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My last article, ”Childhood Diseases – On a Mission to Educate: Ear Infections” we learned that Ear Infection is a painful inflammation of the middle ear where there is decreased drainage from this area resulting in a buildup of fluid behind the ear drum. Young children are more prone for ear infections where the Eustachian tubes do not work properly due to colds, allergies, enlarged adenoids, or not being in a favorable angle to allow for drainage. The child develops ear pain and may have a fever, trouble eating, drinking or sleeping. If the ear drum ruptures, the child might feel dizzy, nauseated and complain of ringing/buzzing in the ear. It is important to have the child examined by his/her doctor for a proper diagnosis and intervention. Today we will move onto another common childhood illness, Pink Eye (Conjunctivitis).
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What Is Pink Eye?
According to the Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/pink-eye/basics/definition/con-20022732) Pink Eye (Conjunctivitis) is “an inflammation or infection of the transparent membrane (conjunctiva) that lines your eyelid and covers the white part of your eyeball. 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.”
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What Causes Pink Eye?
There are four main causes of pink eye according to the Centers for Disease Control and Prevention (CDC):
- Viruses
- Bacteria
- Allergens (pet dander, dust mites, etc.)
- Irritants (smog, chlorine in swimming pools)
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Viral Conjunctivitis
Viral Conjunctivitis according to the CDC is:
- Caused by infection of the eye with a virus
- Can be caused by a number of different viruses, such as adenoviruses
- Very contagious
- Sometimes can result in large outbreaks depending on the virus
The most common viruses that cause pink eye are adenovirus and herpesvirus. Viral conjunctivitis can also occur along with upper respiratory tract infection, cold and/or sore throat.
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Bacterial Conjunctivitis
Bacterial Conjunctivitis according to the CDC is:
- Caused by infection of the eye with certain bacteria
- Can be caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, or, less commonly, Chlamydia trachomatis and Neisseria gonorrhoeae
- Can be spread easily, especially with certain bacteria and in certain settings
- A leading cause of children being absent from daycare or school
- More common in kids than adults
- Observed more frequently December through April
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Allergic Conjunctivitis according to the CDC is:
- The result of the body’s reaction to allergens, such as pollen from trees, plants, grasses, and weeds; dust mites; molds; dander from pets; medicines, or cosmetics
- Not contagious
- Occurs more frequently among people with other allergic conditions, such as hay fever, asthma, and eczema
- Can occur seasonally, when allergens such as pollen counts are high
- Can also occur year-round due to indoor allergens, such as dust mites and animal dander
- May result, in some people, from exposure to certain drugs and cosmetics
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According to the CDC, Conjunctivitis Caused by Irritants is as follow:
- Caused by irritation from a foreign body in the eye or contact with chemicals, fumes, smoke, or dust
- Not contagious
- Can occur when contact lenses are worn longer than recommended or not cleaned properly
Irritants can include chemicals, contact lens wear, foreign bodies in the eye like a loose eyelash, air pollution (chemical vapors, fumes, smoke, dust), fungi, ameba & parasites.
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What Are the Symptoms of Conjunctivitis?
Since there are several kinds of conjunctivitis the followings symptoms are categorized according to the type of conjunctivitis the child has. According to Healthy Children (https://www.healthychildren.org/English/health-issues/conditions/eyes/Pages/PinkEye-Conjunctivitis.aspx) the primary symptoms of each category are as follow:
Bacterial:
- Red or pink, itchy, painful eye(s).
- More than a tiny amount of green or yellow discharge.
- Infected eyes may be crusted shut in the morning.
- May affect one or both eyes.
Viral:
- Pink, swollen, watering eye(s) sensitive to light.
- May affect only one eye.
Allergic:
- Itching, redness, and excessive tearing, usually of both eyes.
Chemical:
- Red, watery eyes, especially after swimming in chlorinated water.
What Are the Symptoms of Childhood Conjunctivitis?
According to Stanford Children’s Hospital (http://www.stanfordchildrens.org/en/topic/default?id=conjunctivitis-90-P01678) the following are the most common symptoms of childhood conjunctivitis. They did stress that each child may experience a different combination of the following symptoms:
- Gritty feeling in one or both eyes
- Itchy, irritated eyes
- Clear, thin drainage (usually seen with viral or allergic causes); increased tearing
- Sneezing and runny nose (usually see with allergic causes)
- Stringy discharge from the eyes (usually seen with allergic causes)
- Thick, green drainage from the eyes (usually seen with bacterial causes)
- Ear infection (usually seen with bacterial causes)
- Lesion with a crusty appearance (usually seen with herpes infection)
- Eyes that are matted together in the morning
- Swelling of the eyelids
- Pink or red discoloration of the whites of one or both eyes
- Discomfort when the child looks at a light
- Burning in the eyes
It should be noted that symptoms of conjunctivitis may be similar to other medical problems and that it is best to always consult the child’s doctor for a diagnosis.
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How Is Conjunctivitis Diagnosed?
Conjunctivitis is usually diagnosed with an eye examination by a doctor. Based on the person’s signs, symptoms and recent history the doctor may be able to determine the type of conjunctivitis the child has. In certain situations, the doctor may take a sample of tears to conduct a test to determine the proper diagnosis.
According to the CDC one should see a doctor if you have pink eye along with any of the following:
- Eye pain
- Sensitivity to light or blurred vision
- Intense eye redness
- Symptoms that get worse or don’t improve
- A weakened immune system, for example from HIV or cancer treatment
- Pre-existing eye conditions
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How Is Conjunctivitis Treated?
The National Eye Institute (NEI) (https://nei.nih.gov/health/pinkeye/pink_facts) stated that most cases of conjunctivitis are mild and will eventually resolve on their own without medication. “In many cases, symptom relief can be achieved by using artificial tears for the dryness and cold packs for the inflammation. Artificial tears can be purchased without a doctor’s prescription.” The following is how each type of conjunctivitis is treated:
Viral Conjunctivitis:
- Most cases of viral conjunctivitis are mild and will clear up in 7 – 14 days without treatment. Antiviral medication can be prescribed by a physician to treat more serious forms of conjunctivitis, such as those caused by herpes simplex virus or varicella-zoster virus. Antibiotics will not improve viral conjunctivitis as these drugs are not effective against viruses.
Bacterial Conjunctivitis:
- Mild bacterial conjunctivitis may get better without antibiotic treatment and without causing any severe complications.
- Antibiotics can help shorten the illness and reduce the spread of infection to others. Your healthcare provider may prescribe antibiotic eye drops or ointment, which should resolve the infection within several days.
- Consult your healthcare provider if you have been given antibiotics for bacterial conjunctivitis and symptoms have not improved after 24 hours of treatment.
Allergic Conjunctivitis:
- Conjunctivitis caused by an allergy usually improves by eliminating or significantly reducing contact with the allergen (such as pollen or animal dander). Allergy medications and certain eye drops can also provide relief.
- Conjunctivitis caused by an irritant often clears up by eliminating the irritant. If you develop conjunctivitis and you wear contacts, stop using them temporarily until the conjunctivitis resolves. In some cases, your healthcare provider may also prescribe drug treatments to improve symptoms.
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How To Prevent Pink Eye?
According to NEI viral and bacterial conjunctivitis are highly contagious and can be easily spread from person to person. Allergic conjunctivitis is not contagious. “If you or someone around you has infectious (viral or bacterial) conjunctivitis, limit its spread by following these steps:
- Wash your hands often with soap and warm water. And wash up immediately if you’ve touched an affected person’s eyes, linens or clothes (for example, when caring for a child who has pink eye). If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.
- Avoid touching or rubbing your eyes.
- If you have conjunctivitis, wash any discharge from around the eyes several times a day.
- Do not use the same eye drop dispenser/bottle for infected and non-infected eyes—even for the same person.
- Avoid sharing articles like towels, blankets, and pillowcases.
- Clean your eyeglasses.
- Clean, store, and replace your contact lenses as instructed by your eye health professional.
- Do not share eye makeup, face makeup, makeup brushes, contact lenses or containers, or eyeglasses.
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How To Avoid Re-Infection of Pink Eye?
NEI stated that there are also steps one can take to avoid re-infection once the infection goes away:
- Throw away any eye or face makeup or applicators you used while infected.
- Throw away contact lens solutions you used while infected.
- Throw away contact lenses and cases you used.
- Clean your eyeglasses and cases.
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Can Newborns Get Pink Eye?
According to Kids Health (http://kidshealth.org/en/parents/conjunctivitis.html) newborns are at risk for pinkeye which can cause serious health complications if it is not treated. “If a pregnant woman has an STD, during delivery the bacteria or virus can pass from the birth canal into the baby's eyes, causing pinkeye. To prevent this, doctors give antibiotic ointment or eye drops to all babies immediately after birth. Occasionally, this treatment causes a mild chemical conjunctivitis, which usually clears up on its own. Doctors also can screen pregnant women for STDs and treat them during pregnancy to prevent spreading the infection to the baby.”
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What Are the Symptoms of Newborn Pink Eye?
Newborns who develop pink eye are called Neonatal Conjunctivitis or less known Ophthalmia Neonatorum. According to NEI common symptoms include “eye discharge and puffy, red eyelids within one day to two weeks after birth. Newborn conjunctivitis may be caused by infection, irritation, or a blocked tear duct. A mother can pass on infectious conjunctivitis to her newborn during childbirth, even she has no symptoms herself, because she may carry bacteria or viruses in the birth canal.”
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What Are the Types of Newborn Pink Eye?
The most common types of neonatal conjunctivitis according to NEI include:
- Chlamydial (or inclusion) conjunctivitis is caused by the bacterium Chlamydia trachomatis and can cause swelling of the eyelids with purulent (pus) discharge. Symptoms often appear 5-12 days after birth but may present at any time during the first month of life.
- Gonococcal conjunctivitis is caused by Neisseria gonorrhoeae, the bacterium that causes gonorrhea. Gonococcal conjunctivitis causes pus discharge and swelling of eyelids, which may appear 2-4 days after birth.
- Chemical conjunctivitis can be caused by eye drops or ointment given to newborns to help prevent bacterial eye infections. Symptoms include red eyes and eyelid swelling, and usually resolve in 24-36 hours. Most hospitals are required by state law to put drops or ointment in a newborn’s eyes to prevent disease. The benefits of preventing a more serious type of conjunctivitis are thought to outweigh the risks of chemical conjunctivitis.
- Other bacteria and viruses can also cause conjunctivitis in a newborn. Bacteria that normally live in a woman’s vagina and that are not sexually transmitted can cause neonatal conjunctivitis. The viruses that cause genital and oral herpes can also cause neonatal conjunctivitis and severe eye damage. Such viruses may be passed to the baby during childbirth.
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What Are the Treatments For Newborn Pink Eye?
Per NEI bacterial conjunctivitis is usually treated with topical antibiotic eye drops and ointments, oral antibiotics or intravenous. Sometimes a combination of topical and oral or topical and intravenous treatments are used at the same time. Saline solution also may be prescribed to rinse the baby’s eye or eyes to remove pus as needed:
- Chlamydial conjunctivitis in newborns is usually treated with oral antibiotics such as erythromycin. Parents are usually treated as well.
- Gonococcal conjunctivitis in newborns is usually treated with intravenous antibiotics. If untreated, this condition can lead to corneal ulcers and blindness.
- Other types of bacterial and viral conjunctivitis are usually treated with antibiotic eye drops or ointments. A warm compress to the eye may also help relieve swelling and irritation.
- Blocked tear ducts may cause conjunctivitis. If a tear duct is blocked, a gentle warm massage between the eye and nasal area may help. If the blocked tear duct is not cleared by one year of age, surgery may be required.
- Chemical Conjunctivitis usually resolves in 24-36 hours without treatment.
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In conclusion Pink Eye or Conjunctivitis is one of the most common and treatable eye conditions in children and adults. It is highly contagious so about 3 million cases of pink eye occur in the US each year. As noted in this post, treatment is not always needed and can be managed at home. But occasionally there can be certain situations that require medical intervention.
Pink eye involves inflammation of the conjunctiva which is a thin, clear tissue that lines the inside of the eyelid and covers the white part of the eye or sclera. The inflammation causes the blood vessels to be more visible resulting in a pink or reddish appearance.
Some symptoms can include a painful, itchy or burning sensation in the affected eye. There may also be tears or a discharge that forms a crust while one is asleep which results in the eye to be stuck shut when one awakes. Finally, pink eye can also occur in newborns which is called neonatal conjunctivitis. Parents should work with the child’s physician to treat their newborns condition.
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I hope you learned something from this article about Pink Eye. There are many resources on the internet if you need more specific information. I will continue this series with another childhood disease post. I hope you will continue to join me in this quest to learn about these illnesses that children usually encounter when they are young. Thank-you for reading my article on Childhood Diseases – On a Mission to Educate: Pink Eye (Conjuntivitis). If you would like to follow me, please check HERE
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