Eye inflammation
Conjunctivitis — what really helps, and what you can save yourself
A red, watering, sticky eye is unpleasant, but rarely dangerous. The real question is a different one: is it the conjunctiva at all? And if it is — viral, bacterial or allergic? Everything hangs on that: the treatment, the risk of infecting others and the answer to 'Can my child go to kindergarten?'.
What conjunctivitis is
The conjunctiva is the thin, transparent mucous membrane that covers the white of the eye and lines the inside of the eyelids. It is the eye's foremost line of defence — and correspondingly often irritated. When it becomes inflamed, its fine vessels widen: the eye goes red, waters, burns or itches.
The medical name for it is conjunctivitis. Pink eye and conjunctivitis mean the same thing; the one term is on the package leaflet, the other in conversation. It is the commonest eye inflammation there is, and in most cases harmless.
'In most cases', though, is not a finding. From the outside a red eye looks red — whether the inflammation involves only the conjunctiva or the cornea, the sclera or the inside of the eye as well shows only at the slit lamp. That is exactly the difference between 'unpleasant' and 'needing treatment'.
Symptoms: how to recognise conjunctivitis
- Redness of the whole white of the eye, often stronger towards the lids
- Watering, burning, a foreign-body sensation — as though you had sand in your eye
- Discharge: watery, mucous or purulent-yellowish
- Eyelids stuck together in the morning, especially where the cause is bacterial
- Itching, which dominates where the cause is allergic
- Light sensitivity in a mild form
- At first usually one eye, and after one to two days it often spreads to the other
What is not part of a simple conjunctivitis: severe pain in or behind the eye, markedly worse vision, pronounced light sensitivity. Those three signs point to something else — and need assessing.
Viral, bacterial or allergic — the three forms
Viral conjunctivitis
The commonest form in adults, usually caused by adenoviruses. Typically: watery discharge, beginning in one eye, often in connection with a cold, occasionally a swollen lymph node in front of the ear. It usually settles on its own — over one to three weeks, which is longer than most people expect. Antibiotic drops change nothing about that, because they do not work against viruses. What is treated is what bothers you: lubrication, cooling, patience.
The most contagious variant is called Keratoconjunctivitis epidemica. It spreads through hands, towels and door handles exceptionally easily — in families, offices and waiting rooms. When we suspect it, we tell you very specifically what you have to watch out for at home.
Bacterial conjunctivitis
Typical is the yellowish, purulent, sticky discharge and the eyelid stuck together in the morning. Some of these courses too settle without treatment; antibiotic eye drops can shorten the course and limit the contagious period. Whether they are indicated is decided by the findings — not by the wish for 'something effective'. Antibiotics given 'on suspicion' are useless with a viral inflammation and encourage resistance.
Allergic conjunctivitis
Here one symptom dominates: Itching. Almost always both eyes are affected, the discharge is watery, and a runny nose often comes with it. The triggers are pollen, house dust mites, animal hair or cosmetics. It is not contagious. It is treated with antiallergic eye drops and, where possible, by avoiding the trigger.
And the fourth possibility
Not every red eye is an infection. Dry eyes, draughts, chlorinated water, smoke, screen work, an inflammation of the eyelid margin or an eyelid malposition produce the same picture. Anyone who puts in drops for weeks without it getting better often does not have the wrong preparation but the wrong diagnosis. And if pain, light sensitivity or worse vision come with it, the cornea needs assessing: Keratitis — when the cornea is inflamed.
Is conjunctivitis contagious?
That depends on the cause — and that is the most honest answer there is:
- Viral: yes, markedly. It is transmitted by the hands, not through the air. You are contagious for as long as the eye is red and watering — with adenoviral courses often one to two weeks.
- Bacterial: yes, but less so. Here too, transmission runs through the hands and shared textiles.
- Allergic: no. Not contagious at any stage.
What works are the banal things, and done consistently: wash your hands, do not rub the eye, your own towel and your own flannel, change the pillowcase frequently, no eye cosmetics, no contact lenses, no shared dropper bottle for two people or two eyes.
What to do about conjunctivitis?
In the first one to two days, if there are no warning signs:
- Take hygiene seriously. Wash your hands before and after you touch the eye. That is not a side issue; it is the most effective part of the treatment.
- Remove the crusts — with a clean cloth moistened with lukewarm water or sterile saline, from the outside inwards, a fresh cloth for each eye.
- Lubricating eye drops with no active ingredient relieve burning and the foreign-body sensation. Preservative-free preparations are better tolerated with frequent use.
- Cooling for allergic irritation. Warmth where the eyelid margin is inflamed as well.
- Leave contact lenses out — completely, until the eye is free of irritation. Replace opened lenses and the storage case afterwards.
What you can save yourself: chamomile tea compresses and eye baths with home remedies. Chamomile is itself a common contact allergen and can make the irritation worse. Also not sensible: leftover antibiotic drops from the last episode or from a relative's cupboard. And never steroid eye drops without a confirmed diagnosis — with an unrecognised infection of the cornea they can do considerable damage.
Conjunctivitis in children, kindergarten and school
Children get conjunctivitis more often than adults — they touch their faces, share everything and sit close together. In children the bacterial proportion is higher than in adults.
For day care, kindergarten and school, a workable rule is: For as long as the eye is clearly watering, discharging pus or sticking together, the child stays at home. The institutions have their own rules for this, so ask them — and if a confirmation is required, do not let a diagnosis be issued over the phone.
Children belong at the paediatrician or with us in any case, if they complain of pain, avoid the light or see worse, if the lid is markedly swollen or reddened, if fever comes with it — and always with newborns and infants in the first weeks of life. A red eye at that age is never a matter for waiting.
When you should see an ophthalmologist
Call us the same day if one of these applies:
- Pain in or behind the eye — not just burning or itching
- Light sensitivity that makes you screw up your eyes
- Worsening or blurred vision
- Contact lenses and a red eye — lenses out immediately, and call
- Marked swelling of the eyelid, fever or a rapidly growing lump on the lid
- Redness that lies mainly around the cornea rather than being spread evenly
- No improvement after three to four days or a worsening
Our phone number: +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30. For findings of this kind we keep short-notice appointments free.
How we assess and treat
The examination rarely takes long, but it is the whole point: at the slit lamp we assess the conjunctiva, the cornea, the eyelid margins and the anterior chamber and, where necessary, stain the surface of the cornea to make defects visible. That is what separates the things that look the same from the outside: conjunctivitis, corneal inflammation, inflammation of the eyelid margin, an inflammation inside the eye — or a dry eye disguising itself as an infection.
The treatment follows from that, and sometimes no treatment follows: when the most honest recommendation is 'watch it, keep it moist, check again in three days', that is exactly what we say. We do not prescribe antibiotic drops for a viral inflammation, or steroids without a confirmed diagnosis.
Assessing and treating conjunctivitis are medical services; where there is a medical indication the cost is covered by basic health insurance (OKP). Your deductible and co-payment apply as at any doctor's appointment.
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Medically reviewed by PD Dr. med. Andrea von Rückmann · Last reviewed
Frequently asked questions
- Viral and bacterial forms are contagious, the allergic form is not. Transmission is almost always by the hands, not through the air. As a rule of thumb: for as long as the eye is visibly red and watering or discharging pus, you should assume you are infectious — with adenoviral courses that is often one to two weeks. Your own towel, frequent hand-washing and not rubbing the eye markedly reduce the risk for the people around you.
- Yes. 'Conjunctivitis' is the medical term, derived from conjunctiva, the membrane that lines the eye. You will find it on prescriptions, medical reports and package leaflets; in conversation most people say pink eye. Both terms describe the same condition and say nothing about whether the cause is viral, bacterial or allergic — that is the question that actually counts.
- Bacterial courses often improve within a few days. Viral ones last longer, often one to three weeks, and in the second week sometimes become unpleasant again before they settle. Allergic symptoms last as long as the trigger is there. If no tendency to improve is apparent after three to four days, an examination is worthwhile — usually the diagnosis is then wrong.
- That depends on the cause. Lubricating drops with no active ingredient relieve the symptoms in every case and never do harm; preservative-free preparations are more comfortable with frequent use. Antibiotic drops help only where the cause is bacterial. Antiallergic drops only where it is allergic. Steroid drops belong exclusively in medical hands, because with an unrecognised corneal infection they can do considerable harm.
- If you feel well and have no warning signs, there is medically little against it — practically, though, there is a fair amount. With viral conjunctivitis you easily infect others in the office, particularly through shared keyboards, door handles and towels. Where there is close contact with many people, in nursing, childcare or catering for instance, a break is the more sensible solution. Talk to us about it; we will weigh it up with you realistically.
- As a rule not, for as long as the eye is clearly watering, discharging pus or stuck together in the morning — the risk of infecting others is greatest in this phase. As soon as the eye is dry and free of irritation, there is usually nothing more against going. Day-care centres, kindergartens and schools do have their own rules for this, some requiring confirmation from a doctor; ask them directly. With pain, fever or marked swelling of the eyelid, the child needs examining first.
- A red eye without pain, without light sensitivity and without any worsening of vision can as a rule be watched for one to two days. If one of those three signs joins it — or if you wear contact lenses — call us the same day. Better a call that turns out to be unnecessary than a corneal inflammation left too long. Describe the symptoms to us on the phone; we will tell you whether it can wait until tomorrow.
When in doubt: call, don't google.
Describe your symptoms to us on the phone. We will tell you straight away whether it can wait until tomorrow — or whether you should come in today.
+41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30. Or book an appointment online.