Pink Eye in Toddlers: Symptoms, Treatment and Daycare

Pink eye in toddlers shows up as a pink or red white of the eye, watery or thick discharge, crusty lashes in the morning and a child who keeps rubbing the eye. Viral pink eye usually clears in 7 to 14 days without treatment, and mild bacterial pink eye often clears in 2 to 5 days; antibiotics don't help viral pink eye. Both types spread very easily, so wash hands often. Eye pain, light sensitivity or blurred vision needs a same-day exam: call us at 310-828-2010, or go to an emergency room when we're closed. A newborn with pink eye symptoms needs a doctor right away.

Key takeaways

A toddler with pink eye may have a red or pink eye, watery or thick discharge and crusty lashes after sleep, and keep rubbing it.
Antibiotics don't help viral pink eye, which usually clears on its own in 7 to 14 days, and mild bacterial cases often clear in 2 to 5 days.
Eye pain, light sensitivity or blurred vision needs a same-day exam, or an emergency room when we're closed.
A red, swollen eyelid with a fever means calling us and coming straight in or calling your child's pediatrician right away, or an emergency room when we're closed.

How can you tell if your toddler has pink eye?

Check the whites of the eyes and the eyelids. Signs of pink eye include:

Pink or red color in the white of the eye
Swollen eyelids
Crusty eyelids or lashes, especially in the morning
Watery, teary eyes
Discharge (pus or mucus) that may be clear, yellow, white or green
Itching, irritation or burning
A feeling that something is in the eye, or an urge to rub it

A toddler may not be able to tell you that an eye itches or feels gritty, so watch for rubbing. Crust can also build up overnight and keep the eyes from opening when your child wakes up.

Where it starts is a clue. Viral pink eye usually begins in one eye and spreads to the other within days, while allergic pink eye usually affects both eyes.

What causes pink eye in toddlers?

Viruses, bacteria and allergens cause pink eye, and so can irritants such as smoke, dust, fumes or chemicals.

Viral pink eye is the most common type. Viruses such as adenoviruses cause it, it can come with a cold or other respiratory infection, and it's very contagious, sometimes causing large outbreaks.

Bacterial pink eye is more common in kids than in adults, especially shortly after birth. It shows up more often from December through April and can come at the same time as an ear infection.

Allergic pink eye is a reaction to things like pollen, dust mites, mold or pet dander. It isn't contagious, and it's common in people who have other allergic conditions, such as hay fever, asthma or eczema. Our page on eye allergies explains how we treat it.

Is my toddler's pink eye viral or bacterial?

The types can look alike at a glance, and an exam is how a doctor tells them apart. The discharge and what comes with it give clues:

Clue	Viral	Bacterial	Allergic
Discharge	Usually watery, not thick	Usually thick pus, almost always yellow or green; can stick the eyelids together	Clear and watery
Can come with	A cold, flu or respiratory infection	An ear infection	Itchy nose, sneezing, scratchy throat or asthma
Spreads to others	Yes, very easily	Yes, very easily	No, it isn't contagious
Usual course	Clears in 7 to 14 days without treatment; sometimes 2 to 3 weeks or more	Mild cases usually clear in 2 to 5 days without treatment; can take 2 weeks	Improves once the allergen is removed

Does a toddler with pink eye need antibiotic eye drops?

Only if bacteria are the cause, and not always then. Antibiotics won't improve viral pink eye, because they don't work against viruses.

Mild bacterial pink eye may get better without antibiotics and without complications. When a doctor prescribes an antibiotic, it's usually an eye drop or ointment, and it may shorten the infection, reduce complications and help prevent spread to others. Antibiotics may be needed when there's pus, when the immune system is weakened, or when certain bacteria are suspected.

For more serious viral infections, such as those caused by the herpes simplex or varicella-zoster virus, a doctor can prescribe antiviral medicine. Allergic pink eye usually improves once the allergen is removed, and allergy medicines or certain eye drops can help. Ask your child's doctor which ones suit your toddler's age.

Use prescribed drops as prescribed, and call the doctor back if bacterial pink eye isn't better after 24 hours of antibiotics.

When can a toddler with pink eye go back to daycare?

When the symptoms are gone and the doctor agrees. CDC's advice for returning to school or work is that someone without fever or other symptoms may be allowed back with their doctor's approval, and that someone who still has symptoms shouldn't attend if the setting involves close contact with others.

Its guidance for doctors adds that people with viral or bacterial pink eye should stay home if they have signs of illness in the whole body, such as a fever, especially if they can't avoid close contact with others, and that they may return with a clinician's approval once any treatment they need has started.

A toddler in group care can't avoid close contact with other children, so plan to keep your child home until the symptoms clear and the doctor says it's fine to go back; the doctor may clear an earlier return once any needed treatment has started. Ask your child care center about its own policy too.

How do you stop pink eye from spreading at home?

Good hygiene controls the spread. CDC recommends these steps:

Wash your hands often with soap and water for at least 20 seconds, including after you put drops or ointment in your child's eye
Use an alcohol-based hand sanitizer with at least 60% alcohol when soap and water aren't available
With clean hands, wipe discharge from around your child's eyes several times a day with a clean, wet washcloth or a fresh cotton ball, and throw cotton balls away after use
Wash used washcloths, pillowcases, sheets and towels often in hot water and detergent
Don't share pillows, washcloths, towels or eye drops
Don't use the same eye drop bottle for an infected eye and one that isn't infected

Try to keep your toddler from touching or rubbing the eyes, and wash small hands often, since germs spread when someone touches objects or surfaces and then their eyes.

When does a young child with pink eye need a doctor?

See a doctor if your child has pink eye along with any of these:

Eye pain
Light sensitivity
Blurred vision that doesn't improve when discharge is wiped from the eyes
Intense eye redness
Symptoms that get worse or don't improve
Bacterial pink eye that isn't better after 24 hours of antibiotics
A weakened immune system

We see eye pain, light sensitivity and blurred vision the same day: call us at 310-828-2010 during office hours (Monday 10 to 5, Tuesday through Friday 8 to 5), and go to an emergency room when we're closed; see our page on same-day urgent eye care.

If a young child has a red, swollen eyelid and a fever, or eyelid swelling with pain when the eye moves, a bulging eye, double vision or changed vision, call us at 310-828-2010 and come straight in, or call your child's pediatrician right away; when we're closed, go to an emergency room. These can be signs of orbital cellulitis, a serious infection of the muscle and fat inside the eye socket: it's more common in children, it's an emergency, and it can lead to vision loss. A red, swollen, tender eyelid without those signs still needs a same-day visit, or an emergency room when we're closed, because an eyelid infection that spreads behind the eye needs immediate medical care.

Newborns need care faster. A baby who develops eye drainage or red, puffy, tender eyelids in the first weeks after birth should be seen by a doctor right away, because untreated pink eye in a newborn can lead to open sores on the cornea and blindness. Call your pediatrician right away, and go to an emergency room if you can't reach one.

If a household chemical splashes into your child's eye, rinse first. Wrap a young child in a towel and let room-temperature water from the kitchen faucet run over the eye, or pour it slowly from a pitcher, for at least 15 to 20 minutes. Let the water hit the bridge of the nose and run gently into the eye, and encourage blinking. Then call Poison Control at 1-800-222-1222, and call us or go to an emergency room; if the symptoms are severe, go straight to an emergency room after rinsing.

If something is stuck in the eye, keep your toddler from rubbing it and call us to come straight in, because we remove these in the office; when we're closed, go to an emergency room. A cut to the eye, or an object that has pierced it, needs an emergency room right away: don't rinse it or remove anything, and protect the eye without pressing on it.

How we check a child's red eye at Cohenmehr Optometry

At our eye clinic in Los Angeles, red eye is one of the problems we see the same day during office hours. Viral, bacterial and allergic pink eye can look alike at a glance and are treated differently, so the exam starts with the clues: the type of discharge, one eye or both, the crusting pattern and how it started. Antibiotic drops are prescribed when the exam supports them.

Toddlers don't need to know their letters for an eye exam. In our pediatric eye exams, toddlers are tested with pictures and lights, and the visit checks how each eye sees and the health of the eye inside and out.

Questions patients ask

How do you treat pink eye at home?

If the case is mild, you can ease symptoms at home with a cold compress and over-the-counter eye drops; for a toddler, ask the doctor before using any drops. Antibiotics won't help viral pink eye. Wipe discharge away several times a day with a clean, wet washcloth or a fresh cotton ball. Eye pain, light sensitivity or blurred vision needs a same-day exam (an emergency room when we're closed), and symptoms that get worse need a doctor.

Is pink eye in toddlers serious?

Usually not. Most viral pink eye is mild, viral is the most common type, and most pink eye gets better on its own. Newborns are the exception: untreated pink eye can cause them serious health problems, so a newborn with symptoms should see a doctor right away. In a toddler, a red, swollen eyelid with a fever means calling us and coming straight in, or calling your child's pediatrician right away; eye pain, light sensitivity or blurred vision needs a same-day exam. When we're closed, go to an emergency room for either.

Can a blocked tear duct cause pink eye in babies?

Yes, in newborns. A blocked tear duct is one cause; irritation from the drops or ointment given at birth and an infection passed from mother to baby during childbirth are others. If the duct is the cause, a gentle, warm massage between the eye and the nose may help, and a duct that hasn't cleared by 1 year of age may need surgery. Because untreated pink eye can cause serious health problems for a newborn, a baby with eye drainage or red, puffy eyelids should see a doctor right away: call your pediatrician.

Can a toddler with pink eye give it to a newborn?

Yes. Viral and bacterial pink eye spread very easily from person to person, and newborn babies are at higher risk for pink eye, which can be very serious for them. Wash your hands after contact with your toddler or the things they use, and don't share pillows, washcloths or towels. If the baby develops eye drainage or red, puffy eyelids, call your pediatrician right away, or go to an emergency room if you can't reach one.

Sources

Written by

Dr. Kevin Cohenmehr, OD

Medical eye care: glaucoma, diabetic eye exams, macular degeneration and eye infections, plus vision therapy for children. A graduate of UCLA and SUNY College of Optometry.

About Dr. Kevin →

Pink Eye in Toddlers: Symptoms, Care and When to Call a Doctor