Friday, April 18, 2014

Conjunctivitis/ includes eye drop tips

Conjunctivitis, also known as pinkeye, is an inflammation of the conjunctiva. The conjunctiva is the thin clear tissue that lies over the white part of the eye (the sclera) and lines the inside of the eyelid.
When small blood vessels in the conjunctiva become inflamed, they're more visible. This is what causes the whites of the eyes to appear reddish or pink.
Sometimes the sclera will look just fine, but the inside of the eyelid will look red.
The easiest way to check this is to put your finger on the upper part of the cheek and gently pull down until you can see the inside of the lower lid. You can see if the lining is a normal light pink or an infected beefy red. Check both eyes. Do they look the same? Consider looking when your child is fine so you can see what normal looks like. 

Pinkeye has a number of different causes, including:
Allergies (dust or pollen)
Irritants like smoke, pollution, or a strong chemical odor (some heavily chlorinated pools can do induce this)

Symptoms include
  • Redness in the white of the eye or inner eyelid
  • Increased amount of tears
  • Thick yellow discharge that crusts over the eyelashes, especially after sleep
  • Green or white discharge from the eye
  • Itchy eyes
  • Burning eyes
  • Blurred vision
  • Increased sensitivity to light

Bacterial conjunctivitis is usually treated with antibiotic eye drops.
The most common culprits are Staph or Strep.
It can clear up on it's own, but might take quite a bit longer if untreated. If your child is in school or daycare, that can be an issue.

Although often the eye drops will come with directions to give 4 times a day, many of our patients have a hard time managing that. Four times a day is ideal, but three times a day is usually adequate.
The directions will often come with a range of time that you need to do the treatment...for example 3-5 days.
Your child is no longer considered contagious after they have completed the first full day of the drops.
I suggest that you continue to treat for a full 2 days after the eyes have cleared up. (minimum 3 days) Don't partially treat or it is likely to come back.
4-5 days is usually standard.
If you don't notice an improvement after 48 hours, your child needs to be reevaluated.

Getting those drops in can be somewhat of an art.
It may be a two person job.
If your child is very uncooperative you may need to wrap them in a blanket so that they don't have their arms to flail around.
Gently pull down the lid. Even if they are clenching their eyes tightly shut, you should be able to find a little pocket in which to put the drops.
Some kids cooperate better if you let them hold onto a tissue and allow them to blot at the eye once the drops have got in.

Try not to touch the dropper tip to the eye. This is harder than you think, for that reason....
Please don't share drops between family members!

Most of the drops that we currently use don't sting, but there are some awful old ones on the market that are quite uncomfortable.
Some of my patients who are traveling were given the stingy ones from other clinics.
(so aggravating)
For your reference, 
The most common ones that we prescribe here are   
Tobramycin (Tobrex)


For older kids, before you go at them. Let them do some playing. Have them give "drops" to 2 different dolls or stuffed animals. Make one cooperative. Give them lots of praise for being brave.
Make the other one kick a fit. You get the idea.

When I see those goopy eyes show up, fully half of my patients have something else going on.
Most of the time the conjunctivitis is associated with an ear infection and/ or sinus infection.
Those kids will likely end up being treated with oral antibiotics. Generally these kids also have some congestion and fussiness (but not always)  

Because of this, I will usually suggest that they get seen in the office.
If your child is over 5, is acting perfectly well and it is difficult to get into the office, exceptions are sometimes made and drops can be phoned it, but it is usually better to have them checked.

Viral: Many cases of pinkeye come  from the same viruses that cause a common cold. Just as a cold must run its course, so must this form of pinkeye, which usually lasts from four to seven days. Viral conjunctivitis can be highly contagious. Avoid contact with others and wash your hands frequently.

Both bacterial and Viral can start in one eye and then spread to the other.
If there is a lot of green and yellow pus it is more likely (but not absolute) that it is bacterial.
Both the conjunctivitis from a virus or bacteria can be easily spread from one person to another.
Because it is contagious, good hand washing is essential.
Wash in  


If Allergies are the culprit, both eyes will likely be affected.
These eyes are usually watery and itchy.

There is an OTC drop called Zaditor that I really like for kids older than 3.

Often it is worth seeing if a couple of drops clear things up. If so, it is likely allergic and you don't need to be stuck doing a several day course of antibiotic drops.

If your baby is under  4 months, gooey eyes may be from a blocked tear duct.
If you happen to have breast milk, feel free to use it for any type of pink eye. You never know, I have seen it help.

What makes me worried?
If the area around the eye looks very pink or red and swollen, that could be something called periorbital cellulitis and it can be quite serious if untreated. This would generally come with a fever and a child who looks ill.

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