Pink eye is one of the most over-treated conditions in outpatient care. The clinical reality is that most cases — especially in adults — are viral or allergic and resolve without antibiotic drops. The decision tree matters more than the prescription.
The three types and how they differ
Viral conjunctivitis: Watery discharge, often starts in one eye and spreads. Typically associated with cold symptoms or recent upper respiratory illness. Highly contagious. Resolves in 1-2 weeks. Antibiotic drops do not help.
Bacterial conjunctivitis: Thick, yellow-green discharge, eyes mat shut overnight, often unilateral initially. Less common in adults than children. Antibiotic drops shorten the course modestly.
Allergic conjunctivitis: Itchy, watery eyes, usually bilateral, often with seasonal pattern. Antihistamine drops are the right treatment; antibiotics do nothing.
The clinical differentiator
Discharge type is the most reliable single sign. Thick, purulent, mat-the-eyes-shut discharge points to bacterial. Watery discharge points to viral. Itch as the dominant symptom points to allergic. Most adult cases on this protocol are viral or allergic.
What to do at home
Cool compresses, lubricating drops (preservative-free artificial tears), and good hand hygiene to prevent spread. Avoid contact lenses until resolved. For allergic conjunctivitis, OTC antihistamine drops (ketotifen, olopatadine) are effective.
When a Sickday licensed clinician helps
The visit makes sense when discharge is clearly purulent, when symptoms persist beyond 7-10 days, when there is significant pain or vision change, or when the wrong-treatment risk is meaningful (contact lens wearers, recent eye surgery). For typical viral pink eye, a virtual evaluation can confirm the read and avoid unnecessary antibiotics — which is its own clinical win.
