Pink Eye (Conjunctivitis) in Children

Symptoms

Pink eye, known medically as conjunctivitis, is inflammation of the conjunctiva, the thin, clear tissue that lines your child's eyelids and covers the white of the eye. When that tissue is irritated or infected, its blood vessels widen and the eye turns pink or red. The American Academy of Pediatrics (AAP) describes conjunctivitis as typically benign and self-limited, which means it usually improves on its own without treatment and causes no lasting harm.

Most parents notice the color first, then the discharge. You may also notice the following symptoms:

Pink or red in the white of the eye. The redness spreads fairly evenly across the whole white of the eye rather than sitting in one patch.
Discharge. Watery and clear with viral and allergic pink eye, thick and yellow or green with bacterial pink eye.
Crusting and stuck lashes. Discharge dries overnight, and your child may wake with lashes glued together or a crust along the lid.
Itching. Mild with infections and intense with allergies.
A gritty or burning feeling. Older children describe it as sand or an eyelash in the eye. Younger ones will simply rub their eye.
Watery eyes. Tearing increases in every type of pink eye.
Puffy eyelids. Mild swelling is common. Marked swelling with warm or firm skin around the eye is something different and needs prompt care.
One eye, then often both. Viral and bacterial pink eye often start on one side and cross over within 1-2 days. Allergic pink eye almost always affects both from the start.

How symptoms differ by type

There is no single sign that determines the type of pink eye, and even clinicians cannot always tell viral from bacterial by looking. These patterns can help you describe what you're seeing.

Viral. Watery discharge, a burning or gritty feeling, and cold symptoms such as a runny nose, cough, or sore throat. A tender gland in front of the ear is a common clue.
Bacterial. Thick yellow or green discharge that returns soon after wiping, and lashes stuck shut in the morning. More than half of pink eye in children is bacterial. The usual culprits are Haemophilus influenzae (a common ear-infection bacterium, unrelated to the flu despite its name), Streptococcus pneumoniae (a strep bacterium, also behind many ear and chest infections), and Moraxella catarrhalis (another everyday ear and sinus bacterium), in that order. An earache alongside the pink eye is common enough to have a name: conjunctivitis-otitis syndrome (pink eye plus an ear infection).
Allergic. Both eyes, intense itching, watery discharge, and sneezing or a runny nose. It tends to follow the seasons and returns each year.
Irritant. Redness and watering in the eye after exposure to pool chlorine, smoke, dust, or soap, with no discharge and no fever.

How symptoms differ by age

Newborns (birth to 4 weeks). Any red, swollen, or draining eye in a newborn needs care right away. Infections passed during birth can move fast and threaten a baby's vision. Chemical irritation from newborn eye ointment tends to appear within the first 24 hours, as redness with minimal to no drainage. Eye redness with drainage appearing between days 2 and 5 may be a sign of gonorrhea and between days 5 and 14 may be a sign of chlamydia.
Babies and toddlers. This age cannot tell you an eye hurts, so watch for rubbing, extra fussiness, waking at night, and turning away from bright light. Bacterial pink eye is the most common type here, and often happens with an ear infection.
School-age children. Viral pink eye moves quickly through classrooms and sports teams. Children can usually describe the gritty feeling and point to the eye that bothers them.
Teens. Seasonal allergic conjunctivitis becomes more common, and contact lens wear introduces a real risk of corneal infection. A teen with a red eye who wears lenses should stop wearing them and be seen the same day.

Symptoms that need urgent attention

Pink eye does not usually cause severe pain, marked light sensitivity, or any persistent change in vision. If your child has one of the following, treat it as urgent rather than routine pink eye:

A newborn 4 weeks old or younger with a red, swollen, or draining eye
Severe eye pain, or an eye your child won't open
Vision loss, or blurry vision that doesn't clear when you wipe the discharge away
Light sensitivity that causes pain, or pain when your child moves the eye
Skin around the eye or on the lid that is red, swollen, hard, or hot, especially with fever
A cold sore or blister near the eye
Eye redness in a child who wears contact lenses
No improvement after 24 hours of antibiotic eye drops

Treatments

Treatment depends entirely on which type of pink eye your child has, and for most children it means comfort care rather than medicine.

Seek care now

Most pink eye can wait for a routine visit. These cannot:

A newborn 4 weeks old or younger with a red or draining eye. Go to the emergency room. Infections passed during birth can damage your baby's vision within days, and they are treated with antibiotics given by injection or through a vein rather than drops.
A cold sore or blister near the eye. This suggests herpes simplex (the cold sore virus), which needs antiviral medicine. Steroid drops make it worse, so it has to be identified before any drops are started.
Red, swollen, or hot skin around the eye. This can be periorbital cellulitis (a skin infection in the eyelid and the tissue around the eye). It needs antibiotics by mouth, not eye drops.
A red eye in a child who wears contact lenses. Take the lenses out and call the same day. It is treated as bacterial and checked for a corneal ulcer (an open sore on the clear front surface of the eye).
Severe pain, light that clearly hurts, or any persistent change in vision. Pink eye does not usually cause these. They point to something else and need same-day care.

The everyday plan

Viral pink eye. There is no medicine that cures viral pink eye, and antibiotics do nothing against a virus. Treatment is about comfort while the infection runs its course: cool compresses, preservative-free artificial tears, and gently wiping drainage away. Think of it like a cold in the eye. Two viruses are exceptions: herpes simplex (the cold sore virus) and varicella-zoster (the chickenpox virus). These infections may need prescription antiviral medicine, so a blister near the eye should be checked by a clinician the same day.

Bacterial pink eye. Mild bacterial pink eye often clears on its own in 2-5 days, and the AAP notes that antibiotics shorten the illness only a little. A clinician may still prescribe antibiotic eye drops or ointment, which can shorten the infection, reduce the small risk of complications, and cut down on spread. Drops are more likely to be recommended when there is heavy pus, when your child has a weakened immune system, when certain bacteria are suspected, or when your child wears contact lenses.

When pink eye arrives alongside an ear infection, treatment changes: that combination is usually caused by Haemophilus influenzae, and it is treated with an antibiotic taken by mouth rather than drops alone. Tell the clinic if your child is tugging at an ear or complaining it hurts.

Allergic pink eye. Because allergic pink eye keeps coming back as long as the trigger such as pollen, grass, or trees is present, treatment works on two levels at once.

Right now. Get away from the trigger where you can, then use cool compresses and preservative-free artificial tears, which rinse allergens off the surface of the eye. A clinician can recommend an antihistamine eye drop or an oral antihistamine suited to your child's age.
Throughout the season. Ongoing control matters more than treating each flare. That means identifying the trigger, reducing exposure at home, and for some children a daily antihistamine or allergy eye drop through the season. Children with stubborn or year-round symptoms may be referred to an allergist.

Never use steroid eye drops in a child without a clinician directing it. They can worsen an undiagnosed herpes infection and raise eye pressure.

Irritant pink eye. Remove the irritant and the eye settles, usually within hours. Rinse with lukewarm clean water or saline, then use artificial tears for comfort. A chemical splash is different: rinse for 15 to 20 minutes immediately, call Poison Control at 1-800-222-1222, and go to the emergency room.

What to expect

Timelines vary by type, which also decides when your child can go back to school or child care.

Type	Typical course	Contagious for	Back to school
Viral	Clears in 7-14 days, sometimes 2-3 weeks	As long as symptoms last; adenovirus can spread for weeks	Usually right away, unless there is fever or your child feels too unwell
Bacterial	Often improves in 2-5 days untreated, up to 2 weeks to clear fully	Until symptoms clear, or about 24 hours after drops begin	Usually right away; some programs ask for 24 hours of drops first
Allergic	Lasts as long as the trigger is present, often seasonal	Not contagious	No restriction
Irritant	Settles within hours to a day once the irritant is gone	Not contagious	No restriction

For school and child care, the AAP suggests thinking about pink eye much like a common cold: it passes between children, and it resolves. Most children do not need to stay home unless they have a fever or feel too unwell to take part in the day. Many programs still set their own rules, so check your school's or childcare's policy. If your child is too young to keep their hands out of their eyes, staying home while discharge is the heaviest cuts down on spread.

If treatment isn't working — Call the clinic if your child's condition hasn't improved after 24 hours of antibiotic drops, if redness or discharge is getting worse rather than better, if symptoms pass 7-10 days without easing, or if a fever appears. Also call right away if pain becomes severe, light sensitivity causes pain, vision changes, or the skin around the eye becomes red and swollen. Any of these means the diagnosis or the treatment needs revisiting, and something other than ordinary pink eye may be going on.

At-home Care

Alongside whatever a clinician recommends, most of what helps a child with pink eye happens at home.

A word on eye drops

Use only drops that a clinician prescribed for your child and this illness. Skip leftover drops, drops prescribed for someone else, and over-the-counter redness relievers, which sting and can mask what is happening underneath. Antibiotic drops do nothing for viral or allergic pink eye. Never use steroid drops without a clinician directing it. And keep home remedies out of the eye, including breast milk and tea bags. They do not clear an infection, and they can introduce new germs.

Comfort care

Wipe discharge with a clean, damp cotton ball or soft cloth, moving from the inner corner of the eye outward. Use a fresh one for each wipe and each eye.
Hold a cool, damp washcloth on the closed eye for a few minutes at a time to ease swelling and itching. A warm compress feels better when the lids are crusted shut.
Soften stuck lashes in the morning with a warm, damp cloth held over the closed eye rather than pulling lashes apart.
Use preservative-free artificial tears, not redness relievers, for comfort. They are available over the counter and safe to use often.
If drops or ointment were prescribed, wash your hands before and after each dose, and keep the tip from touching your child's eye or lashes.
Dim the lights or let your child wear sunglasses if brightness bothers them.
Pause contact lens wear entirely until a clinician says it's OK, and throw away the lenses, case, and any eye makeup used while symptoms were active.

Keeping it from spreading

Wash hands often, and after every time you touch your child's eyes or face.
Give your child their own towel, washcloth, and pillowcase, and change them daily.
Never share a bottle of drops between children. Within one child, the same bottle is fine for both eyes during the same infection, just keep the tip from touching the eye or lashes.
Wipe down shared surfaces such as doorknobs, taps, tablets, and toys.
Discourage rubbing, and keep fingernails short in babies and toddlers.
Wash bedding and towels in hot water once symptoms clear.

Easing discomfort

For soreness or fever, you can give acetaminophen or ibuprofen if your child is at least 6 months old. Follow the label for your child's weight and age. Call the clinic if you're unsure about a dose.

How do you get pink eye?

Is pink eye contagious?

How long does pink eye last?

How long is pink eye contagious?

How long is pink eye contagious after starting drops?

What does pink eye look like?

Does pink eye go away on its own?

When in doubt, schedule a visit

Pink eye is common, usually mild, and almost always something your family gets through in a week or two. Because the treatment depends on the type, and because a few look-alikes need faster attention, a quick look from a clinician tells you which one you are dealing with and when your child can head back to class.

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