“Pink eye,” or conjunctivitis, is a non-specific finding that simply indicates conjunctival inflammation. The vast majority of children who present with “pink eye” will have a simple conjunctivitis. Neonatal conjunctivitis is an infection occurring during the first month of life, and is treated by administering antibiotics immediately after birth. Other causes of a “red, teary eye” in a newborn include congenital glaucoma and nasolacrimal duct obstruction. The most common causes for pediatric pink eye are allergic conjunctivitis, bacterial conjunctivitis, viral conjunctivitis, and blepharitis.
Allergic (hay fever) conjunctivitis is very common and affects approximately 10% of the general population. Seasonal allergic conjunctivitis produces itching and tearing and is usually associated with nasal congestion and other symptoms. For chronic, recurrent conjunctivitis, therapy consists of removal of environmental allergens and the use of topical eye drops that stabilize the cell reaction (mast cell stabilizers) to the allergen. It usually requires 2 to 3 days of continued use to reduce symptoms. Immediate relief can be obtained by the use of topical antihistamines. Topical corticosteroids are reserved for severe allergic conjunctivitis such as vernal conjunctivitis, and are only used for short courses of a few days.
The eye is constantly exposed to bacteria, but tear defense mechanisms work to prevent infection. When bacterial infections do occur, they present as watery irritation of the eyes that can progress to a thick mucous discharge. Children with a bacterial conjunctivitis often complain that their eyelids stick together in the morning. There is usually redness and crusting of the lashes. Antibiotics are often prescribed and used for 7 days.
Viral conjunctivitis is usually caused by an adenovirus and is extremely contagious. There is excessive tearing, redness, and the sensation of having a foreign body lodged in the eye. In children, the eyelids may be quite
swollen and present with a droopy lid as well as severe redness of the eye. Some patients are very light sensitive (photophobia). Often, there is a history of other family members or friends having pink eye. The treatment of adenovirus conjunctivitis is prevention of further transmission. A patient with this disease will be contagious for up to 2 weeks and should observe isolation precautions during this time. Unfortunately, there is no effective antiviral treatment at this time. Cold compresses and topical non-steroidal anti-inflammatories may reduce symptoms.
Products such as cleaning solutions, nail polish, gasoline, and compounds like super glue contain chemical irritants that can be extremely harmful if they come in contact with the delicate tissues in and around the eye. Depending on the extent and duration of exposure to the contaminates, visual outcome after the incident varies. The eye may heal completely with little to no permanent side effects, or the tissues may undergo “melting” and irreversible damage to the cornea. In some cases, blindness and even loss of the eye can occur.
In most cases, the key to preserving the integrity and health of the eye is immediate and ongoing rinsing of the eye with water for at least 5-10 minutes. Then, rapid transport to the doctor’s office or emergency room, if necessary, is warranted.
Blepharitis, or eyelid inflammation, is one of the most common causes of pediatric pink eye. The two most common types of blepharitis are staphylococcal blepharitis and meibomian gland dysfunction. The best treatment for both is lid hygiene (baby shampoo lid scrubs) and topical antibiotics. Children with staphylococcus blepharitis complain of itching and burning and often awake with their eyelids stuck together with crusting. Their eyes are irritated, but there is not the “true" itching as with allergic conjunctivitis. Other signs include scales at the base of the eyelashes. Meibomian gland dysfunction produces irritation, burning, and redness of the eyelid margins and conjunctiva. Obstruction of the meibomian gland opening may result in an acute infection, but more commonly produces a chalazion. A chalazion appears as a lump near the eyelid margin, either on the upper or lower lid. Chalazia may resolve on their own over several weeks; however, applying hot soaks several times a day helps the drainage of lipid material. If it does not resolve, incision and drainage may be necessary.