Natick Pediatrics, PC

Is it Conjunctivitis?
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

If the whites of your child’s eyes are red, with or without a yellow discharge, the answer is "Yes, it is conjunctivitis."

But there are many different causes of conjunctivitis, and the treatment for each is different. Not all conjunctivitis requires the attention of a physician, and conjunctivitis is almost never an emergency.

Conjunctivitis is merely a word that means, "The invisible layer that covers the eye (the conjunctiva) is swollen, or inflamed". There are many reasons why this covering becomes swollen: 1) A viral infection; 2) A bacterial infection; 3) An allergic reaction; and 4) Trauma (i.e., the child got something in the eye, or was poked in the eye).

Viruses
When a child has a cold virus, her nose, her throat, her ears, everything becomes swollen. And so the eyes become swollen. Often the conjunctiva will turn red as the normally invisible tiny blood vessels swell with blood. There is often a small amount of yellow discharge as well. A child with viral conjunctivitis does not need antibiotics. Because antibiotics do not kill viruses, an antibiotic will not prevent your child from infecting other children in a child care setting! These viruses tend to be rather easily passed among children.

One type of virus that causes conjunctivitis deserves special mention, and that is Herpes Simplex. Herpes causes a severe type of infection affecting the conjunctiva and the covering over the colored part of the eye, the cornea. This is a serious infection that could lead to loss of vision. If a child with conjunctivitis has been exposed to an adult or child with known Herpes, you should contact the child’s doctor as soon as possible.

Bacteria
Occasionally, children’s eyes become infected with bacteria. Like viruses, bacterial conjunctivitis is contagious. It isn’t always easy to tell viral from bacterial conjunctivitis without special laboratory tests. For this reason, I employ a fairly simple criterion to decide if an eye should be treated with topical antibiotics: If there is so much pus in a child’s eye that the lashes stick together, such that the child cannot open the eye when waking from sleep, it’s probably bacterial and I recommend treatment. If the eye becomes much more swollen and red, and if the child appears sicker, particularly with fever, the doctor should be called.

Even if your child has a bacterial conjunctivitis, she doesn’t necessarily need to see the doctor immediately. There are a couple of home remedies that work very well for bacterial conjunctivitis. For more information about these, contact your doctor.

Allergies
If your child gets red itchy eyes only at certain times of the year, accompanied by runny, itchy nose, the problem may be allergic. Allergic conjunctivitis is usually made worse by going outside. The therapy may involve allergy eye drops or an oral antihistamine.

Trauma
Anything from an eyelash in the eye, to a grain of dirt, to a splash of shampoo, to a poked finger can give a child a red, swollen eye. These are not infectious causes, but they do deserve attention. If the child is clearly distressed, I recommend attempting to flush the eye(s) with warm water or saline. Younger children may be given a bath (without soap!) in which you pour cupfuls of warm water over the child’s head. If the pain persists or become worse, your doctor may wish to see the child to make sure there are no scrapes on the cornea of the eye.

Narrow Tear Ducts in Babies
In small babies, there is an special reason for eyes to appear swollen. In newborns, yellow or green "goop" often gathers in the eyes because of narrow tear ducts. All of us produce tears 24 hours a day. When we blink, we "wash" our eyes with tears to keep moist and maintain clear vision. Normally, the tears disappear down a tear duct located in our lower eyelid. When we cry, we produce more tears than can be absorbed by our tear ducts and the overflow runs down our cheeks.

In some babies, this duct is narrow or completely blocked. As a result, yellow or green crust accumulates in the eye, and sometimes one or both eyes "cry" constantly. In these cases, I recommend wiping the yellow crust away with a terry cloth towel dipped in warm water. Afterwards, I recommend massaging the baby’s cheek, using the tip of your pinky finger. You start just below the inside ("nose-side") corner of the eye, and massage diagonally down the face toward the corner of the mouth. You can do this while feeding the baby, five or ten minutes per day. This massage actually "milks" the tear duct. It will not "cure" the problem of narrow tear ducts, but it helps. If the eye still collects discharge after 6 months to a year, I refer the baby to a pediatric ophthalmologist.

You Should Bring Your Child to the Doctor When:
• The eyelids themselves become red and swollen
• Your child's vision becomes blurry
• Your child begins acting very sick

You Should Call The Doctor When:
• Your child's eyelids become matted with eye goop
• The problem lasts longer than one week

For more information about Natick Pediatrics, or to talk to the doctor, please call the office at (508) 655-9699.

Natick Pediatrics, PC
Medical Office Building
MetroWest Medical Center
Leonard Morse Campus
67 Union Street, Suite 305
South Natick, MA 01760

(508) 655-9699
(508) 655-2984 fax

Posted: February 7, 2005