There was just a new study that just came out about pink eye. It prompted me to dig out this old post and update it!
Let's start with some basics. The conjunctiva is the thin clear tissue that lies over the white part of the eye and then folds back and lines the inside of the eyelid. Conjunctivitis is the term for when the conjunctiva has some inflammation. When this inflammation happens, the small blood vessels in the conjunctiva become more visible. This is what causes the whites of the eyes to appear reddish or pink. Common symptoms of conjunctivitis 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
The white part of the eyeball isn’t always noticeably impacted. If you suspect conjunctivitis, 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. It isn’t a bad idea to get a baseline and see what normal looks like before there are any symptoms. Pink eye has a number of different causes, including:
- Viruses
- Bacteria
- Allergies
- Irritants
Viral: Many cases of pink eye come from the same viruses that cause a common cold. If there is discharge it is usually fairly thin. It is common to wake up with crusty eyes. Kids might complain that it feels like there is sand in their eyes. Just as a cold must run its course, so must this form of pink eye, which usually lasts from four to seven days. Treatment is focused on relieving the symptoms; soothing eye drops are great. Also warm or cool compresses can ease the symptoms. Do you have access to breastmilk? You can apply some drops directly into the eye. Bacterial conjunctivitis typically is redder and beefier looking with thicker discharge. 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. Historically, pinkeye that is suspected to be bacterial has been treated with antibiotic eye drops.
The new study out of Finland showed that many kids did just as well with lubricating eye drops instead of the prescription medication.
The groups using either kind of drops recovered much faster than the group who did nothing at all. Perhaps this is one of the reasons that breastmilk is so effective (aside from the fact that it is magic). I have seen it help many an irritated eye. If you don’t happen to have breastmilk, Similasan eye drops are a good choice Simple conjunctivitis can clear up on its own, although as noted above, any kind of soothing eye drop can speed up the process. However, it is not uncommon for patients with goopy eyes to have something else going on. I am even more suspicious if kids are fussier than usual. Pinkeye is often part of a ‘package’ with an ear infection and/or sinus infection. Those kids may end up needing oral antibiotics. Both viral and bacterial conjunctivitis can be highly contagious. Understandably, most schools and daycares will not want your child to attend if there is a suspicion that they might have conjunctivitis. The general rule is that kids can return to school once they have been treated for 24 hours. The problem with this is that many cases are actually viral in which case, antibiotic drops are useless; it does get a bit mucky. Lots of parents make the choice to start drops immediately so that they can get back to work sooner. In any case, if your kid's eyes are super goopy they shouldn't be around other kids. I asked Dr Ted what he likes to use for a case that needs to be treated. His preference is a brand called Politrim. He added that he knows of other doctors and ophthalmologists who will often prescribe erythromycin ointments because the medication stays in the eye for longer, making it more effective, technically. However in his opinion ointments are very difficult to instill into a child’s eye. He would rather try to get clear liquids into the eye four times a day instead of a ribbon of thick goop twice a day. 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 an extra day or two after the eyes have cleared up. Don’t partially treat it or it is likely to come back - 3 to 5 days is usually standard. Your child is no longer considered contagious after they have completed a full day of the drops. If there is no improvement after 3 days it is worth having them rechecked. Allergic: If allergies are the culprit, both eyes will likely be affected. The eyes are usually watery and itchy, They are usually not crusty. Common causes can be dust, pollens or exposure to an animal.
Allergy eye drops can be used on an as needed basis. You don’t need to commit to doing a course. Some good choices are
- Zaditor (3 years or older)
- Pataday(2 years or older)
- Similasan (2 years and older)
Irritation: Common causes include harsh shampoo, dirt, smoke, chlorine from a pool, poor fitting, or dirty contact lenses, or a foreign body. The best treatment is flushing the eye out with sterile saline or an eye wash. Keeping an eyewash solution is a good addition to your medicine cabinet. Of course, do I even need to add that Breastmilk is an excellent flushing agent as well? Dr. Ted’s Science: When trying to tell the difference between bacterial, viral, and allergic conjunctivitis, there are a couple of key indicators. The discharge can be telling: your body sends lots of white blood cells to fight bacterial infections, which will lead to copious thick white discharge that needs to be wiped often (almost hourly). The eyes here will become deep red. Viral conjunctivitis doesn’t recruit as many white blood cells to fight, so there can still be discharge, but it tends to be thinner, less frequent, and more yellow. These eyes tend to be more pink. On average, bacterial conjunctivitis will impact one eye more than another (the site of inoculation) while viral pink eye tends to go to both eyes more quickly. Allergic conjunctivitis tends to be quite faint and mostly itchy without any pain, while both viral and bacterial can occasionally be painful. And finally, ear pain plus conjunctivitis should always raise suspicion for bacteria, specifically alongside ear infections. What’s the difference between pink eye and a stye?A stye is a red and painful bump that forms on the eyelid, near the edge of the eyelashes. Conjunctivitis and styes have some overlapping symptoms, such as redness, light sensitivity and crusting along the eyelids. However, these are different conditions, with different causes. Styes are usually caused by an infection in the oil gland on your eyelid. Most of the time the treatment is warm compressing Treating a stye with antibiotics is not indicated. Eye Drop tips I have some parents who claim that it is easier to give a bath to an angry cat than to administer eye drops to their kids. Getting those drops in can be somewhat of an art. If you have the luxury of having a willing partner, It may indeed 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. Try not to touch the dropper tip to the eye. This is harder than you think.
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. If your baby is under 4 months, Crusty eyes may be from a blocked tear duct. Blocked tear ducts mostly will be an issue when the babies wake up from a stretch of sleep with their eyes all gummy. If you are seeing more frequent goopiness, it is worth checking in with your doctor. 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. Extra considerations Frequent hand washing with soap and water is essential. To avoid spreading the infection, swap out pillow cases, and wash clothes or towels that might have been in contact with the goopy eyes. Please don’t share drops between family members! If you have a little one who is getting recurrent infections, little hands going from a snotty nose, up to the eyes could be the culprit. Beyond making sure the those hands are kept clean, make sure you scrub under the nails.
For the grownups - get rid of makeup that might have been used within several days of having conjunctivitis, especially mascara, If you are a contact lens wearer, you might do better wearing your glasses for a few days.
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