Pink Eye in Babies, Children and Adults: Age-Specific Care in Australia

The safest next step for a red or sticky eye depends on age. A newborn with a red or discharging eye needs a same-day in-person medical examination. A school-aged child with mild watery eyes and no warning signs may be able to recover with home care, but the cause should not be assumed. An adult’s red eye has a different list of possible causes again.

This guide covers what changes at each age, what Australian childcare services and schools usually require, and when an eye examination is needed. For the types of conjunctivitis and how they are treated, read our guide to understanding pink eye.

Pink eye by age: a quick guide

These are general patterns. Any age group can have any cause, and the warning signs below always take priority.

Newborns: why a sticky eye needs a same-day check

Conjunctivitis in the first four weeks of life is called neonatal conjunctivitis (ophthalmia neonatorum). Most cases are mild, but some are caused by infections passed from parent to baby during birth. These can damage the eye or affect the rest of the body, so a doctor needs to examine the baby, usually take a swab, and choose treatment based on the result. This cannot be done by telehealth.

Timing can be a clue, not a diagnosis

If one of these infections is found, parents may also be offered testing and treatment. This is a routine part of care.

Do not put breast milk, leftover antibiotic drops or home remedies into a newborn’s eye. Clean any discharge gently with cooled boiled water and a fresh cotton pad for each wipe while you arrange the appointment.

Babies: blocked tear duct or infection?

A blocked tear duct (nasolacrimal duct obstruction) is very common in the first year. Tears cannot drain into the nose, so the eye waters, the lashes crust, and the eye may look sticky. The key difference from conjunctivitis is that the white of the eye stays white and the baby is comfortable. Most blocked tear ducts clear on their own by the first birthday.

• Clean the eye with cooled boiled water, wiping from the inner corner outwards.
• Ask your GP or child health nurse to show you gentle massage over the tear sac, beside the nose.
• See your GP if the watering is still present around 12 months of age.

Get your baby checked the same day if the eye becomes red, the eyelid swells, or a red, tender lump appears at the inner corner of the eye near the nose, which can mean the tear sac is infected. Constant watering with light sensitivity, or a cornea that looks cloudy or unusually large, can rarely be infant glaucoma and also needs urgent review. A white reflection in the pupil in flash photos is not conjunctivitis, but should be checked by a GP promptly.

Toddlers and preschool children

Young children often cannot describe pain or blurred vision. Watch for eye rubbing, refusing to open the eye, turning away from light, bumping into things, or unusual irritability.

Conjunctivitis with an ear infection

Some bacterial conjunctivitis in young children comes with a middle ear infection. Mention ear pain, ear tugging or fever to the doctor, because they will want to check the ears and the treatment may differ from eye drops alone.

Eyelid infection (cellulitis)

A red, swollen, tender eyelid, often after a cold, an insect bite or a scratch, is not ordinary conjunctivitis. It needs a same-day assessment. Fever with a bulging eye, pain on moving the eye or poor vision suggests the infection has spread behind the eye, which is an emergency.

Foreign bodies and chemicals

Sand, grit and splashes are common causes of sudden redness at this age. Detergent capsules and dishwasher products can cause serious chemical burns. Rinse first, then call 000 or the Poisons Information Centre on 13 11 26.

How to give eye drops to a young child

1. Prepare. Wash your hands, check the label and expiry date, and have a tissue ready. Do not let the dropper tip touch the eye or lashes.
2. Position. Lay your child on their back. Wrapping a toddler snugly in a towel can help, or ask a second adult to hold their head gently.
3. Use the inner corner. If your child squeezes their eyes shut, place the drop in the inner corner of the closed eye. It will run in when they open it.
4. Use ointment as directed. Squeeze a thin line into the lower lid, or onto the lashes if the lid cannot be opened. Vision will be blurry for a few minutes.
5. Finish. Wipe away any excess with a fresh tissue for each eye, then wash your hands again.

Each child needs their own bottle or tube. Do not share eye medicines between siblings, even if they have the same symptoms.

School-aged children

Viral conjunctivitis is common at this age and often comes with a cold. Allergic conjunctivitis also becomes more common, particularly in the spring pollen season, and causes itchy eyes in both eyes without spreading to others.

• Teach handwashing with soap and water after touching the face and before touching the eyes.
• Give each child their own towel, face washer and pillowcase while symptoms last.
• Skip swimming lessons and do not share goggles until the eyes have recovered. Our guide to stopping pink eye spreading at home has a full household checklist.
• If your child wears orthokeratology (overnight) lenses to manage short-sightedness, any red or painful eye needs a same-day optometrist review. See our contact lens red eye guide.

Adults: causes children are less likely to have

Severe viral conjunctivitis

Some adenovirus infections (epidemic keratoconjunctivitis) are intensely red and gritty, very contagious for about two weeks, and can leave small spots on the cornea that blur vision or cause light sensitivity weeks later. If vision is affected, see an optometrist.

Cold sores and shingles

A red eye with a cold sore near the eye, blisters on the eyelid, or a shingles rash on the forehead or tip of the nose needs same-day assessment. Herpes viruses can damage the cornea.

Sexually transmitted infections

Chlamydia can cause conjunctivitis that lingers for weeks, often in one eye, and gonorrhoea can cause sudden, heavy pus. If there is any chance of exposure, tell the clinician. Both need specific testing and treatment rather than standard eye drops.

Work, make-up and contact lenses

There is no national exclusion rule for adults. If you work in healthcare, childcare or aged care, check your workplace policy. Throw away eye make-up used while symptomatic. If you wear contact lenses, take them out: redness in a lens wearer needs same-day in-person assessment, because a corneal infection can look like conjunctivitis. Our contact lens safety guide explains why.

Pregnancy and breastfeeding

Ask a pharmacist or GP before using medicated eye drops, including allergy drops. Lubricating drops and cool compresses are generally safe for comfort.

Older adults: when a red eye is not conjunctivitis

• Dry eye and blepharitis are common, usually affect both eyes, and cause gritty, burning eyes that worsen with screens, wind or air-conditioning. They are long-term rather than contagious.
• A burst blood vessel (subconjunctival haemorrhage) causes a painless, bright red patch and settles over one to two weeks. Mention it to your GP if it keeps happening, follows an injury, or you take blood-thinning medicines.
• Acute angle-closure glaucoma causes a painful red eye with blurred vision, haloes around lights, headache and sometimes vomiting. This is an emergency.
• After eye surgery, including cataract surgery, increasing pain, redness or blurred vision needs same-day contact with your surgeon or an emergency department.
• Glaucoma eye drops can cause allergic redness. Do not stop them without advice; contact the prescriber.

How treatment differs by age

• Antibiotic drops do not treat viral or allergic conjunctivitis at any age, and many bacterial cases settle without them.
• Children are more likely than adults to have bacterial conjunctivitis and to be offered antibiotic drops or ointment after assessment.
• Some antibiotic and allergy eye drops sold by pharmacists have minimum ages. Babies and very young children should be assessed by a doctor rather than treated with pharmacy products.
• Lubricating drops and cool compresses help comfort at most ages. Ask a pharmacist which products suit a child.
• Steroid eye drops should only be used when prescribed by an eye specialist.

When telehealth can help, and when an examination is needed

A GP video consultation can work well for a school-aged child or adult with mild redness, normal vision and no pain, or for itchy allergic eyes. Good lighting and a short phone video of the eye taken beforehand help the GP see more clearly.

Telehealth is not suitable for newborns, babies with a red eye, a child who cannot or will not open the eye, a swollen eyelid, contact lens wearers with a red eye, or anyone with the warning signs above. These need an examination in person.

For mild symptoms, a DocTel pink eye consultation can help decide the next step. If a child or adult has several health concerns at once, a general GP telehealth consultation may suit better. A prescription is issued only when clinically appropriate, and the GP may recommend in-person care instead.

Questions parents and adults often ask

Sources and further reading

This article is general information and does not replace an individual medical assessment.

• Healthdirect Australia: Conjunctivitis
• NHMRC Staying Healthy: Conjunctivitis fact sheet
• Healthdirect Australia: School exclusion periods