Infant Pink Eye: When To Seek Medical Attention: Pediatrician’s Advice Dr. Rashmi Jain September 8, 2023

Infant Pink Eye: When To Seek Medical Attention: Pediatrician’s Advice

Infant Pink Eye: When To Seek Medical Attention: Pediatrician's Advice

TABLE OF CONTENTS
1. What is Pink Eye or Conjunctivitis?
           • 1.1 Symptoms of Pink Eye to watch for?
           • 1.2 Types of Pink Eye?
                        • 1.2.1 Viral Conjunctivitis
                        • 1.2.2 Bacterial Conjunctivitis
                        • 1.2.3 Allergic Conjunctivitis
                        • 1.2.4 Irritant Related Conjunctivitis
           • 1.3 Is Pink Eye contagious?
           • 1.4 What about Infant Pink Eye?
           • 1.5 If it’s not Pink Eye, what could it be?
           • 1.6 What is the treatment for Pink Eye?
                       • 1.6.1 Viral Conjunctivitis
                       • 1.6.2 Bacterial Conjunctivitis
                       • 1.6.3 Allergic Conjunctivitis
                       • 1.6.4 Irritant Related Conjunctivitis
            • 1.7 What are some home treatments for Pink Eye?
            • 1.8 When should you seek medical attention?

What Is Pink Eye or Conjunctivitis?

We’ve all seen people who have Pink Eye. The white parts of their eyeballs turn red, there may be swelling & irritation of their eyelids and there might even be yellow/green discharge coming from their eyes alongside tears. We hear a lot about Pink Eye because it is very easily contagious… especially amongst daycare & school going kids!

The medical term for Pink Eye is Conjunctivitis. Conjunctiva is the thin clear membrane that lines the inside of the eye and covers the white part of the eyeball. Though conjunctiva is usually transparent, when it gets inflamed or irritated, the blood vessels become more prominent & visible making the eyeball & it’s lining look red.

Symptoms of Conjunctivitis to Watch For?

Early symptoms of Pink eye in kids include the following points. It is important to note that not all symptoms would be present in patients especially for pink-eye in babies and toddlers.

Pink/Red

Pink/red appearance of the eyeball & inner lining of the eye

Burning

Burning sensation in the eye

Itching
Itching of the eye
Mucus or Pus-like
Mucus or Pus-like discharge from the eye
Tearing/Watering
Tearing/watering of the eye
Gooped or Crusted
The eye can be “gooped” or “crusted” shut when waking in the morning
Swelling
Swelling of conjunctiva and eyelids
Mild Blurry
Mild blurry vision or light sensitivity
Swollen Lymph Nodes
Swollen lymph nodes under the jawbone or in front of the ears
Types of Pink Eye

Pink Eye can be caused by an infection, allergies, or an irritation of the eye. The most common cause of the Pink Eye is a viral infection (viral conjunctivitis). The viruses that cause Pink Eye are the same ones that also cause upper respiratory illnesses like the common cold, so it makes sense that similar to colds, Viral Pink Eye is also super contagious!

Viral Conjunctivitis
Infant Pink Eye

A viral infection of the conjunctiva will usually start in one eye and quite often move over to the other. Viral conjunctivitis causes redness, tearing/watering of the eye, and thin mucus discharge. This irritation leads to the conjunctiva having a burning/itchy sensation & eyelids being swollen. People sometimes feel like “there is sand” in their eyes.

Since these viruses are the same contagious viruses kids are exposed to at schools & daycares, children with viral conjunctivitis will often also have symptoms of a cold like fever, runny nose, sore throat, cough & swollen lymph nodes in the neck. (The most common virus to cause viral conjunctivitis is Adenovirus).

Most schools and daycares will want a child to use eye drop antibiotics for 24 hours before returning to be around others. Though this might help expedite the resolution of bacterial conjunctivitis (see below) it doesn’t alter the course of viral conjunctivitis which will usually resolve on its own in 1-2 weeks. Viral conjunctivitis is contagious until all symptoms related to the eye have resolved.

Take-Home Points about Viral Conjunctivitis:

  • A most common cause of Pink Eye in kids
  • Can be accompanied by cold-like symptoms
  • Not helped by antibiotic drops
  • Is contagious until all symptoms have resolved
Bacterial Conjunctivitis

Just like viral conjunctivitis, bacterial conjunctivitis often starts in one eye but can spread to the other eye by rubbing or touching the infected eye. Along with redness and itching of the eye, bacterial conjunctivitis will often cause pain and thick pus or mucus discharge from the eye. This yellow/green mucus will re-appear quickly even after one cleans the eye with a wet washcloth. Oftentimes, the eye will be “gooped” or crusted shut with mucus discharge upon waking in the morning.

Unlike viral conjunctivitis, a bacterial infection of the eye like this will not usually be accompanied by other symptoms like fever, cough, or congestion. Though bacterial conjunctivitis will resolve on its own in 5-6 days, antibiotic drops help speed up the resolution of symptoms and are routinely required by daycares & schools for children to return.

Take-Home Points about Bacterial Conjunctivitis:

  • Can be painful
  • Causes thick mucus discharge that will “goop” eyes shut
  • Is not accompanied by other symptoms like fever, cough, or congestion
  • Antibiotic drops might speed up resolution, but the infection will still take time to go away
Allergic Conjunctivitis

Unlike infectious conjunctivitis that will start in one eye, allergic (atopic) conjunctivitis usually affects both eyes from the get-go. Allergens in the environment can cause irritation of the eyes immediately upon exposure or sometimes create an allergic response even a few days later. People will have watery, itchy, red eyes, and occasionally a watery stringy discharge. Rubbing the eyes tends to increase irritation. Allergic conjunctivitis is not infectious so it is not contagious. 

Take-Home Points about Allergic Conjunctivitis: 

  • Will usually affect both eyes
  • Symptoms can appear even a few days after exposure to allergens 
  • Is not contagious
  • Red, itchy, watery eyes can be made worse by rubbing them
Irritant Related Conjunctivitis

There are a number of things that might irritate one’s eyes. Chemicals, shampoos, dirt, dust, chlorine, smoke, or other irritants can cause eyes to become red, watery, and irritated. Wearing contact lenses for too long, without hydrating one’s eyes or without cleaning the contacts can cause dryness & irritation. A foreign body like an eyelash, piece of lint/sand in one’s eye can also cause irritation.

This form of eye redness/watering is not contagious. Washing the eye out with saline or water usually helps resolve this irritation. An irritant related conjunctivitis is likely to resolve on its own once the offending agent is gone.

Take-Home Points about Irritant Related Conjunctivitis:

  • Is caused by something that irritates the eye
  • Can be relieved by washing or irrigating the eye with saline/water
Is Conjunctivitis Contagious?
  • YES. Infectious Pink Eye (Viral and Bacterial Types) are spread by contact with the mucus discharge from one’s eye. For example, sleeping on the same pillow as someone with Pink Eye or using their towel to wipe one’s face can spread the virus or bacteria to others. Additionally, rubbing one’s infected eye and then touching door handles, toys or other objects may leave viruses or bacteria there for others to pick up and rub into their own eyes
  • Pink Eye spreads very fast in schools & daycares amongst children, which is why children usually need to be medically cleared to return to school
  • Kids can often return to school or daycare after 24 hours of being on antibiotic drops. Ironically, even though the eyedrops will only help bacterial conjunctivitis to a small extent and not make a difference at all for viral conjunctivitis, schools & daycares still want to see this type of medical management in place before allowing children to return to their facilities
What About Infant Pink Eye?

**If your newborn or infant has red eyeballs with swollen eyelids and a lot of yellow/green mucus discharge preventing them from opening their eye, it is important to seek medical attention as soon as possible. Infant Pink Eye needs to be treated expeditiously to prevent having an effect on the baby’s vision.**

Sometimes, however, newborns will shed tears from one eye (not usually both) and have small amounts of yellow/green mucus on their eyelashes when they wake from sleep. Their eyeballs aren’t red and they are able to open their eyes once the discharge is cleaned away with a warm wet washcloth. This is not an infectious Pink Eye. This is due to dacryostenosis (narrowing of tear ducts). 

At the time of birth, a baby’s tear ducts are very small in diameter. Tears and mucus could have a hard time draining down into the nasolacrimal duct and empty through the nose. Instead, tears and mucus back up into the eye and create what looks like mucus discharge from the eye. The mucus isn’t in quantities enough to cause the entire eye to be “gooped” shut. There may be mild swelling and redness of the eyelids from the baby rubbing at their eyes. This recurring situation resolves as a child gets older and the facial anatomy enlarges sufficiently to allow the tear ducts to widen in diameter (usually no later than by 1 year of age). The mucus and tears can then drain downward. 

Infant Pink Eye needs to be treated expeditiously to prevent having an effect on the baby's vision.

If It’s Not Pink Eye, What Could It Be?

An inflammation or infection of the eyelid can also cause redness, swelling & tears of the eye making it difficult to tell if your child has Pink Eye or not

  • A Chalazion is a blocked oil gland in the eyelid itself that causes a lump, oftentimes in the upper eyelid. As the lump gets bigger it can become red, swollen, and painful to touch
  • A Stye forms at the border of the eyelid and eyelashes if there is an infection of the hair follicle of an eyelash or within the eyelid itself if the oil glands in the eyelid get infected. This is a bacterial infection and often requires antibiotic treatment for resolution
  • Blepharitis is inflammation or infection of the actual skin of the eyelid. Its management depends on the type of blepharitis
Conjunctivitis Pediatric Treatment Plan:

Most Pink Eye infections will resolve on their own in a few days to a couple of weeks

Viral Conjunctivitis
Like all viruses, viral conjunctivitis has to work through its course and it can be irritating in this process. Artificial Tears and some OTC medications might help soothe the symptoms while the conjunctivitis is resolving.
Bacterial Conjunctivitis
Antibiotic drops can speed up the resolution of bacterial conjunctivitis, but ultimately this too must resolve on its own. In babies & young kids, antibiotic ointment might stay in place along the lower eyelid better than drops. If other infections requiring oral antibiotics also occur at the same time (like an ear or sinus infection), it is possible your conjunctivitis pediatric treatment plan will include treating everything with just oral antibiotics instead of both oral and eye drop antibiotics.
Allergic Conjunctivitis
Antihistamine eye drops or oral antihistamines help reduce the body’s allergic response and thus reduce symptoms of allergic conjunctivitis. Sometimes allergic conjunctivitis requires oral antihistamine plus additional antihistamine eye drops to get relief. Many patients require prescription-strength antihistamine eye drops instead of over the counter versions. Applications of these drops work almost instantaneously and are applied once or twice a day and are a great conjunctivitis pediatric treatment for kids. Sometimes they can cause a burning sensation. Keeping antihistamine eye drops in the fridge between applications might help reduce the sensation.
Irritant Related Conjunctivitis
As we discussed above, the most important thing is to wash away the irritant with water or saline. Washing the eyeball and inside of the eye to remove the irritating substance will lead to a quicker resolution of symptoms, often in no more than a few hours. Some people just have dry eyes and need artificial tears to lubricate their eyes and keep them from turning red.
What Are Home Treatments & Prevention For Pink Eye In Kids?
Wash Your Hands
Gently scrubbing your hands with soap & warm water after touching your face will prevent spreading the infection. Alternatively, if someone in your household has Pink Eye, make sure to wash your hands before you touch your face or eat a meal to prevent yourself from getting it.
Don’t Rub or Touch
Don’t rub or touch your eyes if you have Pink Eye. Use a cotton ball or tissue to wipe away discharge throughout the day to prevent spreading the infection to others via the mucus discharge.WAS
Wash Pillowcases & Towels
Wash pillowcases & towels in hot water and change them out daily to prevent others from accidentally coming into contact with the germs. 
Avoid Eye Make Up
Avoid eye makeup and contact lenses if you have conjunctivitis. Never share eye makeup or contact lenses with anyone! 
Frequently Sanitize
Frequently sanitize commonly touched surfaces like doorknobs, tables, telephones, blankets & toys to prevent the spread of Pink Eye.
Warm or Cool Compresses
Using warm or cool compresses with any type of conjunctivitis can help soothe the pain, irritation, and reduce swelling of the eyelids.
When Should You Seek Medical Attention?

Seek IMMEDIATE medical attention IF:

  • You have a loss of vision
  • You experience extreme pain when looking at a bright light
  • You’re unable to move your eyeball from one side to the other
  • You have a severe headache with nausea
  • You have associated fever, chills, or facial pain

Seek medical attention SOON if: 

  • You have thick mucus or pus discharge causing your eyelids to be “gooped” or crusted shut in the mornings
  • It’s been more than 2 weeks without the resolution of your Pink Eye symptoms

Pink Eye is a relatively easy diagnosis for Pediatricians. It is a good idea to contact the best Pediatrician near you to manage the condition to make our little ones as comfortable as possible. 

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