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Pinkeye: Second Opinion

Details on pinkeye

Boogers. When they come out the noses of our little charges, we wipe them away, shrug, and think, "Here comes another cold." But move an inch or two up and to the right or left, and the appearance of boogers will clear the snack table faster than you can say "erythromycin." Pinkeye, a.k.a. conjunctivitis, is rarely serious, but it is seriously annoying.

Take Harry (not his real name), a snazzy 4-year-old I recently saw. He was his smiling self, but his right eye looked kinda nasty — pink, to be sure, and weeping. Nothing serious, but he bought himself a day home from preschool and some antibiotics. Potential wildfire contagion necessitates treating and/or quarantining children with pinkeye, pitting medicine wary (or weary) parents against schools and child care centers against pediatricians.

What I Preach
Conjunctivitis involves the "itis" or inflammation of the membrane (or conjunctiva) that lines the eyelid and eyeball. The eye is equipped with tear ducts and mucus glands to keep it lubricated, but when this system gets overwhelmed, it can go into overdrive, secreting protective tears or mucus and causing the eye to become swollen and gooey.

An infection (either viral or bacterial) is commonly the cause, but allergens or other irritants (like household cleaners) also can set the eye on fire. Especially in school-age kids, certain viruses are often the culprit and can spread rapidly among children and adults and even from eye to eye in a matter of days.

The biggest concern with pinkeye is preventing it from spreading to others (as usual, hand washing is key). But at the onset of conjunctivitis, it can be difficult to distinguish bacterial from viral and therefore is difficult to treat.

What I Practice
As a medical student, I developed a rip-roarin' case of pinkeye. Budding diagnostician that I was, I proudly declared that the pus-like goo coming from my eyelids was evidence of bacteria. Turns out: nope. It was enterovirus, a friend I've seen many times since. I take some solace in the fact that viral and bacterial entities appear similarly, with much overlap in their symptoms. In either case, parents will note eyes that are sticky or gummed shut upon awakening. Children may complain of discomfort, itchiness, or sensitivity to light. There may be fever or swollen lymph nodes near the ears. Conventional wisdom suggests viruses cause teary discharge and enlarged lymph nodes, while bacteria cause sticky pus to leak from the eye. Sometimes yes, but not always.

If it's bacterial, antibiotics are often prescribed, but it turns out they may not be necessary. (Viruses don't respond to antibiotics —l ike the flu or a cold, there's not much you can do.) In a recent study in Britain, 326 children ages 6 months to 12 years with conjunctivitis were studied: Half were given potent eyedrop antibiotics and half were given a placebo. Both groups got better, in about the same amount of time — and in fact, most had bacterial infections. Yet as many Parents of a Pinkeyed Participant can attest, these cases send kids rocketing home with a See Doctor note. Some day cares allow children to return while "treated but gooey" (consistent with the American Academy of Pediatrics' guidelines). Others require kids to stay home until the eyes are dry, especially if there is a severe outbreak.

Why the Hypervigilance?
To be fair to our school nurse and day care colleagues, pinkeye is complicated, so they typically react conservatively in sending new cases home until cleared or evaluated. As I often tell parents, this is a bit of a public health compromise. Remember Harry? His mom was not happy; she did not relish the idea of putting eyedrops in her squirming offspring for a week for something that might be bacterial (and might get better on its own even if it was). Yet she had to go to work. Harry was allowed to return to day care . . . on antibiotics after a day at home. It is a sort of cahoots we parents and physicians and day care providers fall into. The result in many cases? Days lost from work or school, and the fact that we may be confederates in overtreating with antibiotics — which can lead to breeding bacterial resistance and reducing these medications' effectiveness in the long run.

Ultimately, the best way to treat a case of conjunctivitis is to look at its history. Lots of kids in day care with the same thing? More likely viral. One-sided infection, with fever and tenderness to the eye? Best be treated with topical antibiotic drops for potential bacterial badness. Some docs may manage it over the phone; I prefer to have a peek at the eye.

Whatever the hunch, lessen discomfort by using cold or warm compresses and acetaminophen or ibuprofen. Keep an eye on the, um, eye and contact your health care provider if symptoms worsen.

By the Numbers

  • 1 in 9 — Number of children under 15 who get pinkeye each year.
  • 1 in 5 — Number of children under 4 who get pinkeye each year.
  • 7 — Days it takes bacterial conjunctivitis to resolve with or without antibiotics, according to a 2005 study.
  • 30 — Percentage of all eye-related ER visits that are due to pinkeye.
  • 7 — Days viral pinkeye is contagious from its first appearance of symptoms.

Extra Tip: How to Apply Eyedrops (The Coward's Method)
For those who, like me, remain utterly squeamish about stuff in the eyes: Have your child lie on the floor, face up. Kneel down with his head between your legs. Have him close his eyes, then lace drops of fluid in pools in the inner corners of his eyes. Then, keeping his head still encourage him to blik so that the medication washes over the eyes. If you have more than one medication to apply, wait a good three to five minuets between them. Don't let the dropper or medication vial touch the eyes, and (obviously) wash your hands before and after application.

About the Author:
Jack Maypole is a pediatrician in Boston and shares cases of pinkeye with his wife and three children.

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