Conjunctivitis - Pediatric Conditions - Children's Health

Conjunctivitis, also known as pink eye, is inflammation (redness and swelling) of the conjunctiva, the tissue covering the “whites” of the eyes and the inside of the eyelids. It most commonly is caused by an infection from bacteria or viruses that are passed from person to person. However, conjunctivitis also can be caused by an allergic reaction to something (for example, tree pollen), by contact with something irritating (for example, smoke in the air or chlorine in a pool), or rarely, by problems of the eye.

Conjunctivitis usually causes some eye redness, pain, itchiness and discharge. The discharge can be clear and watery, or green-yellow and thick, making the eyelashes stick together, particularly after someone has been sleeping.

These eye infections can occur at any time of year, in any age child. However, bacterial conjunctivitis is more commonly seen during the winter, in children younger than 6 years of age, while viral conjunctivitis is more common during the fall, in older children with colds.

Redness of the “whites” of the eyes
Redness of the inside of the eyelids
White, or green-yellow discharge from the eyes, especially at night, that makes the eyelashes stick together
Watery eyes
Itchy eyes
Pain or discomfort in the eyes (may feel like “sand” is stuck in the eye)
Sensitivity to light (photophobia)

Check your child’s temperature. Fever may be caused by a cold, which often happens along with viral conjunctivitis, but sometimes fever is a sign of a more serious infection of the eye or other part of the body.
Examine your child’s eyes carefully. In bacterial conjunctivitis, one or both eyes may be red with green-yellow discharge, crusted eyelashes and swollen eyelids. In viral conjunctivitis, one or both eyes usually are red with watery discharge. A sample of the eye discharge is tested for bacteria only in special circumstances. The doctor may also look inside the eye with a special light called an ophthalmoscope.
Check your child’s ears with a special light called an otoscope. Some children with conjunctivitis also may have an ear infection.

Discuss whether your child needs an antibiotic or not.
Treat the bacterial conjunctivitis with antibiotic ointment or drops in the eye (topical). If your child also has an ear infection and was given an antibiotic to take by mouth, a topical antibiotic may not be necessary.
Sometimes give antibiotics to prevent a bacterial infection from developing, even though antibiotics do not treat conjunctivitis caused by viruses (or allergies or irritants), Eye infections caused by the herpes virus are treated with special anti-viral medications and usually are monitored by an eye doctor (ophthalmologist).
Recommend ways to ease the pain.
Discuss the things you should watch for at home.
Tell you if your child should be seen again. Usually no follow-up visit is required if your child is feeling better.

If the doctor prescribed an antibiotic for the eye, be sure your child uses it exactly as directed:

Clean the eyes before putting in any medicine. Then pull down on the lower eyelid and put the medicine in the “pocket” between the eyeball and the eyelid. Do not allow the applicator tip to touch the eye or your fingers.
Ointments generally are given two or more times per day. They may cause blurry vision for 15 to 30 minutes after each dose.
Drops typically are given every two to four hours while awake and may sting slightly when first put onto the eye. Do not put more than the recommended number of drops into each eye.
Putting medicine into the eyes of a young child can be challenging and is more easily done with two people. One person can hold the child still while the other person puts in the medicine. If you are alone, try sitting on the floor and holding your child’s head face up between your knees so your hands are free to open the eyes and put in the medicine.
If your child will not open his eyes and you can not open them yourself, you can lay your child on his back and then put some ointment on the edge of the eyelids (using clean fingers). Wait a few minutes for it to melt and run into the eye. If giving drops, hold your child’s head still and put one in the inner corner of the eye. The drop usually will run in when he opens his eye.

Salt water (saline) solution (for example, artificial tears or eye washes) can be used to help wash discharge and irritants out of the eye.
For pain and fever, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).

Certain over-the-counter medications should not be used unless directed by your doctor:

Eye drops that are meant to relieve dry, irritated or red eyes (such as those containing tetrahydrozoline, naphazoline or pheniramine) may be helpful for symptoms caused by allergies or irritants, but generally are not useful for bacterial or viral conjunctivitis and may even cause further eye irritation.
Herbal remedies (such as chamomile and calendula) have not been well studied for treating conjunctivitis in children and may have unwanted side effects.
Never give your child aspirin or any products containing aspirin because it has been associated with Reye’s syndrome, a serious illness that affects the liver and brain.

Apply cool or warm compresses to the eye several times a day. You can do this by holding a wet washcloth over the closed eye for five to 10 minutes. Make sure you clean the washcloth in hot soapy water before using again.
Clean the eye carefully with warm water and cotton balls to remove any discharge and keep the eyelids from sticking together. Wipe gently along the eyelashes from the inner to the outer corner of the eye once, and then throw away the cotton ball.
Try not to scratch or rub the eye. This may worsen the irritation or spread the infection.
Do not wear contact lenses until all symptoms have gone away. Disinfect lenses before wearing again or use a new pair of disposable lenses.
Wash hands frequently to prevent the spread of the infection to your child’s other eye or to another person’s eyes.

Is getting worse.
Gets a fever.
Has severe or worsening eye pain.
Has changes in eyesight such as blurriness or loss of vision.
Has more swelling or redness of the eyelid or area around the eye.
Shows no improvement after two to three days of treatment.
Gets ear pain.

Teaching your child always to wash his hands regularly, but especially after touching his infected eyes.
Teaching your child not to touch his eyes.
Making sure that you wash your hands before and after applying the medication or touching your child’s eyes.
Washing all towels, washcloths, sheets and pillowcases that your child has used in hot soapy water.
Throwing away all cotton balls used to remove eye discharge.
Not sharing makeup of any kind.

Check with your school or day care regarding specific policies about returning after illness. Conjunctivitis is highly contagious (spread from person to person). Most often, children with conjunctivitis can go back to school or day care after they have been treated with antibiotics for at least 24 hours and no longer have lots of eye discharge.

If your child needs to take a dose of antibiotic during the school day, it can be helpful to ask your pharmacist to put the medicine into two different labeled containers. That way you can send one to school or day care and leave the other at home. Also be sure to fill out any necessary forms, including a note from your doctor with specific instructions for giving the medicine.