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Conjunctivitis (Pink Eye)

Pink eye Verified · Sep 2026

NEI: "Pink eye, or conjunctivitis, causes swelling and redness in the inside of your eyelid and the white part of your eye. Your eye may also feel itchy and painful." StatPearls: "Conjunctivitis is a common, treatable, and typically benign eye condition."

Pink eye is common and usually benign, but the nurse has three jobs: stop the spread (hand hygiene, no shared towels or drops), sort the likely cause (watery with a cold, thick pus, or itchy and bilateral), and catch the red eye that is something else — pain, photophobia, blurred vision that does not clear with blinking, or a contact-lens wearer. Antibiotics do not help viral pink eye, and steroid eye drops belong under an eye specialist’s direction.

What’s going wrong in the body

The normal physiology, where it fails, and why the body’s compensation backfires.

01 The conjunctiva and its three common attackers

"The conjunctiva is the transparent, lubricating mucous membrane covering the eye’s outer surface with 2 main parts: the bulbar conjunctiva, which covers the globe, and the tarsal conjunctiva, which lines the eyelids' inner surfaces." When it is inflamed, the result is conjunctivitis, which "manifests as engorgement of blood vessels" — a red eye — with pain and discharge (StatPearls).

Causes. "Conjunctivitis is caused by viruses, bacteria, allergens, contact lens use, chemicals, fungi, and certain diseases" (CDC). "Among adults, viral conjunctivitis is the most frequent infectious cause, followed by bacterial conjunctivitis. About 80% of acute conjunctivitis cases are viral" (StatPearls), mostly adenovirus. "Bacterial conjunctivitis is more common in children than adults" (StatPearls).

How it spreads. "Viral conjunctivitis is very contagious and mostly spread through hand-to-eye contact by hands or objects that are contaminated with the virus" (CDC). "Bacterial conjunctivitis is very contagious and can spread from person to person in many ways," including sexual contact "with eye to genital contact, or vertically from mother to baby." "Allergic conjunctivitis is not contagious" (CDC).

Timing terms. "Hyperacute conjunctivitis occurs during the acute period, with a rapid onset of typically severe symptoms within 24 hours." "Chronic conjunctivitis describes symptoms lasting longer than 4 weeks" (StatPearls).

Viral, bacterial and allergic conjunctivitis overlap, but the discharge, itch and setting point to the likely cause (CDC, StatPearls).

02 Allergic conjunctivitis — a mast-cell reaction

"IgE molecules bind with high affinity to type I Fc ε receptors (FcεRIs) on conjunctival mast cells, priming the ocular surface for subsequent allergic responses." "Upon reexposure, allergens cross-link adjacent IgE molecules on mast cell surfaces, resulting in rapid degranulation" (StatPearls).

"Preformed mediators, including histamine, tryptase, chymase, and heparin, are released within minutes and produce vasodilation, increased vascular permeability, conjunctival edema, hyperemia, itching, and tearing." "Histamine stimulates sensory nerve endings within the conjunctiva, producing the characteristic itching associated with allergic conjunctivitis" (StatPearls).

Why not rub. "Eye rubbing should be discouraged because mechanical stimulation can trigger mast cell degranulation and worsen symptoms" (StatPearls). This is also why antihistamines and mast-cell stabilizers are the core drugs.

Allergic conjunctivitis is a type I (IgE, mast-cell) reaction; rubbing restarts the cycle, and the drugs block degranulation or histamine (StatPearls).

03 When a red eye is dangerous

Hyperacute bacterial conjunctivitis. "A very rare and severe type of conjunctivitis with rapid onset and progression" with "massive exudate, severe chemosis, eyelid swelling, marked hyperemia, pain, and decreased vision" (CDC). "Causative organisms in hyperacute conjunctivitis include Neisseria gonorrhea" and Neisseria meningitidis, and it "can lead to rapid corneal perforation, systemic involvement, and even death" (StatPearls). "Gonococcal conjunctivitis and primary meningococcal conjunctivitis are ophthalmic emergencies with risks of vision loss and death" (StatPearls).

It may not be conjunctivitis at all. "Some signs and symptoms that point to a diagnosis other than conjunctivitis include sectoral redness, ciliary flush, elevated intraocular pressure, vision loss, moderate to severe pain, hypopyon (white or whitish-yellow collection of inflammatory cells in the anterior chamber), hyphema (collection of blood in the anterior chamber), pupil asymmetry, decreased pupillary response, and trouble opening or keeping the eye open." "All patients with acute angle-closure glaucoma, hypopyon, hyphema, suspected iritis, keratitis, scleritis, corneal ulcers, or corneal foreign bodies should be urgently evaluated by an ophthalmologist" (StatPearls).

Contact lenses. "Contact lens wearers with bacterial conjunctivitis are at higher risk of bacterial keratitis. They should be asked to remove their contact lenses; treated with topical antibiotics; and promptly evaluated by an ophthalmologist" (CDC).

Herpes viruses. Herpes simplex conjunctivitis may affect one eye with blister-like skin lesions (CDC), and "Patients with herpes simplex conjunctivitis are at the highest risk of complications" (StatPearls). In shingles, "Vesicles on the tip of the nose (Hutchinson sign) are especially indicative of ophthalmic involvement."

Red flags turn a simple red eye into a referral or an emergency (StatPearls non-AAO referral paragraph; CDC).

Causes & risk factors

Modifiable factors are teaching targets — the patient can act on them.

Viruses — adenovirus most often; herpes simplex and varicella-zoster less often Bacteria — Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae; Neisseria gonorrhoeae in sexually active adults (StatPearls) Contact with someone who has pink eye; a recent respiratory infection (NEI) modifiable Wearing contact lenses — higher risk of bacterial keratitis (CDC) modifiable Allergy — "Allergic conjunctivitis is common in people who have other signs of allergic disease, such as hay fever, asthma, and eczema" (CDC) Sexual exposure — gonococcal and chlamydial conjunctivitis ("Serovars D-K cause chlamydial inclusion conjunctivitis and affect both the eyes and genitals") modifiable Newborns (one line) — NEI: "Pink eye can cause serious health problems for newborn babies. Call a doctor now if your baby has:" unusual discharge from the eye or puffy red eyelids.

Signs & symptoms

Each finding tied to the mechanism that produces it — and the triage it calls for.

Pink or red eye, gritty feeling, burning, tearing, crusting of the lids early Expected
Why: Engorged conjunctival vessels and inflammation. NEI also lists "A lump in front of your ear," "Sensitivity to bright light" and "Blurry vision." "It can be hard to figure out the exact cause of pink eye, because the symptoms are usually the same" (NEI).
[VIR] Watery discharge, often with a cold; tender node in front of the ear Expected
Why: StatPearls: viral conjunctivitis presents "with sudden onset foreign body sensation, red eyes, itching, light sensitivity, burning, and watery discharge"; a tender preauricular node "will help differentiate viral conjunctivitis versus bacterial." "Most cases of viral conjunctivitis are highly contagious for 10-14 days."
[BAC] Thick, purulent discharge that mats the eyelids together Expected
Why: CDC: "Purulent discharge that causes eyelids to be matted together"; StatPearls: "mucopurulent discharge and mattering of the eyelids upon waking." Antibiotics may shorten it.
[ALL] Itching, redness and tearing of both eyes, with sneezing or a runny nose Expected
Why: Mast-cell histamine release stimulates conjunctival nerves; StatPearls: "Common symptoms are itching, watering, and chemosis." Not contagious.
Eye pain, light sensitivity, blurred vision that does not clear when discharge is wiped away, intense redness, or worsening symptoms Hold & notify
Why: CDC: "See a healthcare provider if you have pink eye along with any of the following" — these signs. StatPearls: moderate to severe pain, vision loss or photophobia should prompt "a prompt referral to an ophthalmologist." These point to keratitis, iritis, glaucoma or scleritis.
[CL] Red eye or discharge in a contact-lens wearer Hold & notify
Why: CDC: higher risk of bacterial keratitis — remove lenses, topical antibiotics, and "promptly evaluated by an ophthalmologist."
[BAC] Hyperacute: massive pus within 24 hours, severe lid swelling and chemosis, pain, decreased vision Report immediately
Why: Gonococcal or meningococcal. StatPearls: "ophthalmic emergencies with risks of vision loss and death"; "Meningitis and sepsis caused by Neisseria gonorrhoeae or Neisseria meningitides can be life-threatening."
[VIR] Vesicles on the lids or face; vesicles on the tip of the nose Hold & notify
Why: Herpes simplex or zoster eye involvement. StatPearls: HSV patients "should always see an ophthalmologist for close re-evaluation"; Hutchinson sign signals ophthalmic zoster.

Diagnostics

Test In this disorder Normal
Clinical examination and history CDC: "Healthcare providers can usually identify pink eye by examining the eye while considering patient history and other symptoms." "Visual acuity and pupillary exams are important for all ocular complaints" (StatPearls). Examine with hand hygiene and gloves because infectious conjunctivitis is highly contagious (StatPearls). Diagnosis is usually clinical —
Red-flag screen: pain, photophobia, vision, pupils, corneal clarity StatPearls: sectoral redness, ciliary flush, raised eye pressure, vision loss, moderate to severe pain, hypopyon, hyphema, pupil asymmetry and trouble keeping the eye open "point to a diagnosis other than conjunctivitis." Normal vision and pupils; no ciliary flush, hypopyon or hyphema —
[BAC] Conjunctival culture and Gram stain StatPearls: cultures are not needed in most cases, but "conjunctival cultures should also be obtained in recurrent conjunctivitis and conjunctivitis refractory to treatment." Suspected meningococcal conjunctivitis "should be empirically treated with systemic antibiotics, even if culture results are pending." Reserved for suspected gonococcal, meningococcal or chlamydial infection, recurrence or treatment failure —
[STI] Evaluation for sexually transmitted infection CDC: "Presenting with chlamydial conjunctivitis will have an associated genital infection." CDC STI Guidelines (2021): "Patients should be instructed to refer their sex partners for evaluation and treatment." Genital testing and partner referral when gonorrhea or chlamydia is suspected CDC STI Treatment Guidelines 2021 —

Complications

Black-box warning — most severe: ■ [BAC] Hyperacute gonococcal or meningococcal conjunctivitis Report immediately
"Hyperacute conjunctivitis can lead to rapid corneal perforation, systemic involvement, and even death" (StatPearls). "Can progress to corneal infiltrates, melting and perforation, and vision loss if not treated promptly by an ophthalmologist" (CDC).
Treatment "Requires both parenteral and topical antibiotic therapy" (CDC). "Severe gonococcal conjunctivitis, meningococcal conjunctivitis, and neonatal conjunctivitis require hospitalization" (StatPearls). For meningococcal cases, "close contacts should receive prophylactic antibiotics."
Warning: Vision-threatening mimics — keratitis, iritis, acute angle-closure glaucoma, scleritis, corneal ulcer Hold & notify
"These conditions can cause vision loss and require ophthalmologic management" (StatPearls). "Anisocoria and photophobia are associated with serious eye conditions including anterior uveitis, keratitis, and scleritis" (StatPearls).
They "should be urgently evaluated by an ophthalmologist." Acute glaucoma may show "a semi-dilated pupil, corneal clouding secondary to edema, ciliary flush, and elevated intraocular pressure."
Warning: [CL] Bacterial keratitis in contact-lens wearers Hold & notify
"Contact lens wearers with bacterial conjunctivitis are at higher risk of bacterial keratitis" (CDC).
StatPearls: they "should always be prescribed antibiotics with broad-spectrum coverage of gram-positive and gram-negative organisms (eg, fluoroquinolones, aminoglycosides, macrolides)."
Caution: [VIR] Herpes simplex conjunctivitis and steroid misuse Hold & notify
"Patients with herpes simplex conjunctivitis are at the highest risk of complications" (StatPearls). "Topical corticosteroids alone are contraindicated in epithelial herpes simplex keratitis and are associated with prolonged viral shedding and infection" (StatPearls).
Caution: [VIR] Viral complications
StatPearls lists punctate keratitis, bacterial superinfection, conjunctival scarring, corneal ulceration and chronic infection. "Complications of isolated acute conjunctivitis are rare. However, refer patients who do not improve within 5 to 7 days to an ophthalmologist for further evaluation."

Medications for this condition

Why each class is prescribed here — every card links to its full pharmacology page.

Antihistamines
Respiratory · diphenhydramine (1st-gen)

[ALL] Symptom relief. CDC: "Allergy medications and certain eye drops (topical antihistamine and vasoconstrictors), including some prescription eye drops, can also provide relief from allergic conjunctivitis." StatPearls: "Oral antihistamines can also be used for moderate-to-severe allergic conjunctivitis," and "Loratadine is generally preferred for daily use because of a lower sedative effect compared with diphenhydramine." "Prolonged use of vasoconstrictor drops should be avoided because of the risk of rebound conjunctival injection."
Mast-Cell Stabilizers
Respiratory · cromolyn

[ALL] Longer-term control. StatPearls: seasonal and perennial allergic conjunctivitis "can be treated with topical antihistamines, mast-cell stabilizers, or a combination of both"; mast cell stabilizers "may be prescribed for several weeks, with maximal therapeutic effects achieved after continuous use, making these agents suitable for long-term symptom control." Combination drops such as ketotifen and olopatadine "provide rapid symptom control."
Fluoroquinolones
Immune / Anti-infective · ciprofloxacin

[BAC][CL] Topical antibiotic drops; broad coverage for contact-lens wearers. StatPearls lists ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin and gatifloxacin drops, and notes "No significant differences in outcomes have been observed in trials comparing ophthalmic antibiotic drops of different types." Contact-lens wearers need broad-spectrum coverage, "eg, fluoroquinolones, aminoglycosides, macrolides." Stewardship: "Reserve antibiotics for appropriate bacterial infections to limit unnecessary antimicrobial exposure." Not for viral pink eye. No doses here.
Macrolides
Immune / Anti-infective · azithromycin

[BAC] Topical azithromycin or erythromycin; part of hyperacute combinations. StatPearls: "Topical erythromycin has been a therapeutic choice for years; however, microbial resistance has limited its usefulness." Hyperacute gonococcal or meningococcal treatment "includes systemic and topical antibiotics (eg, ceftriaxone, azithromycin, fluoroquinolones)." Adult chlamydial (inclusion) conjunctivitis "does not respond to standard antibiotic therapies" and needs systemic treatment with partner treatment.

Beyond medications

  • [VIR] Supportive care only. "Antibiotics will NOT improve viral pink eye; these drugs are not effective against viruses" (CDC). Adenoviral conjunctivitis "is self-limiting, and treatment should target symptomatic relief with cold compresses and artificial tears" (StatPearls). It "usually clears up in 7 to 14 days without treatment" but can take 2 to 3 weeks or more (CDC).
  • [VIR] Antivirals for herpes. "A doctor can prescribe antiviral medication to treat more serious forms of pink eye (like infection caused by herpes simplex virus or varicella-zoster virus)" (CDC).
  • [BAC] Mild bacterial pink eye "usually clears up in 2 to 5 days without treatment but can take 2 weeks to go away completely"; antibiotics "may help shorten the length of infection, reduce complications, and prevent the spread to others" (CDC). "While ointments typically last longer than drops, they tend to interfere with vision" (StatPearls).
  • [STI] Gonococcal conjunctivitis (CDC STI Treatment Guidelines 2021): a single dose of intramuscular ceftriaxone; "Providers should consider one-time lavage of the infected eye with saline solution," and consultation with an infectious disease specialist "should be considered." Partners are referred for testing and treatment.
  • [ALL] Remove the trigger. "Pink eye caused by an allergen (such as pollen or animal dander) usually improves by removing the allergen from the person's environment" (CDC); artificial tears and cold compresses help (StatPearls).
  • Steroid eye drops — eye specialist only. Patients "who may need treatment with steroids should also be referred" to ophthalmology (StatPearls). Steroids "may slow healing, increase the risk of corneal melting, and increase the risk of elevated intraocular pressure"; in allergic disease they are short courses "under specialist supervision with appropriate follow-up."
  • Home care. "Use cold compresses and artificial tears to help relieve some of the inflammation and dryness caused by pink eye" (CDC).

Nursing considerations

The RN-specific layer — each action paired with the reason it matters.

Assessment
Ask about pain, light sensitivity and vision, and check whether blurred vision clears when discharge is wiped away.
Why: Pain, photophobia and vision loss point away from simple conjunctivitis toward keratitis, iritis or glaucoma (StatPearls); CDC lists "Blurred vision that does not improve when discharge is wiped from the eyes."
Ask about contact lens use, recent colds, allergies, sexual exposure and whether a household member has pink eye.
Why: Contact-lens wearers risk bacterial keratitis (CDC); gonococcal and chlamydial conjunctivitis come with genital infection (CDC); allergic conjunctivitis occurs with hay fever, asthma and eczema (CDC).
Describe the discharge (watery, mucus, thick pus, massive pus) and whether one or both eyes are involved.
Why: Watery suggests viral, matted pus suggests bacterial, bilateral itch suggests allergic; massive pus within 24 hours suggests hyperacute infection (CDC, StatPearls).
Look for vesicles on the lids, face or tip of the nose.
Why: Herpes simplex or zoster eye disease needs ophthalmology; Hutchinson sign signals ophthalmic zoster (StatPearls).
Interventions
Perform hand hygiene and wear gloves for eye examination and care; disinfect instruments.
Why: StatPearls calls hand hygiene and gloves imperative because infectious conjunctivitis is highly contagious; hospitalized patients "should be isolated, and any medical instruments used in their care should be disinfected."
Escalate a hyperacute presentation or suspected gonococcal/meningococcal conjunctivitis immediately.
Why: StatPearls: these are "ophthalmic emergencies with risks of vision loss and death"; treatment is systemic plus topical antibiotics, often in hospital.
Refer promptly to ophthalmology for pain, vision loss, photophobia, corneal involvement, severe purulent discharge, contact-lens wear, immunocompromise, or a possible steroid need.
Why: StatPearls referral list (non-AAO): these "should receive a prompt referral to an ophthalmologist."
Instill eye drops with clean hands, and use a separate bottle for an uninfected eye.
Why: CDC: wash hands "before and after cleaning, or applying eye drops or ointment," and "Do not use the same eye drop bottle for your infected and non-infected eyes."
Question an antibiotic order for clearly viral pink eye and a steroid drop order without ophthalmology involvement.
Why: Antibiotics "will NOT improve viral pink eye" (CDC); topical steroids alone are contraindicated in herpes simplex keratitis and carry risks of corneal melt and raised eye pressure (StatPearls).
Patient and family teaching
Wash hands often for at least 20 seconds, avoid touching or rubbing the eyes, and clean discharge with a fresh cotton ball or clean wet washcloth each time.
Why: CDC prevention guidance; "Throw away cotton balls after use."
Do not share towels, pillows, eye drops, makeup or lenses; wash linens in hot water; stay out of swimming pools while infected.
Why: CDC: "Do not share personal items, like pillows, washcloths, towels, eye drops, eye or face makeup"; "Do not use swimming pools."
Stop wearing contact lenses until cleared, and throw away disposable lenses, cases, solution and makeup used while infected.
Why: CDC: "Stop wearing contact lenses until your eye doctor says it's okay"; NEI: throw away contact lens products and makeup used while you had pink eye.
Return to work or school with clinician approval after any indicated treatment; stay home with fever or other illness signs, or if close contact cannot be avoided.
Why: CDC: "Patients may return to work or school if they receive clinician approval and after any indicated therapy is implemented"; remain home with "systemic signs of illness, especially if they cannot avoid close contact with others."
Come back promptly for more pain, worse vision, light sensitivity, or bacterial pink eye not better after 24 hours of antibiotics.
Why: StatPearls: "Advise all patients to return promptly with new or worsening symptoms (eg, decreased vision, increased pain)." CDC: see a provider if bacterial pink eye "does not improve after 24 hours of antibiotic use."
Allergic pink eye: avoid the allergen, use cool compresses, do not rub the eyes, and limit decongestant (redness-relief) drops to short-term use.
Why: Rubbing triggers mast-cell degranulation; prolonged vasoconstrictor drops cause rebound redness (StatPearls).

How a real nurse thinks

The clinical-judgment loop, worked for a typical presentation — reasoning, not reference.

  1. 1
    Recognize cues

    A contact-lens wearer with purulent discharge, eye pain, photophobia and blurred vision that does not clear, and a request to use someone else’s steroid drops.

  2. 2
    Analyze cues

    Contact-lens wearers with bacterial conjunctivitis "are at higher risk of bacterial keratitis." Pain, photophobia and vision loss are red flags for a condition other than simple conjunctivitis. Steroids need ophthalmology involvement and can "slow healing, increase the risk of corneal melting."

  3. 3
    Prioritize

    Protect vision: remove the lenses and get a prompt ophthalmology evaluation for possible keratitis; stop the steroid plan; prevent spread.

  4. 4
    Generate solutions

    Have him remove the lenses; notify the provider for prompt ophthalmology referral and broad-spectrum antibiotic drops; teach that shared or leftover steroid drops are not used; teach hand hygiene, no sharing towels and no lenses until cleared.

  5. 5
    Take action

    Assists with lens removal using clean hands and gloves; documents visual acuity and symptoms; arranges same-day ophthalmology; reinforces "Do not share personal items" including eye drops.

  6. 6
    Evaluate

    Confirms he was seen by ophthalmology, is using the prescribed drops, has stopped wearing lenses, and knows to return promptly for worse pain or vision.

Scenario — you’re the nurse

Work each question before revealing the answer. Rationales explain the wrong options too.

Urgent care clinic · Monday morning

A 29-year-old man who wears soft contact lenses, including overnight, woke with a red, painful right eye. His partner had pink eye last week.

Eye — right eye red with yellow discharge; lids stuck together on waking
Symptoms — eye pain rated 6/10; light hurts; vision blurry and does not clear when he wipes the eye
Lenses — still wearing yesterday’s lenses
Other — no fever; no vesicles; no rash
Request — asks for the leftover steroid eye drops his partner was given
Q1 Select all that apply
Which findings in a patient with a red eye suggest it is NOT simple conjunctivitis? Select all that apply.
  1. A. Moderate to severe eye pain
  2. B. Light sensitivity
  3. C. Blurred vision that does not clear when discharge is wiped away
  4. D. Watery discharge with a cold
  5. E. Itching of both eyes in spring
Reveal answer & rationale
Answer: A, B, C
StatPearls lists "moderate to severe pain" and vision loss among signs that point to another diagnosis, with photophobia on the referral list; CDC lists blurred vision that does not improve when discharge is wiped (A, B, C). Watery discharge with a cold fits viral conjunctivitis (D), and seasonal bilateral itching fits allergic conjunctivitis (E).
Q2 Multiple choice
A patient with viral conjunctivitis asks for antibiotic eye drops. What is the best response?
  1. A. Antibiotics will clear it within 24 hours
  2. B. Antibiotics do not help viral pink eye; use cold compresses, artificial tears and careful hand hygiene
  3. C. Use the antibiotic only in the other eye to prevent spread
  4. D. Steroid drops work better than antibiotics
Reveal answer & rationale
Answer: B
CDC: "Antibiotics will NOT improve viral pink eye"; StatPearls: treatment "should target symptomatic relief with cold compresses and artificial tears" (B). Antibiotics do not treat viruses (A, C). Steroids need ophthalmology involvement and are not routine (D).
Q3 Multiple choice
A sexually active adult has a massive, rapidly worsening purulent discharge from one eye that began yesterday, with severe lid swelling and decreased vision. What does the nurse anticipate?
  1. A. Warm compresses and follow-up in a week
  2. B. Emergency evaluation for gonococcal conjunctivitis with systemic and topical antibiotics
  3. C. An antihistamine eye drop
  4. D. Reassurance that bacterial pink eye clears in 2 to 5 days
Reveal answer & rationale
Answer: B
Hyperacute conjunctivitis with this picture suggests Neisseria gonorrhoeae; StatPearls calls gonococcal conjunctivitis an "ophthalmic emergency" with "risks of vision loss and death," treated with systemic and topical antibiotics (B). The sources recommend cold, not warm, compresses, and delay risks corneal perforation (A). Antihistamines treat allergy (C). The 2-to-5-day course applies to mild bacterial pink eye (D).
Q4 Multiple choice
Which instruction about returning to work is consistent with CDC guidance for infectious conjunctivitis?
  1. A. Return as soon as the eye looks less red, without seeing anyone
  2. B. Return with clinician approval after any indicated treatment; stay home with fever or if close contact cannot be avoided
  3. C. Stay home for a full 4 weeks
  4. D. Allergic conjunctivitis requires staying home until it resolves
Reveal answer & rationale
Answer: B
CDC: "Patients may return to work or school if they receive clinician approval and after any indicated therapy is implemented," and should remain home with "systemic signs of illness, especially if they cannot avoid close contact with others" (B). Return depends on approval, not appearance (A). There is no 4-week rule (C). "Allergic conjunctivitis is not contagious" (D).
Q5 Multiple choice
A patient with seasonal allergic conjunctivitis has been using an over-the-counter redness-relief (vasoconstrictor) drop for 6 weeks and says the redness is worse. What should the nurse explain?
  1. A. Use the drops more often
  2. B. Prolonged vasoconstrictor use can cause rebound redness; talk with the provider about antihistamine or mast-cell-stabilizer drops
  3. C. Rub the eyes to relieve the itch
  4. D. The redness means the allergy is now contagious
Reveal answer & rationale
Answer: B
StatPearls: "Prolonged use of vasoconstrictor drops should be avoided because of the risk of rebound conjunctival injection"; mast cell stabilizers suit "long-term symptom control" (B). More drops worsen rebound (A). Rubbing triggers mast-cell degranulation (C). Allergic conjunctivitis is not contagious (D).

Common questions

What causes conjunctivitis (pink eye)?
Common causes and risk factors include viruses — adenovirus most often; herpes simplex and varicella-zoster less often, bacteria — staphylococcus aureus, streptococcus pneumoniae, haemophilus influenzae; neisseria gonorrhoeae in sexually active adults (statpearls), contact with someone who has pink eye; a recent respiratory infection (nei), wearing contact lenses — higher risk of bacterial keratitis (cdc), allergy — "allergic conjunctivitis is common in people who have other signs of allergic disease, such as hay fever, asthma, and eczema" (cdc), and others.
Is pink eye contagious?
Viral and bacterial conjunctivitis are "very contagious" (CDC); viral cases are "highly contagious for 10-14 days" (StatPearls). "Allergic conjunctivitis is not contagious" (CDC).
How can you tell viral from bacterial pink eye?
Not reliably by symptoms alone: "Signs and symptoms of bacterial conjunctivitis overlap with other causes of conjunctivitis" (CDC). Watery discharge with a cold and a tender node in front of the ear suggests viral; thick pus that mats the lids suggests bacterial (CDC, StatPearls).
When does a red eye need an eye specialist?
With moderate to severe pain, vision loss, light sensitivity, corneal involvement, severe purulent discharge, recurrent episodes, no response to treatment, herpes eye infection, immunocompromise, contact lens wear, or a possible need for steroids (StatPearls). Hyperacute gonococcal or meningococcal conjunctivitis is an emergency.
Can I use steroid eye drops for pink eye?
Only under an eye specialist’s direction. StatPearls: patients who may need steroids should be referred; steroids "may slow healing, increase the risk of corneal melting, and increase the risk of elevated intraocular pressure," and "Topical corticosteroids alone are contraindicated in epithelial herpes simplex keratitis."
How long does pink eye last?
Viral: "usually clears up in 7 to 14 days" but can take 2 to 3 weeks or more; mild bacterial: "usually clears up in 2 to 5 days without treatment but can take 2 weeks" (CDC). NEI: "Pink eye often gets better on its own after 7 to 10 days."

Sources

Reviewed by Hae Suk Lee, RN

Educational summary for nursing students. Scenarios are fictional teaching cases. Always verify against current guidelines and your institution's protocols before acting in practice. Not medical advice.

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