Pink Eye: When It Needs Antibiotic Drops and When It Doesn't

Pink eye (conjunctivitis) only needs antibiotic eye drops when it's caused by bacteria. Most pink eye is caused by a virus or by allergies, and antibiotic drops don't help either of those. A clinician can usually tell which kind you have from your symptoms and a quick look at the eye, and many cases can be handled by video.

Here's how the three types differ, what treatment usually looks like, and the signs that mean it isn't simple pink eye at all.

What is pink eye?

Pink eye is inflammation of the conjunctiva, the thin, clear layer that covers the white of the eye and the inside of the eyelids. When it's inflamed, the small blood vessels in it show up, which is where the pink or red color comes from. The usual symptoms are redness, watering, itching or burning, a gritty feeling, and discharge or crusting that's often worst when you wake up.

Viral, bacterial or allergic: how do they differ?

• Viral pink eye is the most common kind. It often comes with a cold or sore throat, tends to start in one eye and spread to the other, and the discharge is usually watery. It's contagious and usually runs its course on its own over one to two weeks.
• Bacterial pink eye tends to produce thicker yellow or green discharge that can glue the lashes together overnight. It's also contagious. This is the type where antibiotic drops can shorten the illness and help stop it spreading.
• Allergic pink eye usually affects both eyes at once, itches a lot, and comes with sneezing or a runny nose. It isn't contagious. Allergy eye drops and avoiding the trigger are the usual approach.

These patterns overlap, so they're a guide, not a diagnosis. Contact lens wearers are a special case: redness with pain in a lens wearer should be looked at, because infections linked to lenses can be more serious than ordinary pink eye.

When do you need antibiotic eye drops for pink eye?

Antibiotic drops treat bacteria. They don't shorten viral pink eye, and they do nothing for allergies. Using them when they aren't needed adds cost and side effects without benefit. A clinician will usually consider antibiotic drops when the discharge is thick and pus-like, when symptoms aren't improving, when someone wears contact lenses, or when a school or daycare needs a plan before a child can return.

If your pink eye looks viral, the clinician can talk you through what to expect, how to stay comfortable, and when to check back. If it looks allergic, they can discuss allergy drops. Either way, the goal is matching the treatment to the cause.

Pink eye treatment you can do at home

• Clean away discharge with a clean, damp cloth, wiping from the inner corner outward, and use a fresh cloth for each eye.
• Cool or warm compresses can ease itching and soreness.
• Stop wearing contact lenses until your eyes are back to normal, and replace the case.
• Wash your hands often, don't share towels or pillowcases, and throw away eye makeup used while you had symptoms.

When should you get pink eye checked?

It's worth seeing a clinician the same day if the discharge is thick, symptoms are getting worse instead of better, a newborn or young child is affected, you wear contacts, or you need a note for work, school or daycare. Pain, light sensitivity or a change in vision are not typical of simple pink eye and should be looked at promptly.

Pink eye is one of the problems a telehealth video visit can often handle, and it's $75 self-pay. If the clinician needs to examine your eye in person, they'll say so and you can come into a clinic. A standard in-clinic visit is $175 self-pay. If you're using insurance, we contract with all major commercial and government plans, including Colorado Medicaid and Medicare; we can't guarantee a particular commercial plan has us in network, and if it's out of network or denies the visit, we drop you to the self-pay rates. Details are on our cost and insurance page.

Call 911 or go to the ER if… you have vision loss or blurred vision that doesn't clear with blinking; severe eye pain or strong sensitivity to light; a chemical splash in the eye (rinse with water first); an injury to the eye or something stuck in it; or redness and swelling spreading into the eyelids and face, especially with fever.

Where to find us

Four clinics across metro Denver, all ages welcome, se habla español:

• Hampden (Southeast Denver): 8 AM–11 PM daily
• Littleton: 8 AM–11 PM daily
• Thornton: 8 AM–11 PM daily
• Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM

Walk in, or book online.