What a doctor prescribes for pink eye depends entirely on the cause. Bacterial pink eye gets antibiotic drops or ointment, viral pink eye usually gets supportive care rather than a prescription, and allergic pink eye is treated with antihistamine or anti-inflammatory eye drops. Most cases clear up within one to two weeks, but the right treatment can speed recovery and prevent complications.
Bacterial Pink Eye: Antibiotic Drops and Ointments
Bacterial conjunctivitis is the type most likely to result in a prescription. The two most common first-line options are erythromycin ointment and trimethoprim-polymyxin B eye drops. Both are broad-spectrum antibiotics that cover the bacteria responsible for the majority of cases. Once treatment starts, symptoms typically improve within one to two days, though you’ll usually need to continue using the drops for the full course (five to seven days) to prevent the infection from returning.
If you wear contact lenses, the prescription may differ. Contact lens wearers are at higher risk for infections caused by a specific type of bacteria called Pseudomonas, so doctors often prescribe ciprofloxacin or gentamicin drops instead. These provide stronger coverage against that particular organism. You’ll also need to switch to glasses until the infection fully resolves.
Viral Pink Eye: Mostly Supportive Care
Viral conjunctivitis, the most common form overall, doesn’t respond to antibiotics. In most cases, doctors won’t write a prescription at all. Instead, they’ll recommend managing symptoms at home with artificial tears (available over the counter), cool or warm compresses, and an over-the-counter pain reliever like ibuprofen if your eyes are sore. The infection runs its course in one to three weeks.
There are exceptions. If your pink eye is caused by herpes simplex virus, the chickenpox/shingles virus, or a sexually transmitted infection, your doctor will prescribe antiviral medication. These specific viruses carry a higher risk of complications, including damage to the cornea, so they require active treatment rather than a wait-and-see approach.
Allergic Pink Eye: Antihistamine Eye Drops
When pink eye is triggered by pollen, pet dander, or other allergens, the treatment targets the allergic response rather than an infection. Doctors have a wide range of prescription eye drops to choose from, and most of them work through two mechanisms at once: blocking histamine (the chemical that causes itching and redness) and stabilizing mast cells (the immune cells that release histamine in the first place).
The most commonly prescribed options in this category include olopatadine, ketotifen, azelastine, epinastine, and bepotastine. These dual-action drops tend to work faster and last longer than older, single-mechanism alternatives. For milder cases, over-the-counter antihistamine drops may be enough. Some formulations of ketotifen and olopatadine are now available without a prescription, so your doctor may suggest trying those first before writing a script.
When Doctors Prescribe Steroid Drops
Corticosteroid eye drops are reserved for more severe cases of pink eye, regardless of the cause. They’re powerful anti-inflammatory agents that can quickly reduce swelling, redness, and discomfort when other treatments aren’t enough. But they come with real risks: prolonged use can raise pressure inside the eye, increasing the chance of glaucoma, and can contribute to cataract formation over time.
Steroids also interact poorly with certain infections. They can make herpes simplex eye infections significantly worse and may prolong adenoviral infections, which are the most common viral cause of pink eye. For these reasons, steroid drops are typically prescribed only for short courses of two weeks or less, often in combination with an antibiotic to prevent secondary infection. Your doctor will likely want to monitor your eye pressure during treatment.
Treatments for Children and Newborns
For children, doctors generally prefer erythromycin ointment over drops. Ointment is easier to apply to a squirming child, and it stays in contact with the eye longer. The typical regimen is applying a small ribbon of ointment inside the lower eyelid up to six times a day, though your pediatrician will adjust the frequency based on severity.
Newborns are a special case. Erythromycin ointment is routinely applied once, shortly after birth, as a preventive measure against bacterial eye infections that can be picked up during delivery. If a newborn develops pink eye despite this precaution, doctors will often culture the discharge to identify the exact bacteria involved, since neonatal conjunctivitis can be caused by serious pathogens that require more targeted treatment.
How Doctors Decide What to Prescribe
In most cases, your doctor can determine the type of pink eye just by asking about your symptoms and examining your eyes. Bacterial conjunctivitis tends to produce thick, yellow-green discharge that may crust your eyelids shut overnight. Viral pink eye usually starts in one eye and spreads to the other, with watery (not thick) discharge and often accompanies a cold. Allergic conjunctivitis affects both eyes simultaneously and is dominated by intense itching.
Lab cultures, where a sample of eye discharge is sent for analysis, are rarely needed. Doctors typically reserve cultures for cases with severe symptoms, suspected sexually transmitted infections, or when a foreign body might be involved. The results guide treatment if standard prescriptions aren’t working or if the infection seems unusual.
Fungal eye infections are extremely rare but do occur, particularly after eye injuries involving plant material or soil. The only FDA-approved topical treatment for fungal eye infections is a 5% natamycin suspension, though doctors may also use other antifungal agents depending on the specific organism identified. These cases almost always require specialist care from an ophthalmologist.