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What Causes Pink Eye?

Posted on Dec 20, 2021

So many parents have woken up and notice it, and others have been called by their child’s school stating that their child has it. We are talking about “pink eye.” On this week’s On Call for All Kids, Patrick Mularoni, M.D., an emergency medicine physician at Johns Hopkins All Children’s Hospital, talks about the common childhood ailment.

What is pink eye and what causes it?

Pink eye is one of those terms in medicine that is exactly what it sounds like. It’s a pink or red eye. In medical terms, we call it conjunctivitis. It happens when the surface of the eye has inflammation just like any other part of the body can get inflamed, but the difference is that it is very easy to see and often causes a considerable amount of concerns for parents. The causes for conjunctivitis or redness in the eyes are varied and can be due to an infection caused by bacteria or a virus, allergies, an irritant or foreign body in the eye or from trauma to the eye.

You mentioned an injury to the eye, irritants or a foreign body leading to pink eye. That sounds painful. Could you tell us about this cause of a pink or red eye?

The surface of the eye is sensitive and will get inflamed if you get poked in the eye or some other injury happens that scratches the surface of the eye. Another irritant could be sand or another small particle that can get in the eye and irritates the surface of the eye. I have seen dirt, sawdust and even a small piece of metal that has gotten into a patient’s eye. These situations are often very painful and your child will often want to keep his or her eye closed after it happens.

When compared to an infection in the eye children with an injury or a foreign body in the eye will have pain that comes on all of a sudden followed by an eye that becomes red and painful. If your child has a red eye and will not open it or is complaining of intense pain, that is a reason to see a doctor that day.

Let’s talk about infections in the eye. Parents and teachers know that these infections can spread easily between children, is there a way to tell the difference between a bacterial or viral infection in the eye?

Most parents know that we can treat bacterial infections with antibiotics and viral infections do not respond to antibiotics. For physicians, it can be difficult to decide whether an infection in the eye is being caused by bacteria or by a virus. One thing that can be a difference between the two is that a viral infection often starts in both eyes. Bacterial infections in the eye will often start in one eye and then could eventually affect the other eye. We also see that the viral infections that cause redness in the eyes typically come with other cold symptoms and the bacterial infection that causes pink eye can present on its own in a child that isn’t sick.

The difficult part is that a child who is sick with a virus can develop a bacterial pink eye as a secondary infection as well. This happens because the tears and mucous that run across our eyes throughout the day might not drain as well in a child with a congested nose and that could be a set up for a bacterial infection in the eye as well. Since it is difficult to tell the difference, your best bet is to make a doctor appointment if your child is sick and has a pink eye.

You mentioned other causes. What about those kids with allergies. If you know that your child has allergies that cause red itchy eyes, is there something a parent can do?

Seasonal allergies definitely cause red irritated eyes, and we seem to have pollen from some source year-round in Florida. The best thing to do is to know the pattern of your child’s allergies so that you can be prepared and treat their symptoms with allergy medicines during the seasons where they have the most symptoms. There are allergy medicines that are taken by mouth, but there are also allergy eye drops that work well. This is something that you should talk to your pediatrician about so that you have a plan to make your child more comfortable especially when their allergies are at their worst.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children's Hospital experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report. You also can explore more advice from Patrick Mularoni, M.D., or download our free Pocket Doc app, which features a symptom checker, parenting advice and other tools for staying in touch with us.


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