Check out the PedsDocTalk YouTube Video: Pink Eye – What you Need to Know for more details and guidance on navigating pink eye in children, including viral vs. bacterial pink eye, allergic conjunctivitis, other causes, and when to bring your child to the doctor.
What is conjunctivitis?
Conjunctivitis is inflammation of the conjunctiva, which is the mucus membrane that covers the inside of the eyelids and the outer surface of the eye. Usually, the conjunctiva are transparent, but when it gets inflamed, the eye appears pink or red. Conjunctivitis can be caused by an infection that can be viral or bacterial. Viruses that infect the upper respiratory tract and cause inflammation can also cause inflammation in the conjunctiva of the eye.
BUT! Allergies, irritation, or trauma can also cause it. Not all conjunctivitis or pink eye is infectious like many people sometimes think!
Is it viral or bacterial?
Viral pink eye is a reddening of the eye or eyes. It is more likely to affect both eyes and is usually associated with red, watery eyes. It often presents with other viral symptoms, like fever, runny nose, sore throat, or cough, or it can be the first sign a child is sick.
Viral pink eye can cause crusting of the eyelashes in the morning but is less likely to have consistent eye discharge throughout the day. If the discharge is noted, it’s typically mild and thinner. It appears less like pus and more like clear mucus or wateriness.
Viral pink eye will resolve spontaneously on its own, and no antibiotic drops are needed. Antibiotic eye drops will not fix a viral pink eye. It is contagious during the initial days of illness, and good hand washing should be encouraged. Usually, symptoms progress for 3-5 days and slowly resolve over 1-2 weeks.
Bacterial pink eye is much different from viral pink eye. This presents with redness and thick, pus-like discharge from one eye, although sometimes both eyes are affected. Discharge can be yellow, white, or green and usually reoccurs throughout the day even if you attempt to clean the eye.
If your eyes are oozing and you wipe it away and it doesn’t return, it’s likely viral pink eye. However, if it oozes and oozes and you’re constantly wiping or cleaning, we’re headed into bacterial pink eye territory.
Eyes often appear stuck shut in the mornings with crusty eyelashes. Bacterial pink eye can occur in isolation, but ear infections and pink eye often do occur at the same time. This is because some bacteria that like to follow virus infections can cause bacterial ear infections and pink eye.
Check out the PedsDocTalk YouTube video on ear infections for more information on what causes them and the symptoms kids often show if they have one.
What to do if your child has bacterial pink eye?
Well, both viral and bacterial pink eye are contagious and spread through contact with eye drainage and contaminated objects. For example, your kid rubs their eyes and touches a toy and another kid touches that toy and then touches their eyes – there we go.
It often spreads quickly through childcare facilities. Good hand washing is important to reduce the spread. Also, a trip to your child’s clinician is worthwhile because it is treated with prescription antibiotic drops. For bacterial pink eye, a child can return to daycare or school once they are fever free and have been on the drops for a full 24 hours minimum.
What about viral pink eye and returning to school?
This is where things get a little tricky. Viral pink eye does not need antibiotic drops.
Once your child’s eye discharge is resolved and they are fever free for 24 hours, they can return to childcare. But, with viral pink eye, those symptoms can linger like a cold.
Unfortunately, many childcare facilities have certain strict rules on pink eye and treat all pink eye as bacterial.
The best prevention of the spread of viral pink eye is good hand hygiene similar to limiting the spread of common colds, which are also caused by viruses
Allergic conjunctivitis is caused by an airborne allergen, such as pollen, coming into contact with the eye and causing a hypersensitive or allergic response to the allergen. This results in a release of chemicals like histamine, which causes itching – the hallmark symptom of allergic conjunctivitis. If your child has very itchy, watery, red eyes, they likely have allergic conjunctivitis. Another sign can be puffiness under the eye and very minor runny nose compared to the thick mucous of a cold. Rubbing the eyes can make the redness and itching worse. Symptoms may resolve on their own but over-the-counter eye drops can help speed up the resolution of symptoms.
Watch this PedsDocTalk YouTube video for more information on OTC eye drops for allergic conjunctivitis.
When to bring your child in for conjunctivitis
It’s important to bring your child to their pediatrician if there is a thick pus-like discharge from the eye. They may have bacterial conjunctivitis and need antibiotic drops. The pediatrician will be able to differentiate and prescribe antibiotic drops if needed.
If your child is expressing sensitivity to light, complaining of persistent eye pain, trouble opening their eyes, changes to their vision, or eyelid swelling and redness their pediatrician needs to assess for more serious conditions such as a possible foreign body, corneal abrasion, or periorbital cellulitis.
And as always, you should bring your child in for evaluation if something doesn’t seem right to you or they’re not improving as you would expect.