This is another time of the year that I see a lot “pink eye”. Any time the eye is pink..you have “pink eye”, which mothers seem to be quite confused by!! They often comment…”this is pink eye?” , to which I respond, “well, the child’s eye (conjunctiva) is pink (red), so yes…this is pink eye”. The term is just a description of the eye….but then you need to determine why the eye is “pink”.
Conjunctivitis is one of the most common causes of a pink eye….and there are many different types of conjunctivitis. As with any condition the history is really important in helping to determine why a child’s eye is inflamed. Several of the most common causes of the “pink eye” are bacterial, viral and allergic conjunctivitis.
Bacterial conjunctivitis often shows up in younger children and they have lots of matting of the eye lids and lashes and a mucopurulent discharge (gooey eyes). Some moms say that the “goo of gunk” comes as quickly as they can wipe it. The child often has a lot of tearing and will rub the eyes as they feel that something is in their eye and it is irritated. Bacterial conjunctivitis will typically resolve in 8 -10 days on its own, but antibiotic eye drops are used to shorten the course of the pink eye and also reduce the contagiousness. It seems as if every child in a day care class room will get conjunctivitis as they constantly rub their eyes and touch toys!! Hand washing helps….but you can’t wash a child’s hands every time they touch their eyes.
Viral conjunctivitis usually occurs in combination of with systemic viral illness. Sore throat, fever and bright red eye are often seen in older children and teens and is due to adenovirus. While the eye is red, the discharge is typically watery and matting is much less common. These patients are contagious for up to 12 days so it is important to practice good eye/hand hygiene, especially in the household. Artificial tears may help the feeling of eye irritation, but antibacterial eye drops rarely help except in cases of a secondary infection. I get many phone calls from parents saying, “we tried prescription eye drops and they are not working”. I make sure to tell my older patients to take out their contacts and wear glasses for 7-10 days.
At this time of year I am also seeing a lot of seasonal allergic conjunctivitis. These children have intensely itchy and watery eyes, as well as swelling of the eyelids and area surrounding the eyes. They look like they have been crying for days as they are so swollen and miserable. Many also have a very watery nasal discharge. They do not have fever. Using over the counter medications for allergy control, such as nasal steroids and anti-histamines will help some of the allergic symptoms. There are also over the counter eye drops (Zaditor, Patanol) that help when used daily. During the worst of the season I make sure that the child has daily hair wash and eyelash and eyebrow wash with dilute soapy water to make sure the pollen is removed after they have been playing outside. It is nearly impossible to keep a child indoors for the 6 or more weeks of allergy season!