Pardon the Pink Eye: What to do about Conjunctivitis

Your child wakes up with a pink eye that’s matted shut with drainage. A number of questions come to mind: Will over-the-counter eye drops suffice or are antibiotics necessary? Should she stay home from school? How can I keep it from spreading to my other children?

What Is It?

Conjunctivitis means inflammation of the conjunctiva, which is the transparent membrane covering the eyeball and the insides of the eyelids. When the conjunctiva becomes irritated, the tiny blood vessels within the conjunctiva become larger, causing the eye to appear red or pink. There are different causes of conjunctivitis, including infection, allergies and trauma. Many cases of conjunctivitis resolve without treatment and do not cause long-term effects; however, it is important to know the warning signs of a more serious condition.

Infectious conjunctivitis may be caused by bacteria or a virus. In either case, the eye will appear red and be matted shut upon awakening. Bacterial conjunctivitis usually causes the eye to produce large amounts of thick yellow, green or white pus, which quickly reappears after cleaning and continues throughout the day. One or both eyes may be affected.

Another common type of conjunctivitis is caused by airborne allergens, which get in the eyes and cause an allergic reaction. Allergic conjunctivitis is similar to viral conjunctivitis in that both eyes are commonly affected and they may be matted shut in the mornings. The discharge is more watery, and often the eyes are very itchy. Patients frequently have other signs of allergies, such as eyelid and facial puffiness, sneezing, nasal congestion and a runny, itchy nose.

How to Treat

Bacterial conjunctivitis can be treated with a topical antibiotic. Your doctor may prescribe antibiotic ointment or drops to be applied directly to the eye three to four times a day for five to seven days. Most patients note improvement within two days of starting treatment. Ointment is preferred in young children because it stays on the eyelid and works even if you are unable to get it in the eye. Ointment can blur vision, so older children and adults should only use it at night.

Viral conjunctivitis usually causes the eye to produce a thinner, more watery discharge that is worse in the morning. Both eyes are commonly affected and the condition may be accompanied by cold symptoms including fever, sore throat, runny nose, nasal congestion, swollen lymph nodes or cough. Often the patient feels as though something is in their eye or complains that their eyes feel gritty or sandy. Unlike bacterial conjunctivitis, viral conjunctivitis does not improve with antibiotics. The course of viral conjunctivitis commonly mirrors that of the common cold: Symptoms worsen in the first three to five days and then gradually improve over the next 10 to 14 days. Over-the-counter lubricant drops often provide some relief of symptoms.

Bacterial and viral conjunctivitis are highly contagious and are spread by contact with the infected secretions of the eye, either directly or on contaminated surfaces. To prevent it from spreading, frequent hand-washing is recommended. Children are usually advised to stay home from school or day care until there is no longer any eye drainage. If this is not feasible, the patient should stay home for at least 24 hours after starting topical therapy.

For allergy-induced conjunctivitis, multiple prescription and over-the-counter antihistamine eye drops are available. Many patients also find relief from oral over-the-counter allergy medicines.

Other causes of a red or pink eye can be trauma to the eye, a foreign body in the eye or a chemical exposure. If any of the above are suspected, the eye should be thoroughly rinsed with water for 15 minutes to ensure that any foreign substance is removed. The eye may continue to be red and produce a discharge for 12 to 24 hours. Your physician may choose to place drops of dye in the affected eye to be sure damage to the eye surface has not taken place. Over-the-counter lubricant drops may provide some relief from irritation while the eye heals.

Occasionally a patient with pink eye will have symptoms that warrant a visit to an ophthalmologist, an eye specialist. If any of the following symptoms are present, seek medical attention promptly: changes in vision, redness in only one spot on the eye rather than diffusely over the whole eye, pain when looking at light, inability to open the eye, pink eye in a contact lens wearer, recurrent conjunctivitis or severe headache and nausea associated with a red eye. For more information, go online to www.healthychildren.org.

Dr. Melissa Taylor is a resident pediatrician at Carolinas Medical Center, and Dr. Erin Stubbs is a board-certified pediatrician at CMC Myers Park Pediatrics.

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