If you have a young child, especially one in daycare or preschool, you have probably had some type of experience with conjunctivitis, otherwise known as pink eye.  Either your child has had it, you’ve received the dreaded notification that it is going around the class or you have unfortunately had it yourself.  Pink eye is so common that it is estimated to affect 3 million people yearly, according to the National Institutes of Health.  The good news is, pink eye is typically self limited and not dangerous.  So take a deep breath and read up on the different causes and what you can do.

What is conjunctivitis?

The conjunctiva is the lining of the white part of the eye and the inside of the eyelid.  When this thin membrane becomes inflamed, you have what is known as conjunctivitis.  There are many causes of conjunctivitis so this post will focus on the most common types we see in children.

What causes conjunctivitis?

The 3 main causes of conjunctivitis are bacterial, viral or allergic.  The type of conjunctivitis that most parents refer to as “pink eye” is usually the bacterial kind.

• Bacterial: The most common bacterial causes of pink eye are Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus species.  While these names sound scary, they are easily treatable.  Sometimes the same bacteria that causes pink eye, also causes an ear infection so it is not unusual to see both illnesses together, especially in younger children.  That is why you may be asked to bring your young child to the doctor for a check up instead of having medication called in over the phone.
• Viral:  Viral pink eye is caused by the same viruses that cause the common cold.  We commonly see kids with colds who also have red, watery eyes as part of their illness.  Some viral infections present with red eyes as a hallmark of the illness.   For example,  measles and Adenovirus typically cause conjunctivitis along with other tell-tale signs of either infection.
• Allergies: Anything that causes allergic symptoms can cause allergic conjunctivitis.  This means pollen, grass, trees, pets, dust mites, etc…

Babies can get conjunctivitis from the bacteria in the birth canal or from bacteria that cause sexually transmitted infections.  Therefore, newborns are given antibiotic eye ointment after birth to protect the eye from any complications of conjunctivitis due to these causes.  If your infant has red eyes, discharge from the eyes or swollen eyelids, seek medical care.

What are the symptoms of pink eye?

The most obvious sign your child has conjunctivitis is redness in the eye(s), hence the name pink eye.  They may also experience some irritation, pain or itching of the eye.  Sometimes they report sensitivity to light or a feeling of grittiness under the eyelid.  Patients with viral conjunctivitis will frequently have watery discharge and will present with lymph nodes in the neck, as well as other symptoms of a cold.  Patients with allergic conjunctivitis will also have watery discharge from the eyes, which when built up (for example after sleeping) will cause some crusting around the eye.  Finally, patients with bacterial conjunctivitis will have a thick yellowish discharge from the eyes that tends to be persistent all day as opposed to just build up in the morning.  These patients will frequently get so much discharge overnight that their affected eye(s) is glued shut in the morning.

How is pink eye treated?

Both viral and bacterial conjunctivitis are self-limited and will usually get better on their own within 7-10 days.  There are no medications for common viral pink eye but there are antibiotic drops for bacterial pink eye.  The reason we prescribe drops is to reduce spread as pink eye is extremely contagious.  However, if your child is not in daycare or exposing other children, he/she can forgo treatment because it will resolve on its own without any complication (outside of infancy).

Allergic conjunctivitis can be treated with a variety of different allergy eye drops.  Reducing exposure to allergens, like pets, can also help.  When other allergy symptoms are present; like sneezing, runny nose, stuffy nose and cough, your doctor may recommend an oral allergy medication.

How is pink eye spread and how can it be prevented?

Infectious causes of conjunctivitis are spread very easily from person to person.  If an infected individual touches their eye and touches another person’s eye, that person will most likely get it.  If an infected individual touches their eye and touches a surface, someone else can touch that surface and then spread the infection to their own eyes.  This is why it is spread like wildfire through a daycare or preschool.

The best way to prevent spread is to avoid touching your eyes, frequent hand washing and avoid sharing towels or blankets with someone else.  Also, don’t share makeup, makeup brushes or eye drop bottles.  If you wear contacts, it is a good idea to start a new pair after treatment.

It is important to note that the American Academy of Pediatrics does NOT recommend excluding a child from school or daycare because of a red or crusty eye.

Other causes of red eyes

Chemical irritation, like chlorine, can cause red and painful eyes and is a common complaint in the summer.  Also, scratches on the cornea from an injury or debris in the eye can also cause red and painful eyes.  If your child is complaining of pain or visual change, along with redness in the eye, but they do not appear to have other symptoms of conjunctivitis, have him/her seen by their doctor.

As always, if you have concerns or questions about your child, make an appointment with your pediatrician.