Conjunctivitis (Pink Eye) – Types and Management

Conjunctivitis is the inflammation or infection of the conjunctiva, also known as pink eye. Conjunctiva is a transparent membrane that lines the white part of eyeball (sclera) and the inner surface of upper and lower eyelid. Conjunctivitis is highly contagious spreading more common in school-going children.

Symptoms of conjunctivitis

Some common symptoms include:

  • Discomfort (may be perceived as pain)
  • Conjunctival congestion (eye appears to be red or pink because small vessels in the conjunctiva become inflamed)
  • Irritation and itching
  • Tearing
  • Papillae, follicles, or scar formation
  • Discharge of varying types (watery in viral, mucopurulent in bacterial, and mucoid in allergic conjunctivitis)
  • Photophobia in case of allergic conjunctivitis
  • Lymphadenopathy (swollen lymph nodes) more common in viral infection

Types of conjunctivitis

  1. Allergic
  2. Viral
  3. Bacterial
  4. Irritants
types of conjunctivitis

1. Allergic conjunctivitis

It is caused by an allergic reaction to substances like pollen, spore, mold, animal dander, or household dust. It usually affects both eyes and is further divided into 2 types

Acute allergic conjunctivitis

  • Seasonal: Sensitivity to specific antigens in specific times of the year (spring or summer)
  • Perennial: May last all year round with exacerbations

Acute condition presents with:

  • Severe itching
  • Photophobia (depends on the degree of inflammation)
  • Conjunctival congestion
  • Mucoid discharge (stringy or ropy – forms a string if touched with finger)
  • Papillae formation (localized small elevations of the conjunctiva that covers the inner surface of eyelids)

Chronic allergic conjunctivitis

Chronic condition can take up 3 forms:

Vernal keratoconjunctivitis

This severe form presents with usual features (itching, congestion, photophobia, and mucoid discharge) along with the formation of:

  • Cobblestone papillae: Constant rubbing of the eyes flattens the traditional papillae to resemble cobblestones.
  • Corneal erosions, ulcers, and scarring: Excessive rubbing leads to erosions, subsequent ulcers, and scarring.
  • Keratoconus: Persistent scarring aggravated by rubbing of eyes leads to change in the shape of the malleable cornea. 

Giant papillary conjunctivitis

This is not a true form of allergy but chronic irritation of conjunctiva most commonly due to contact lenses. Most common cause being:

  • Poor-fitting
  • Poor contact lens hygiene
  • Hypersensitivity reaction to lens solution

Atopic conjunctivitis

It is associated with asthma and atopic dermatitis. Usually presents with similar symptoms as vernal keratoconjunctivitis.

2. Viral conjunctivitis

Viral conjunctivitis is self-limiting but highly contagious. It comes in epidemics affecting all age groups. The most common viruses are adenovirus in adults whereas measles, chickenpox, and rubella in children. It presents with:

  • Watery discharge
  • Conjunctival congestion (pink eye)
  • Lymphadenopathy
  • Secondary corneal inflammation (keratitis)

Infection usually starts from one eye and, spread to the other in 2 to 3 days because viruses take time to establish infection.

3. Bacterial conjunctivitis

It is divided into different types depending upon the organism involved:

Acute Bacterial conjunctivitis

Acute bacterial conjunctivitis is self-limiting unless the patient is immunodeficient. It is highly contagious and affects all age groups. The most common organisms are staphylococcus aureus, streptococcus pneumoniae, and Haemophilus influenzae. It presents with:

  • Muco-purulent discharge results in gluing of eyes (causing the eyelids to stick to each other)
  • Conjunctival congestion
  • Foreign body sensation and irritation due to tear film disruption
  • Itching in eyes

Hyperacute bacterial conjunctivitis

  • Neo-natal: Transmission via birth canal (from mother to baby)
  • Acquired: Transmission via sexual contact

The most common organisms are neisseria gonorrhea and neisseria meningitidis. Hyperacute condition presents with:

  • Copious discharge that reappears in minutes after cleaning the eyes
  • Congestion of conjunctiva
  • Disruption of the tear film
  • Itchy eyes

Chronic bacterial conjunctivitis

Infection lasting more than 4 weeks is classified as chronic bacterial conjunctivitis. It is a less common type. The most common organisms are atypical bacteria i.e chlamydia trachomatis and obligate intracellular (inclusion bodies by iodine staining).

Further divided into 3 types:


Transmission via birth canal (from mother to baby). It presents with:

  • Mucopurulent discharge
  • Conjunctival congestion
  • Itching


It is a disease of young age (5 to 7 years) that occurs in crowded conditions and is associated with poor hygiene. It presents with:

  • Mucopurulent discharge
  • Follicle formation
  • Intense inflammation
  • Scarring
  • Trichiasis (inward turning of lid margin and eyelashes)
  • Corneal opacity


It is sexually transmitted and has low virulence, presents with:

  • Mucopurulent discharge
  • Mild inflammation
  • May leads to complication such as Trichiasis (inward turning of lid margin and eyelashes) and corneal opacity

4. Conjunctivitis caused by irritants

Irritants such as makeup, soaps, shampoos, lotions, and pool chlorine can also cause conjunctivitis. It presents with:

  • Severe itching
  • Redness (conjunctival congestion)
  • Watery discharge

Complications of conjunctivitis

Conjunctivitis very rarely develops complications, especially if treated on time. Some of the complications are

  • Erosions, subsequent ulcers, scarring, and eventually change in the shape of the malleable cornea (keratoconus)
  • Trichiasis
  • Corneal opacity
  • Decrease in vision
  • Severe photophobia

Risk factors

Some of the risk factors are:

  • Young age
  • Crowded living conditions
  • Poor hygiene
  • Allergens such as pollen, spore, mold, animal dander, or household dust
  • Cosmetics (eye make-up)

How to prevent conjunctivitis?

Being highly contagious, it can be prevented by taking these measures:

  • Wash your hands with soap and warm water, regularly
  • Do not touch your eyes with dirty hands
  • Do not use contact lenses very often
  • Protect your eyes from household dust, pollen, etc
  • Do not share your makeup or towels with others
  • Use lubricants such as artificial tears

Management of conjunctivitis

Management depends on the cause

Allergic conjunctivitis

Since the major group affected is children, it is difficult to control itching (which can lead to corneal erosions and ulcers). For which parent counseling is very important.

Acute allergic conjunctivitis

  • Lubricants that help in reforming the tear film
  • Cool compresses and ice packs
  • Topical antihistamines and decongestants
  • Topical mast cell stabilizers
  • For severe attacks, a short course of topical steroids

Chronic allergic conjunctivitis

  • Antihistamines all around the year
  • Mast cell stabilizer all around the year for prophylaxis
  • Lubricants and cool compresses as required
  • Steroids only for acute outbreaks
  • In severe cases, if keratoconus has developed; rigid contact lens, corneal cross-linking with riboflavin, and keratoplasty

Viral conjunctivitis

Since viral conjunctivitis is self-limiting, symptoms usually last 4 to 7 days. Thus, only supportive treatment is required.

  • Lubricants
  • Cool compresses
  • Anti-viral therapy in case of herpes virus infection

Bacterial conjunctivitis

Acute bacterial conjunctivitis is self-limiting, however, antibiotics are required in hyperacute and chronic conditions.

  • Lubricants
  • Cold compresses
  • Topical antibiotics in acute infection (fluoroquinolones or aminoglycosides)
  • Ceftriaxone to both mother and baby in neonatal hyperacute infection
  • Oral azithromycin in chronic infection
  • Keratoplasty in corneal opacity


  • Rinse your eyes with a lot of water every 5 minutes
  • If the irritants are acidic or alkaline, immediately consult your doctor
conjunctivitis treatment

Home remedies and life style modifications

  • Strict ocular hygiene
  • Use cold compresses
  • Use lubricants to prevent rubbing injury
  • Do not wear contact lenses, until the infection resolved
  • Change your pillow cover daily

When to consult a doctor?

It is not a very serious condition, but you should immediately consult a doctor if you have any of these symptoms:

  • Severe photophobia (pain when you look into light)
  • A lot of discharge
  • Decrease vision
  • Pain in eye


What does an infected eye look like in conjunctivitis?

  • Discharge from one or both eyes (watery in viral, mucopurulent in bacterial, and mucoid in allergic conjunctivitis)
  • Redness due to congestion
  • Papillae, follicles, or scar formation

How do I know if I have bacterial or viral conjunctivitis?

Discharge is watery in viral infection whereas mucopurulent in bacterial infection. Viral infection usually starts from one eye and, spreads to the other in 2 to 3 days because viruses take time to establish infection whereas bacterial infection may affect one or both eyes, taking 24 hours to spread one to the other eye. Bacterial conjunctival infection is usually followed by an ear infection.

How do you treat Covid conjunctivitis?

It is the same as any other viral conjunctivitis, treated with cold compresses and lubricants. An antibiotic may be required to prevent secondary infection.

What is the best treatment for conjunctivitis?

  • Lubricants
  • Cold compresses
  • Antibiotics in the case of bacterial infection
  • Anti histamines in case of allergic reaction

What is commonly misdiagnosed as pink eye?

Blepharitis is commonly misdiagnosed as pink eye.

Last medically reviewed on February 25, 2022.