Signs and symptoms of conjunctivitis

Signs and symptoms of conjunctivitis

General signs and symptoms of conjunctivitis

These include:

  • Discolouration in the white of the eyes (pink / red / ‘bloodshot’ appearance)
  • Swelling of the conjunctiva and or / eyelids (accompanied by redness)
  • Itching and or / burning sensations (these can be intense and often worsen when the eye is rubbed)
  • Increased tear production (shiny, watery eyes due to overactive tear glands)
  • A sense of eye irritation or ‘grittiness’ (i.e. feeling like a foreign substance or object is in the eye accompanied by an urge to rub in an attempt to rid the eye of the irritation)
  • Photophobia (sensitivity to light)
  • A pus or mucous discharge (which may be white or tinged with green or yellow)
  • Crusting of the lashes or eyelids (which most often builds up at night)
  • Discomfort while wearing contact lenses / lenses which do not remain in place on the eye
  • Cracked and or / dry eyelids
  • Blurry vision
  • Mild pain

Illustration showing primary difference between a healthy functioning eye and one affected by conjunctivitis.

Signs and symptoms of conjunctivitis based on the cause:

  • Viral conjunctivitis: The onset of viral pink eye usually develops over a period of time. It initially affects one eye and is then spread to the other. The sufferer may experience mild itching or burning but usually no pain is associated with this condition. Discharge from the eyes is normally watery (not pus or mucous) with this form of pink eye. These general symptoms are often accompanied by others similar to those of the common cold, influenza or respiratory infections. These include swollen lymph nodes, fever, headache, a sore throat, cough, sneezing and body aches. Symptoms typically affect one eye but may spread to the other within a few days.
  • Bacterial conjunctivitis: This type of conjunctivitis usually comes on suddenly and occurs in one eye first and may spread to the other in two to five days. It causes significant irritation and the sufferer may feel as though they have something in their eye. The discharge experienced in this type of conjunctivitis is that of mucous or pus (which may have a grey, yellow or green hue) and can cause a sticking together of the eyelids (which can later crust). Sticking together and crusting (due to an accumulation of discharge) most often happens during the night when the affected person is asleep. Swelling (oedema) and redness may affect the eyelids of both eyes. Bacterial conjunctivitis can sometimes lead to the development of an ear infection, as well as symptoms such as fever, headache, sore throat, body aches and swollen lymph nodes.
  • Allergic conjunctivitis: General symptoms which typically affect both eyes at the same time occur due to exposure to a specific allergen. Itching, tearing and swelling (puffy eyes) can be severe and also accompanied by other allergy related symptoms such as sneezing, an itchy nose, nasal congestion (stuffiness), a scratchy throat, or asthma.
  • Chemical conjunctivitis: Eyes may become very watery and red, accompanied by a mucosal discharge.
  • Neonatal conjunctivitis: A new-born baby may experience red, excessively puffy (swollen) and tender eyelids. Bacterial causes can result in a pus discharge within a few days (or up to a few weeks) following birth, often accompanied by other signs of infection in other areas of the body (such as problems with the lungs and nasopharynx, where the back of the nose connects with the mouth, as well as bacteraemia, an infection of the bloodstream, brain and or / spinal cord). Symptoms of a chlamydial infection normally present between 5 and 12 days following birth. 13 Infection caused by gonorrhoea normally present symptoms between 2 and 4 days following delivery. A newborn can also experience an adverse reaction to eye drops (topical antimicrobials) given shortly after birth (as a bacterial infection preventative measure) and this can cause conjunctivitis symptoms (a saline solution to flush the eyes will then be given).

What does pink eye look like

How long do conjunctivitis symptoms last?

Symptoms of conjunctivitis can last anywhere from a few days to several weeks (2 to 4 weeks), depending on the nature of the underlying cause (or type). If complications develop, symptoms (along with others) may persist for a longer period.

Viral conjunctivitis / pink eye is highly contagious for the 3 to 7-day prodromal period (i.e. the time when the first signs and symptoms begin to show) and approximately 10 to 12 days thereafter, for as long as the eyes are red.

The contagious period may vary however, according to the underlying cause. If pink eye is due to measles or German measles for instance, symptoms may persist for a few weeks. This type of pink eye is typically at its worst during the first 4 to 7 days once symptoms begin and improves thereafter, generally resolving after two to four weeks. Bacterial conjunctivitis usually takes 1 – 2 weeks to resolve (even without treatment). A person is, however, not normally contagious 24-hours following the commencement of antibiotic treatment. Thus, a doctor may advise that a person remains home, away from the company of others, until at least 24-hours after treatment commences so as to avoid potentially spreading the infection. Once undergoing treatment, the risk of transmission is reduced, and a person is less likely to spread infectious conjunctivitis to others.

If no treatment is prescribed (as may be the case in viral conjunctivitis which will run its course), a person with pink eye should stay clear of others until all symptoms resolve, or for as long as a medical doctor recommends. Eye drops may be recommended to ease irritation and discomfort. Antibiotic treatment will only be effective in the case of a bacterial infection.

Allergic conjunctivitis typically resolves in a short time period once the allergen triggering the adverse response is removed. Recurrences are common where the cause of the reaction is not entirely avoided / avoidable.

In all instances of conjunctivitis, it is wise to follow the directions of a medical doctor, especially where contagious forms of pink eye are determined. A doctor will likely indicate the type of conjunctivitis based on a thorough medical evaluation, and as such, make recommendations on treatment, including the time necessary to be spent away from others to avoid transmitting the infection. It is best to follow these recommendations, especially if pink eye is of the contagious variety.

When should you worry?

A consultation with a medical doctor is advisable if:

  • The affected eye becomes very painful, tender, red and swollen
  • Visual disturbances develop, such as blurry vision and a heightened sensitivity to light
  • Pink eye or any type of ocular infection develops in a newborn baby (this is considered a medical emergency and must be attended to by a doctor immediately)
  • There is no improvement in symptoms within 10 days (under treatment or not)
  • Symptoms worsen
  • One’s immune system is already compromised or weakened due to a pre-existing condition such as HIV/AIDS or while undergoing medical treatment like chemotherapy or radiation therapy (for cancer).

What can go wrong when I have pink eye?

Complications of conjunctivitis can include:

  • Inflammation of the cornea (keratitis), causing scarring (affecting visual acuity) – this can occur as a complication of conjunctivitis caused by viral or bacterial infections (such as those resulting from adenoviruses, chlamydia or gonorrhoea), as well as dermaconjunctivitis and giant papillary conjunctivitis.
  • The formation of ulcers on the cornea (causing intense pain in the eye, photophobia (light sensitivity), blurred vision, a gritty feeling in the eye and watery eyes) – this raises the risk for permanent visual impairment.

The risk of developing conjunctivitis complications is reasonably small, however, if pink eye is one of several symptoms associated with an underlying medical condition, such as sexually transmitted infections (STI) like HSV-2 (genital herpes) or gonorrhoea, chances increase somewhat.

Most at risk for complications are newborn infants. Neonatal conjunctivitis can be severe and progress (worsen) fairly quickly. If inadequately or not timeously treated, complications can be devastating, potentially resulting in permanent visual impairment. If the underlying infection is chlamydial, a newborn is at risk of developing pneumonia (inflammation of the lungs), which can be highly life-threatening for a baby.

It is possible, although very rare, for newborns to also develop complications such as:

For the most part, neonatal conjunctivitis is usually picked up in a newborn and treated timeously. Newborns affected by infectious conjunctivitis thus generally make a full recovery with little to no serious complications or long-term effects.


13. Centers for Disease Control and Prevention. 2 October 2017. Conjunctivitis (Pink Eye) in Newborns: [Accessed 22.08.2018]

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