Treatment and Causes: Viral vs. Bacterial Pink Eye

Conjunctivitis, more commonly called “pink eye,” is inflammation or infection of the clear covering over the eyeball. It typically extends to the inner lining of the eyelids. Pink eye is easy to spot because of the redness and swelling, but it can be very hard to figure out what caused it. Viruses, bacteria, and fungi are all infectious causes of pink eye, and the signs and symptoms associated with pink eye, regardless of the infectious cause, can be very similar.

Besides infectious causes of pink eye, there are many other conditions commonly mistaken for pink eye. Like an infection, these conditions cause the conjunctiva to become inflamed, but they may not cause the drainage, swelling, and itching that are associated with infections.

Symptoms of Pink Eye

Viruses and bacteria are the most common causes of pinkeye. The symptoms for both are similar, but there are a few ways to tell them apart.

Symptoms of conjunctivitis include:

• Increased tearing
• Pink or red color to the white of the eye
• Swelling of the eye and inner eyelid
• Itching or burning
• Discharge can vary from clear to yellow-green
• Crusting on the eyelids

Symptoms of Viral Pink Eye

Symptoms associated with viral pinkeye:¹

• Clear to yellow-tinged discharge
• Watery discharge
• Cold symptoms
• Contact with people with cold symptoms

Symptoms of Bacterial Pink Eye

Symptoms associated with bacterial pink eye:²

• Yellow to green discharge
• Crusty discharge
• Ear infection
• Contact with an infected source, such as makeup

Bacterial and viral causes of pinkeye are both contagious through direct contact or by coming in contact with droplets when infected people cough or sneeze. The most common cause of viral conjunctivitis is adenoviruses, a common cold virus.

Conjunctivitis can also be spread after touching your eyes with contaminated fingers, using old and contaminated makeup, sharing personal items, and using swimming pools.³

When you have conjunctivitis, avoid close contact with other people because it is easy to get and spread pink eye.

How To Know If You Have Viral or Bacterial Pink Eye

While you cannot tell for sure whether you have bacterial or viral pink eye unless you have a culture taken from the discharge? Cultures are not routinely ordered to diagnose the cause of pink eye. There are a few clues that can help you determine which one you might have.

Consider Your Other Symptoms:

Viruses tend to inflame all your respiratory membranes before your immune system can stop their progress. If you have a runny nose and a sore throat, conjunctivitis is more likely caused by a virus. Viral conjunctivitis typically begins in one eye and spreads to the other.

Bacterial causes of conjunctivitis tend to cause more localized infections, such as an ear infection along with conjunctivitis.

Consider the Source

Were you recently around someone with cold symptoms or swimming in a pool? Viral conjunctivitis is spread when infected droplets contact your eye. Some viruses that cause conjunctivitis are very contagious and can cause large outbreaks of conjunctivitis, especially in schools and daycare settings.

Herpes simplex is a virus that causes cold sores and can also cause conjunctivitis. If you have a cold sore and eye redness, contact your doctor. Herpes simplex eye infections are potentially serious, especially if not treated. Likewise, with varicella virus and Epstein-Barr viruses, the viruses that cause chicken pox and mononucleosis.

Have you recently used old makeup or contact lenses? Did you touch your eyes with dirty hands or share makeup or other personal items with someone who may have had an infection?

Treating Pink Eye

While viral causes of pink eye cannot be treated with antibiotics, symptomatic care can make you feel better. Antibiotics and antiviral drugs can be used to treat infections caused by more serious viral causes of conjunctivitis and bacterial conjunctivitis, respectively.

Viral Pink Eye Treatment

Viral pinkeye, unless caused by herpes simplex virus or varicella virus, does not need treatment. Most viral causes of pink eye are mild and will clear up within 7 to 14 days.

Antibiotics only treat bacterial causes of conjunctivitis. Antiviral medications are used to treat more serious forms of viral conjunctivitis. If you have a cold sore or a rash or have been exposed to someone with a rash that may be caused by herpes simplex virus, Epstein-Barr, or varicella virus, contact your healthcare provider for evaluation and treatment.

Symptomatic treatments for viral conjunctivitis help improve the symptoms and include:

• Cool compresses
• Artificial tears or saline eye drops
• Remove contact lenses
• Antihistamines

Bacterial Pink Eye Treatment

Mild bacterial causes of pink eye will also clear up on their own, but antibiotic drops or ointment are commonly prescribed to shorten the length of the infection, reduce complications, and reduce the risk of spreading it to other people.

See an online doctor for a proper diagnosis and treatment for bacterial conjunctivitis, especially if you cannot see your regular doctor in person. Your online doctor can write a prescription online and transmit it to your local pharmacy for pickup.

Pink Eye Prevention

Since viruses or bacteria can cause conjunctivitis, the best way to prevent its spread is to follow standard infection control practices, such as:

• Wash your hands frequently
• Avoid being around people who are ill
• Cover all coughs and sneezes
• Avid touching your face and eyes
• Avoid crowded spaces
• Don’t swim in a pool with another person with conjunctivitis
• Don’t share makeup and other personal items
• Check your makeup and cosmetics for a due date
• Avoid sharing towels and bedding
• Wash any discharge from your eyes using a clean washcloth

Once your pink eye has cleared up, you will want to prevent reinfection by throwing away any face or eye makeup you currently use, replacing your contact lenses, and cleaning your eyeglasses.

When To Seek Medical Attention

See a doctor in person or online if your symptoms worsen or persist, your eye is swollen, you have a fever or pain, or redness extends to the skin around the eye or the eyelid.

If you think bacteria, or herpes or varicella viruses may be the cause of your conjunctivitis, call an online doctor to receive help fast. Seek emergency care if you experience vision changes, have intense pain or redness, or have a high fever.  

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

2. Epling J. Bacterial conjunctivitis. BMJ Clin Evid. Feb 20 2012;2012

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