Pink Eye in Kids: What Parents Need to Know

As a parent, one of the common health concerns you’ll probably encounter is pink eye (conjunctivitis). While pink eye can be unpleasant and sometimes contagious, it’s usually manageable.

Learn more about what pink eye is, its causes, how to treat it, and when to worry in a blog and HealthTalks podcast from Lauren Strelitz, MD, a pediatrician at Stanford Medicine Children’s Health — Pediatrics in Pinole.

What is pink eye?

Dr. Strelitz explained that conjunctivitis, more commonly known as pink eye, is caused by an infection or irritation of the conjunctiva, which is what we see as the whites of the eyes. When this tissue becomes inflamed, it leads to redness and irritation.

Viral pink eye is the most common form of pink eye, especially in kids, and is often caused by adenoviruses—the same group of viruses that cause colds. Viral pink eye is highly contagious and usually occurs alongside symptoms like a runny nose, cough, or sore throat. Another emerging common viral cause of pink eye in Covid.

“You really need to take the whole clinical picture into account,” Dr. Strelitz said. “Does the child have a runny or stuffy nose? Are they a younger child? Viral is the most common cause for school-aged children, preschoolers, even really up to middle schoolers and high schoolers.”

Bacterial pink eye is less common than viral, and often causes thick, yellow, or green discharge, which can make the eye appear goopy. It may start in one eye and spread to the other and is commonly seen in children who have been in close contact with others who have bacterial infections.

“If it’s one sided, there are no associated symptoms like a runny nose, then you might start thinking more about a bacterial infection, especially if they’ve been around other kids that have bacterial pink eye,” Dr. Strelitz said.

Allergic pink eye is triggered by allergens like pollen, dust, pet dander, or mold. It isn’t contagious but can cause significant discomfort, such as itchy and watery eyes and puffiness around the eyes.

Dr. Strelitz explained that this form of pink eye could be triggered by an exposure to an allergen. For example, visiting a home where there are cats, or a child could have an allergic reaction in the classroom in the winter because its dustier than usual with all the windows closed and the heater on.

Another non-contagious form of pink eye is caused by an injury or scratch on the eye. “It could be caused by a foreign body, like an eyelash, or a recent injury,” Dr. Strelitz said. “Did somebody poke their finger into their eye? Did they fall on something? Were they out at the beach on a windy day and catch a speck of sand?”

Another more serious form of infectious pink eye is caused by chickenpox or the herpes virus and necessitates emergency treatment to prevent vision loss, Dr. Strelitz explained.

Signs and symptoms of pink eye

According to Dr. Strelitz, when we think about symptoms of pink eye, we usually picture the classic goopy eye. But pink eye symptoms actually vary based on the cause:

Viral: Redness, watery discharge, irritation, and often cold symptoms.

Bacterial: Redness, swelling, and thick yellow or green discharge that may cause the eyelids to stick together, especially in the morning.

Allergic: Redness, itching, swelling, and watery eyes, often affecting both eyes at once.

How pink eye is spread

Pink eye is infamous for being easy to catch and spread, particularly in schools or daycare settings, Dr. Strelitz shared.

“It’s spread by touching. You touch something with bacteria, then you touch your eye. If you’re in a grocery store with a bunch of people who have COVID, you may get COVID and you may get pink eye from it,” she said.

“Other viruses, like adenovirus, are spread by droplets. So, if somebody sneezed or coughed near you, those droplets get in your mouth, your nose or in your eye. And any of those things could cause viral-associated pink eye.”

Sharing contaminated objects like towels or eye makeup can also transfer germs to the eye and cause infection. However, allergic pink eye isn’t spread from person to person but is activated by allergens in the environment.

Managing and treating pink eye

Your doctor is going to tell you what kind of treatment is necessary based on the type of infection. Dr. Strelitz explained that most of the time pink eye resolves on its own. Viral pink eye should go away within 7 to 14 days. Cool compresses can soothe symptoms, and parents should encourage handwashing to prevent spreading.

Bacterial pink eye is usually treated with prescription antibiotic eye drops or ointments. Giving eye drops to a squirmy preschooler may be challenging, but Dr. Strelitz has a tip: “One method that I recommend is having the child lie down, put the dropper on the inside corner of the affected eye and then do a couple drops and then have them blink it in,” she said.

She also noted that kids with bacterial pink eye should stay home from school or daycare for at least 24 hours after starting antibiotics.

Managing allergies can help with allergic conjunctivitis. Dr. Strelitz suggests limiting contact with allergens and maintaining good hygiene. “If you can find out what they’re allergic to, try to limit contact with that, or if they cannot avoid it, make sure they’re taking their medicine,” she said.

Dr. Strelitz explained that hardwood floors are the best for someone with a dust allergy. If your home has carpeting, then use a vacuum that has a HEPA filter. Also remember to wash curtains, too.

For teens who wear contact lenses, Dr. Strelitz recommends getting seen as soon as any symptoms appear. “One special circumstance that warrants more urgent evaluation is somebody with pink eye who wears contact lenses,” she said. “Contact lenses can harbor bacteria behind them. And that can lead to some pretty serious infections that can be extremely severe, but maybe just start off with red eyes.”

When to see the doctor

Dr. Strelitz urges parents to visit the pediatrician if you notice any of the following:

Pain, light sensitivity, or vision changes.

Swelling or redness of the eyelid that worsens throughout the day.

Symptoms lasting more than two weeks.

Pink eye caused by herpes or chickenpox requires immediate antiviral treatment to prevent serious complications.

“If it’s just one eye and it’s been a few days without spreading to the other eye, if it’s bothering the child, or if they’re waking up and their eyes or eyelids are stuck together, that would be a reason to see a pediatrician,” she said.

“If we think it’s viral and it’s lasting beyond two weeks, they definitely need to see a doctor. I think any time a family is worried, they should see the doctor, as that’s what we’re here for.”

For more advice from Dr. Strelitz, read Be Sun Smart: How to Protect Your Child’s Skin, or Doctor’s Office, Urgent Care or Emergency Room: What’s the Right Choice for Your Child?

To learn more about pink eye, check out Conjunctivitis.