Reviewed by the Evolve Health clinical team · 2026-10-17 · 7 min read
Clinically reviewed by the Evolve Health clinical team — October 2026
Every article is checked by the clinicians who care for patients at Evolve Health in Denton. Meet the care team →
Quick answer
Pink eye (conjunctivitis) is inflammation of the clear membrane over the white of the eye, and it has three common causes. Viral pink eye — the most common — causes watery discharge, often comes with a cold, is very contagious, and clears on its own in about one to two weeks; antibiotics do nothing for it. Bacterial pink eye causes thick yellow-green discharge that seals the lids shut in the morning, and it usually does respond to antibiotic drops. Allergic pink eye itches intensely, hits both eyes at once, and is not contagious at all. Classic allergic and viral patterns can often be handled by a photo or video visit from anywhere in Texas. Pain, light sensitivity, vision changes, a red eye in a contact lens wearer, or discharge in a newborn always need an in-person visit.
The questions land at our front desk in a pattern every week: "My eye is red and goopy — do I need drops?" "My daughter's school sent her home; can she go back tomorrow?" "Can you just call something in?" The honest answer to all three is the same: it depends which kind of pink eye it is. Conjunctivitis is one of the most over-treated minor conditions in medicine — a large share of the antibiotic drops prescribed for it go into eyes that were never bacterial to begin with. Ten minutes spent identifying the cause saves you money, saves you a wasted prescription, and gets the eyes that actually need drops treated faster.
Three causes, side by side
Start with the discharge, then the itch, then which eyes are involved. Those three clues, plus what else is going on in your body, separate the causes most of the time:
| Clue | Viral | Bacterial | Allergic |
|---|---|---|---|
| Discharge | Watery, clear | Thick, yellow-green; lids stuck shut on waking | Clear, watery, sometimes stringy |
| Itch vs. burn | Burning, gritty, "sand in the eye" | Mild itch or irritation | Intense itching — the dominant symptom |
| One eye or both | Starts in one, often spreads to the other in a day or two | One or both | Both eyes, at the same time |
| What comes with it | Cold symptoms — sore throat, runny nose; sometimes a tender node in front of the ear | Often an ear infection in children; otherwise little else | Sneezing, itchy nose, seasonal allergy pattern |
| Contagious? | Yes — spreads like a cold, for as long as the eye is red and watering | Yes — much less so after about 24 hours on antibiotic drops | No — nothing to spread |
No single row is a diagnosis — patterns overlap, and a viral case can look messy by day three. But the pattern as a whole is informative: itchy + both eyes + allergy season points one way; glued-shut lids point another; a red eye riding along with a head cold points a third. When the pattern is classic and nothing on the in-person list below applies, a clinician can often sort it out from photos and a short history alone.
Why the antibiotic question matters
Antibiotic drops treat bacteria. They do nothing else. That sounds obvious, but it drives most of the waste — and some of the harm — in pink eye care:
- Viral pink eye is the most common kind, and antibiotics cannot touch it. The same viruses that cause colds cause most pink eye. It runs its course in about one to two weeks, and the treatment is comfort care and not spreading it.
- Bacterial pink eye usually does respond. When the discharge is thick and the lids are sealing shut, antibiotic drops shorten the illness and make you less contagious sooner. This is the case where drops earn their keep.
- Allergic pink eye never needs antibiotics. It needs the allergy addressed — antihistamine drops, oral allergy medicine, or a look at what is triggering it. If spring in North Texas sets your eyes off every year, our North Texas allergy season guide covers the bigger picture.
- Unnecessary drops are not harmless. They cost money, they can irritate the eye further, every unnecessary course feeds antibiotic resistance, and worst of all they can create false confidence while a more serious eye problem goes unseen.
When a photo or video visit can handle it
Pink eye is one of the conditions telehealth genuinely suits, because so much of the diagnosis is the story plus what the eye looks like. At Evolve Health, a video or photo visit can usually handle a classic allergic pattern (both eyes, intense itch, clear discharge, allergy symptoms, allergy season) and a classic viral pattern (watery discharge alongside a cold, mild burning, normal vision, no pain). You can be anywhere in Texas — the rule is that you are physically in Texas at the time of the visit — and if prescription drops are appropriate, they are sent to your pharmacy. Our guide to what telehealth in Texas can and can't treat explains how those visits work. A self-pay video sick visit is the same $75 flat as in person, told to you before you are seen.
One honest limit: if the pattern is not classic — mixed signs, a story that does not fit, or any feature from the list below — the right move is an in-person look, and we will tell you that on the call rather than guess.
When eyes must be seen in person
Some red eyes are not pink eye at all, and a few are emergencies. Be seen in person — the same day — if any of these apply:
- Pain rather than itch. Pink eye itches, burns, or feels gritty. True pain suggests something deeper — a corneal scratch or infection, or inflammation inside the eye.
- Light sensitivity or any change in vision. Blurred vision that does not clear when you blink the discharge away is never a wait-and-see symptom.
- You wear contact lenses. Contact lens wearers with a red, uncomfortable eye are always seen in person. Lenses raise the risk of a corneal infection that can threaten sight, and that risk is not assessed over video.
- Discharge or redness in a newborn or young infant. Eye infections in the first weeks of life are treated as urgent, always.
- A weakened immune system. Infections behave differently and escalate faster; a lower threshold for in-person care is right.
- Injury or chemical exposure. A splash, a scratch, or a foreign body needs an in-person exam — and a chemical splash needs urgent care or the emergency room now, after rinsing the eye with clean water.
School, daycare, and the send-home note
Here is the part that surprises most parents: current pediatric and public-health guidance is that most children do not need to stay home from school or daycare for pink eye alone. Exclusion is generally reserved for children who cannot keep their hands away from their eyes, situations where a school or the health department is managing an outbreak, or schools whose own written policy requires a visit or a period on drops before returning — and policies genuinely vary by school and district, so yours is the one that counts. Whatever the policy, a sick visit is $75 flat for self-pay, and we see children the same day: if the school wants a note, we provide one at the visit. If your child's red eye comes with fever, ear pain, or other symptoms, our same-day sick visits cover the whole picture in one appointment.
Home care that helps — and what to avoid
- Compresses: a cool compress soothes allergic and viral itching; a warm compress loosens the crusting of bacterial discharge so you can wipe it away gently, outward from the nose.
- Hands off, hands washed: rubbing spreads the infection to the other eye and to everyone you live with. Wash hands after touching your face, and use your own towel and pillowcase — nothing that touches your face gets shared until this clears.
- Contacts out: switch to glasses until a clinician clears you, then start fresh — new lenses, cleaned or new case. The pair that sat in an infected eye does not go back in.
- Makeup off and replaced: no eye makeup while infected, and mascara or liner that touched the infected eye should be thrown away.
- Never use leftover drops. Last year's antibiotic may be expired, wrong for this cause, or contaminated. And never use a leftover steroid drop without an exam: steroids can seriously worsen certain eye infections. If a drop was not prescribed for this episode, it does not go in the eye.
Frequently asked questions
Do I need antibiotics for pink eye?
Only if it is bacterial. Bacterial pink eye — the kind with thick yellow-green discharge that glues the eyelids shut in the morning — usually responds to antibiotic drops. Viral pink eye, the most common kind, does not respond to antibiotics at all and clears on its own in about one to two weeks. Allergic pink eye never needs antibiotics; it needs the allergy treated. This is why the cause matters more than the redness: the wrong drops cost money, delay the right treatment, and add to antibiotic resistance.
Can pink eye be treated over a video visit?
Often, yes. A classic allergic pattern — both eyes, intense itching, clear watery discharge during allergy season — and a classic viral pattern — watery discharge with a cold, no pain, no vision change — can usually be assessed by video or photo visit with a clear history, anywhere in Texas. Eyes need an in-person visit when there is pain rather than itching, light sensitivity, any change in vision, an injury or chemical exposure, or a discharge in a newborn. Contact lens wearers with a red eye should always be seen in person.
How long is pink eye contagious?
Viral pink eye is contagious for as long as the eye is red and watering — often a week or more — and it spreads the same way a cold does: hands, shared towels, pillowcases, and makeup. Bacterial pink eye is generally considered much less contagious once antibiotic drops have been started, commonly after about 24 hours. Allergic pink eye is not contagious at all, because nothing is being spread — it is your immune system reacting to pollen or dust. Careful hand washing and not sharing anything that touches your face matter more than anything else.
Does my child have to stay home from school with pink eye?
Usually not for pink eye alone. Current pediatric and public-health guidance is that most children do not need to be excluded from school or daycare just for pink eye, unless they cannot avoid rubbing their eyes, there is an outbreak the school or health department is managing, or the school's own policy requires it. Policies vary by school and district, so check yours. If your school asks for a note or requires a visit before your child returns, we can see your child the same day and provide one.
Can I wear contact lenses with pink eye?
No — take them out and leave them out until a clinician clears you to wear them again. Contacts trap discharge and germs against the eye, slow healing, and raise the risk of a corneal infection, which is far more serious than pink eye. Wear glasses in the meantime, and once you are cleared, start with a fresh pair of lenses and a cleaned or new case: the old pair was in the infected eye. If you wear contacts and your eye is red and painful, skip the video visit and be seen in person — contact lens wearers are the group we never guess with.
When is a red eye an emergency?
Go to urgent care or the emergency room the same day for eye pain (especially moderate or severe), light sensitivity, blurred or changed vision, a chemical splash or injury to the eye, discharge or redness in a newborn or young infant, or a red eye in someone with a weakened immune system. Those are not typical pink eye features, and some causes — corneal infections, chemical burns, inflammation inside the eye — can threaten vision if they wait. Ordinary pink eye itches or burns mildly, waters or discharges, and leaves your vision normal; it can safely start with a clinic or video visit.
Sources
- Centers for Disease Control and Prevention — Conjunctivitis (Pink Eye): causes, transmission, and treatment guidance, including that most cases are viral and do not require antibiotics
- American Academy of Ophthalmology — What Is Conjunctivitis?: viral, bacterial, and allergic comparison, and the warning signs that need an in-person eye exam
- American Academy of Pediatrics / HealthyChildren.org — guidance on pink eye in children, school attendance, and when exclusion is and is not recommended
Red eye? Let's find out which kind
Book a video visit from anywhere in Texas or a same-day visit in Denton. A self-pay sick visit is $75 flat — in person or by video — with the price told before you are seen, and if you have insurance we verify your coverage free from your card, photo ID, and date of birth before your visit.