Pink eye is a huge hassle. Kids are kicked out of school or daycare for it routinely and yet many really aren’t that sick. Most kids with pink eye will get better on their own without any treatment but because the infection is quite contagious, using eye drops is common. Pink eye can be due to a variety of things, some infectious and some not. Here’s how to tell what type of pink eye your child has and whether or not you need to seek care.
Viral pink eye is the most common form of contagious pink eye and is hallmarked by redness in the white part of the eye as the blood vessels there get irritated by the virus. The eyes are usually both involved and have a watery discharge rather than a goopy one. Viral pink eyes accompany colds or sore throats and as long as there isn’t goop collecting frequently eye drops don’t help and may actually irritate the eye. This form of pink eye is quite contagious but since the symptoms are mild, most of the time I would still allow my child to participate in activities — although most schools and daycares won’t allow him to be there until he’s been seen by a doctor and given the OK. This form of pink eye may last five or more days, and my rule of thumb is to let children return to school if they aren’t feverish. When pink eye and red, sore throat are found together adenovirus is the likely cause. There’s no treatment for it but fever can accompany this form of viral pink eye.
Allergic pink eye is less common and often overlooked. This type of pink eye occurs when a child has an environmental allergy to pollens or dust for example. Sometimes the children are sneezing or have clear runny noses but often the pinkish whites to the eyes is the symptom that brings them into the office. This form of pink eye gives itchy eyes and usually an itchy nose too along with pale red inner eyelids if you pulled down on them to look inside. Infectious pink eyes have more beefy red conjunctiva in that area. If there’s any discharge, it’s watery or slightly whitish and stringy. The management for this is either an oral antihistamine or an allergy eye drop. There’s no reason to keep kids out of school for this one.
Bacterial pink eye is usually seen in one eye and then may spread to the other. It is hallmarked by redness in the white of the eye and the inner eyelid. Green or yellow discharge, often crusting in the lashes, is characteristic. It won’t just be there upon waking in the morning but will continue to accumulate throughout the day. The eye may feel a bit irritated but it isn’t classically itchy. This form of pink eye is often seen with ear infections and the younger the child the greater the likelihood of having an ear infection as well. Indeed 1/3 of children under 3 will have an ear infection if they have a goopy pink eye. It is for this reason primarily that seeing children in the office is important. If a child has both an eye and an ear infection, using eye drops alone won’t work. An oral antibiotic is usually needed and because the bacteria that causes this combo is usually resistant to amoxicillin, a stronger antibiotic like augmentin is usually chosen. If no ear infection is found, eye drops are used. Either way, the child can return to school or daycare the next day.
Traumatic pink eye happens when the eye is scratched by something. This would only occur in one eye typically and is quite uncomfortable. Older children can easily tell you they were poked or hit in the eye but infants and toddlers cannot. If a child seems quite cranky and is rubbing one eye a lot and that eye is red (usually a more discreet area of redness rather than just globally red) then putting a drop of fluorescin on the eyeball and looking at the cornea makes sense. If there is a scratch there it’ll be found using this method. If there is a scratch there, the old school approach was to patch the eye and put eye drops or ointment in the eye several times over the next 24 hours and then to be rechecked. Newer approaches are not as challenging. Patching probably isn’t needed and eye drops are used to prevent infection but otherwise make no difference when it comes to healing. Over 90% of the time the scratch is gone the next day no matter what you do. I do still prescribe the drops but no longer patch the child’s eye unless it is an infant who cannot seem to stop rubbing it.
Lastly, some systemic diseases can cause a red eye which is often painless but occasionally is uncomfortable. When the eye is red very near the iris and less red at the periphery, uveitis or increased pressure in the eyeball may be the cause. There is no discharge or upper respiratory illness that accompanies this form of pink eye but seeing an ophthalmologist pronto is needed.
Given the many forms of pink eye, getting checked out by your healthcare provider makes sense!