
• Discharge, which varies from clear to yellow-green
• Gritty feeling in the eyes
• Irritated eyes
• Itchiness
• Swollen eyelids
• Watery eyes

Pinkeye signs and symptoms may also vary based on whether you have bacterial, viral, or allergic conjunctivitis.

Bacterial conjunctivitis

Bacterial conjunctivitis typically comes on suddenly, causes little pain or itching, and is characterized by a yellow, green discharge. Many people with bacterial conjunctivitis can identify a recent exposure. Symptoms typically develop in one eye and spread to the other.

Viral conjunctivitis

Viral conjunctivitis also typically starts in one eye but quickly spreads to the other eye. Like with bacterial conjunctivitis, many people can identify a recent exposure to conjunctivitis. When you have a viral cause of conjunctivitis, the discharge is watery to yellowish, and there is little pain or itching.

Many people with viral conjunctivitis have other symptoms associated with viral infections, such as:

• Runny nose
• Cough
• Sneezing
• Nasal congestion
• Sore throat
• Swollen glands
• Low-grade fever

Allergic conjunctivitis

Unlike viral or bacterial conjunctivitis, allergic conjunctivitis is not contagious, and there is no exposure history. Allergic conjunctivitis is characterized by intense itching, tearing, and swelling with a watery discharge. In addition to pink eye, most people with allergic conjunctivitis have other allergy symptoms, such as a runny nose, facial itchiness, and a dry cough.  

If you notice a pattern to your conjunctivitis, such as increased symptoms in the spring or fall, it is more likely allergic conjunctivitis.

Using telemedicine for conjunctivitis, your online doctor can evaluate your symptoms, make an online conjunctivitis diagnosis, and provide a treatment plan for conjunctivitis or another condition.

When Should You See a Doctor for Conjunctivitis?

Pink eye is common and easy to diagnose, but the underlying cause is difficult to determine, and treatment depends on the cause. Besides infectious and irritant causes of red or pink eye, the Centers for Disease Control and Prevention recommend seeking more immediate in-person care if you have the following symptoms.

• Eye pain
• Fever
• Light sensitivity
• Swelling, redness, or tenderness around the eye or eyelids
• Symptoms that don’t improve within 24 hours
• Vision changes

Finding a virtual doctor on call is easy in this age of telemedicine. A virtual doctor can evaluate your symptoms and provide an online conjunctivitis diagnosis. Many online doctors who treat conjunctivitis provide 24-hour access, which means you can expect doctor access whenever you need it. If your online doctor believes that you have bacterial conjunctivitis and need an antibiotic or conjunctivitis that needs symptomatic treatment, they can send an online prescription to an online or local pharmacy.

Are Some People at Increased Risk of Conjunctivitis?

Children are at increased risk for conjunctivitis, especially viral causes. People who wear contact lenses are also at increased risk. If you wear contact lenses, stop wearing them until your treatment is complete. Contact lens wearers are at an increased risk for corneal damage. If your symptoms change or worsen, contact your doctor for a re-evaluation.

How Do You Diagnose Conjunctivitis?

Conjunctivitis is a clinical diagnosis. Virtual and in-person doctors follow standard practice guidelines. Your doctor will ask about your symptoms and past medical history. They may also ask whether you have been recently exposed to someone with conjunctivitis.

Next, they will examine your eyes or ask you to submit a picture of your eyes. In most cases, a diagnosis of conjunctivitis can be made after reviewing your medical history and looking at your eyes. Eye discharge type and pattern are important clues about the cause of your conjunctivitis.⁷

If you have any of the following symptoms or signs, your doctor may refer you to an eye specialist called an ophthalmologist for further evaluation:⁷

• Vision loss or changes
• Moderate or severe eye pain
• Changes in the surface of your cornea, a part of the eye that covers your iris and pupil
• Conjunctival scarring
• No response to treatment within a week
• A history or concern about herpes simplex or varicella-zoster conjunctivitis
• Sensitivity to light

Research suggests that the clinical presentation of conjunctivitis is often nonspecific, meaning that symptoms associated with one type of conjunctivitis overlap with other types. When consulting with a virtual doctor for conjunctivitis, please provide them with as much information as possible. Make a follow-up appointment if your symptoms worsen or change.

How do You Treat Conjunctivitis?

The treatment for conjunctivitis will depend on the cause.

Viral conjunctivitis

Viruses account for about 80% of all infectious conjunctivitis cases.⁷ The most common viruses that cause conjunctivitis are adenoviruses (65% to 90% of cases).⁸ Other viral causes of conjunctivitis include rubella, rubeola, enterovirus, Epstein Barr virus, herpes simplex virus, and varicella-zoster virus.

Most cases of viral conjunctivitis are mild and will resolve on their own within 7 to 14 days. Antibiotics do not treat viral conjunctivitis. If your doctor diagnoses viral conjunctivitis, they will probably recommend symptomatic treatment such as: ⁹

• Saline eye drops
• Cold or warm compresses

Viral conjunctivitis is very contagious, so don’t share compresses or use the same compress for an infected and noninfected eye.

If you have a cold sore and conjunctivitis, your conjunctivitis may be due to herpes simplex virus 1 (HSV-1). If you have herpes conjunctivitis, your doctor will control the infection with antiviral medication. Eye herpes can be a serious condition. The virus can invade deeper layers of the eye and potentially cause blindness. Varicella-zoster virus can cause a similar presentation and also needs to be diagnosed quickly and treated.

Bacterial conjunctivitis

Bacterial conjunctivitis is commonly seen in children, with a peak incidence from December through April.⁷ Bacterial conjunctivitis is treated with antibiotic ointments or drops, although mild cases may resolve on their own. Antibiotics can shorten the length of symptoms, reduce complications, and reduce the spread of infection to others. Saline drops or compresses can also help with conjunctivitis symptoms.

N. gonorrhoeae and chlamydia can cause a more severe form of conjunctivitis that requires systemic treatment in addition to antibiotic eye ointments.⁷ See an eye doctor if you suspect these forms of conjunctivitis. Avoid wearing contact lenses until your bacterial conjunctivitis has resolved.

Allergic conjunctivitis  

Overall, allergic conjunctivitis is the most common form of conjunctivitis, with a peak incidence in the spring and summer. Approximately 40% of the U.S. population has allergic conjunctivitis at some point, but only one in ten people with symptoms seek medical care.⁷ Allergic conjunctivitis is treated with a combination of medications, including:

• Antihistamines
• Decongestants
• Mast cell stabilizers
• Nonsteroidal anti-inflammatory drugs
• Saline drops
• Steroid eye drops

See a doctor in person or online and experience the benefits of telemedicine if your symptoms worsen or persist or if you are unsure whether you have pinkeye or need antibiotics to treat an infection.

What Are Some Common Medications Used to Treat Conjunctivitis?

Medication choice will depend on the cause of conjunctivitis.

Viral conjunctivitis:

• Artificial tears
• Topical antihistamines

Herpes simplex virus

• Oral acyclovir
• Oral famciclovir
• Oral valacyclovir
• Topical ganciclovir 0.15% gel
• Trifluridine 1% solution

Bacterial Conjunctivitis

• Gonococcus (adult): Ceftriaxone, Azithromycin, or Doxycycline
• Chlamydia (adult): Azithromycin or Doxycycline

For other bacterial causes of conjunctivitis, potential treatment options include:

• Azithromycin drops
• Bacitracin ointment
• Ciprofloxacin drops or ointment
• Erythromycin ointment
• Gatifloxacin drops
• Gentamicin drops or ointment
• Moxifloxacin drops
• Ofloxacin drops 
• Trimethoprim-polymyxin B
• Bacitracin-polymixin B
• Sulfacetamide solution or ointment
• Tobramycin drops or ointment

Can You Prevent Conjunctivitis?

Because viral and bacterial conjunctivitis are very contagious, it is important to protect yourself and others from infection by

• Washing your hands frequently
• Avoid touching your face and eyes
• Cover coughs and sneezes
• Don’t go in a swimming pool if you or someone else has conjunctivitis
• Wash your pillowcases, sheets, washcloths, and towels, often with hot water and soap
• Don’t share personal items

If you have a red or pink eye, consult with an online doctor to be evaluated quickly, receive treatment, get a doctor’s note, and rule out any other conditions that are commonly misdiagnosed as pink eye.

 Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Ohnsman CM. Exclusion of students with conjunctivitis from school: policies of state departments of health. J Pediatr Ophthalmol Strabismus. 2007 Mar-Apr;44(2):101-5. doi: 10.3928/01913913-20070301-03. PMID: 17410961.

2. Schneider JE, Scheibling CM, Segall D, Sambursky R, Ohsfeldt RL,Lovejoy L. Epidemiology and economic burden of conjunctivitis:a managed care perspective.J Manag Care Med.2014;17(1):78–83.

3. Høvding G. Acute bacterial conjunctivitis. Acta Ophthalmol. Feb 2008;86(1):5-17. doi:10.1111/j.1600-0420.2007.01006.x

4. Smith A, Waycaster C. Estimate of the direct and indirect annual cost of bacterial conjunctivitis in the United States. BMC Ophthalmology. 2009;9(1):13.

5. Pepose JS, Sarda SP, Cheng WY, McCormick N, Cheung HC, Bobbili P, Joseph C, Duh MS. Direct and Indirect Costs of Infectious Conjunctivitis in a Commercially Insured Population in the United States. Clin Ophthalmol. 2020 Feb 11;14:377-387. doi: 10.2147/OPTH.S233486. PMID: 32103884; PMCID: PMC7023864.

6. Grief SN. Upper respiratory infections. Prim Care. Sep 2013;40(3):757-70. doi:10.1016/j.pop.2013.06.004

7.  Azari AA, Barney NP. Conjunctivitis: A Systematic Review of Diagnosis and Treatment. JAMA. 2013;310(16):1721-1730. doi:10.1001/jama.2013.280318

8. O’Brien TP, Jeng BH, McDonald M, Raizman MB. Acute conjunctivitis: truth and misconceptions. Curr Med Res Opin. Aug 2009;25(8):1953-61. doi:10.1185/03007990903038269

9. Chan VF, Yong AC, Azuara-Blanco A, Gordon I, Safi S, Lingham G, Evans J, Keel S. A Systematic Review of Clinical Practice Guidelines for Infectious and Non-infectious Conjunctivitis. Ophthalmic Epidemiol. 2022 Oct;29(5):473-482. doi: 10.1080/09286586.2021.1971262. Epub 2021 Aug 29. PMID: 34459321.