Friday, March 13, 2015

Pink Eye

We have been seeing lots of pink eye these past couple of weeks. Medical lingo for pink eye is conjunctivitis, which simply refers to an inflammation of the conjunctiva. The conjunctiva is the thin clear tissue that lies over the white part of the eye 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 your eyes to appear reddish or pink.  Symptoms might 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

Sometimes the white part of the eyeball (also known as the sclera) will look just fine. If you suspect conjunctivitis, check to see if the inner lining of the eye looks redder than normal. My favorite way to check is to put a finger on the upper part of the cheek and gently pull down. This will allow you to assess the color inside that lower lid. Check both eyes.

Pink eye 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)

The conjunctivitis from a virus or bacteria can be easily spread from one person to another.

Bacterial conjunctivitis is usually caused by Staph or Strep. It is treated with antibiotic eye drops. Dr Schwanke also likes to add a dab of topical antibiotic ointment to the inside of the nostrils several times a day. Hands going from snotty nose up to eye rubbing are a common way for pinkeye to spread. He often prescribes a medication called Mupirocin. Over the counter Neosporin is another option.

It can clear up on it’s own, but might take quite a bit longer if untreated. Most schools and daycares will not want your child to attend if they have an obvious case of conjunctivitis, so some parents opt to start treatment sooner, so that they can get back to work.

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. 4 times/day is optimal, but 3 times/day is usually adequate. Some of the newer antibiotic drops don’t need to be given as frequently, but may not be covered by your insurance. The directions will often come with a range of time that you need to do the treatment; for example 3-7 days. I suggest that you continue to treat for a full 2 days after the eyes have cleared up. Don’t partially treat or it is likely to come back. 3-5 days is usually standard. Your child is no longer considered contagious after they have completed a full day of the drops.

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. I have some parents who claim that it is easier to give a bath to an angry cat. It may be a 2 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. 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!

For older kids, a little preparation before you go at them with the eye drops can go a long way. 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 pink eye is coming along with an ear infection and/or sinus infection. Those kids will likely end up being treated with oral antibiotics.

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. To avoid spreading the infection, swap out pillow cases, and wash clothes or towels that might have been in contact with the goopy eyes.

Allergic: 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. Pataday is another allergy eye drop option, but it is a prescription. Allergy eye drops can be used on an as needed basis. Often it is worth seeing if a few drops makes everything better. If so, it is 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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