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Acute Conjunctivitis

Acute conjunctivitis (adenoviral conjunctivitis or “pink eye”) is an inflammation that can be caused by infections from bacteria or viruses. Pink eye can also be caused by allergy, eye injury, or reaction to medication.

Pink eye affects nearly 6.9 million people in the U.S. every year, primarily children.1 It tends to be a little more common in the spring and summer months and less common in the winter months.

Acute conjunctivitis is highly contagious with intra-familial attack rates of up to 50%2-3 and 35-50% of patients develop complications.4-5 Unfortunately, many healthcare professionals believe that they can easily and accurately diagnose and treat pink eye patients based on clinical symptoms and signs, however, one simple misdiagnosis can lead to mistreatment driving the spread of disease.

Unlike bacterial conjunctivitis, which is usually self-limiting, acute conjunctivitis is associated with significant morbidity such as:

  • Decreased visual acuity or light sensitivity from persistent subepithelial infiltrates (inflammatory corneal deposits)6
  • Chronic epiphora (excessive tearing) from lacrimal drainage problems7
  • Visual loss from conjunctival foreshortening and symblepharon (conjunctival scarring) formation8


  • Eye redness
  • Swollen, red eyelids
  • Itching
  • Burning
  • Tearing
  • Eyelash matting or crusting
  • Foreign body sensation (feeling as if something is in the eye)


Pink eye can be highly contagious and may easily spread through many of our daily activities as well as close contacts. Depending on the type of pink eye, isolation may be necessary to stop the spread of infection to others.

Viral conjunctivitis: Typically lasts from 7-21 days. The viral form of pink eye remains contagious until the eye is no longer red or producing excess tears.

Bacterial conjunctiviti: The contagious phase of bacterial pink eye lasts from the time symptoms appear until there is no more discharge from the eye. This is typically just a few days, or until 24 hours after taking a prescription antibiotic.

Allergic conjunctivitis: This type of pink eye is not contagious.


Studies show that 95% of healthcare professionals will prescribe an antibiotic for all cases of acute conjunctivitis9 – whether it’s viral or bacterial. Unfortunately, antibiotics are ineffective at treating viral conjunctivitis and have no therapeutic impact. Prescribing unnecessary antibiotics delays proper treatment, can lead to potential allergies, toxicities, or even antibiotic resistance.

Knowing the cause of your patient’s acute conjunctivitis infection is imperative to administering the appropriate treatment.

Viral conjunctivitis: Antibiotics are ineffective against viral infections. If antibiotics are prescribed for a case of viral conjunctivitis, the patient will remain contagious and most likely spread the disease to others.

Recommended treatment options include the following:

  • Cool compresses 3-4 times a day
  • Frequent hand washing
  • Artificial tears
  • Decontaminate home/office by wiping down surfaces with diluted bleach, changing sheets, using clean towels, etc.
  • Wear sunglasses if eyes are light sensitive
  • Throw away old makeup to prevent re-infection
  • Avoid wearing contact lenses while feeling discomfort, especially if the eyes remain red.
  • Avoid close contact with others for at least 5-7 days or until there are no symptoms (redness, tearing, itching, etc.)

Bacterial conjunctivitis: The most common treatment for bacterial conjunctivitis is an antibiotic eye drop or ointment. Generally, within 24-48 hours after starting this treatment, your patient can return to work or school with little risk of spreading the infection to others.

Allergic conjunctivitis: Topical ocular antihistamine eye drops can help your patient recover from the effects of allergic conjunctivitis.


1 Thomson Reuters Medstat Marketscan Data, 2005.

2 McMinn PC, Stewart J, Burrell CJ. A community outbreak of epidemic keratoconjunctivitis in Central Australia due to adenovirus type 8. J Infect Di. 1991;164: 1113–1118.

3 Schepetiuk SK, Norton R, Kok T, et al. Outbreak of adenovirus type 4 conjunctivitis in South Australia. J Med Virol. 1993 ;41:316‐8.

4 Colon LE. Keratoconjunctivitis due to adenovirus type 8: report on a large outbreak. Ann Ophthalmol. 1991;23:63‐5.

5 Richmond S, Burman R, Crosdale E, et al. A large outbreak of keratoconjunctivitis due to adenovirus type 8. J Hyg (Lond). 1984;93:285‐91.

6 Butt AL, Chodosh J. Adenoviral keratoconjunctivitis in a tertiary care eye clinic. Cornea. 2006;25:199-202.

7 Hyde KJ, Berger ST. Epidemic keratoconjunctivitis and lacrimal excretory system obstruction. Ophthalmology. 1988;95:1447-1449.

8 Hammer LH, Perry HD, Donnenfeld ED, et al. Symblepharon formation in epidemic keratoconjunctivitis. Cornea. 1990;9:338-340.

9 Everitt H, Little P. How do GP’s diagnose and manage acute infective conjunctivitis? A GP survey. Fam Pract. 2002;19:658-60.

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