How Do You Get Pink Eye?

My daughter has just been diagnosed with pink eye. The doctor prescribe eye drops and said it's contagious for the first two days. Since nobody seems to have it, how did she get it?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Your question is a good one, and it is also quite timely. Many parents have recently written in with similar concerns about pink eye. The reason for this sudden interest in pink eye is somewhat hidden in the answers to your questions. Therefore, let me give you a broad overview of what pink eye is.

What is pink eye?

Pink eye, or conjunctivitis, is an infection of the inner eyelids and surrounding tissues of the eye. Some of these tissues overlay the white part of the eye, so when they become inflamed, the eye appears red. Technically, the term conjunctivitis simply means an inflammation of these tissues. Therefore, anything resulting in an irritation and swelling of these tissues such as allergies or spilling a chemical into the eye is considered conjunctivitis. However, for this discussion, I will limit the term, pink eye, to that caused by infections.

What causes pink eye?

Pink eye may be caused by viruses or bacteria. The prevalence of viral pink eye depends a lot upon the season. During the cold and flu season, most pink eye is caused by viruses. And just other viral infections, they do not respond to antibiotics. Those caused by bacteria do respond to antibiotics by decreasing the length of time of having the pink eye by a couple of days; however, most children with bacterial pink eye are able to successfully fight off the infection without medication. In other words, the vast majority of children with pink eye will get better without antibiotic drops.

How do you get pink eye?

There many myths and misconceptions within the schools and daycare centers concerning pink eye. While it is true that conjunctivitis is contagious, it is not because the bacteria or viruses that cause it are worse than in other contagious illnesses.

The viruses that cause pink eye are the same ones that cause the common runny nose, cough, post-nasal drip and, occasionally diarrhea. What causes pink eye in one child may only cause nasal congestion in another. In other words, pink eye does not necessarily beget pink eye. The contagiousness lies in how it is transmitted. Like most cold season viruses, the infection gets transmitted hand-to-mouth through secretions. Those with pink eye tend to rub their eyes often. Then when they contact another by playing or handshaking, the virus gets transmitted. Simply being in the room with someone with pink eye is of no danger. And if the person with pink eye carefully avoids rubbing his eyes and washes his hands throughout the day, the risk of transmission is quite low. This, obviously, is difficult in a pre-school or daycare setting, so these affected children are often excluded from attending.

The bacteria that cause pink eye are the same ones that cause ear infections. It is not uncommon for the doctor to find an ear infection along with the pink eye. In this scenario, it is almost certain that the eye and ear infection are caused by the same bacteria. These bacteria are easily found in the environment, and the infection is usually started simply because the unlucky child happened to rub his eyes when he had these bacteria on his hands.

If most kids get better on their own without antibiotic drops, why all the fuss about pink eye?

And that question is a good one. The problem is that determining whether the pink eye is caused by a bacteria or virus is virtually impossible by just examining the eye. Therefore, many physicians simply opt to give antibiotics to cover the possibility of bacterial illness. The funny part is that most schools and daycare centers do not allow children to attend until they are on antibiotic drops, thinking that this will eliminate the risk of transmission. This is a false assumption because if the pink eye is caused by a virus, the child is just as infectious whether he is taking the eye drops or not.

Well then, how long should I exclude my child if she has pink eye?

This is the $64,000 question because there is no easy answer. If the child is old enough to be responsible about handwashing (usually school age), exclusion from school or activities is unwarranted. If he is a toddler or pre-schooler, it is probably best to keep him away from the other children for a couple of days due to the fact these children tend to "swap secretions" rather readily. Unfortunately, how long a child is excluded from daycare or school is often dictated more by the school's individual policy than by sound medical science.

So, you see, if the pink eye your daughter got was caused by a virus, she probably got it from someone who had a cold. It is now the beginning of the cold and flu season, which explains why I have had so many questions concerning pink eye. As long as there are people running around with stuffed-up noses and scratchy throats, there will be others who happen to get pink eye from it. If, however, it was caused by bacteria, she most likely deposited them there by rubbing her eyes. These bacteria are very common, normally live in the throats and noses of many people and usually do not cause a problem. It is often just bad luck that a few of these bacteria decide to run rampant in the eye. In either case, it is usually quite difficult to pin down exactly where the infection came from.

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