Your child wakes up with something new and unexpected: her eyes are matted shut, and she has trouble opening them! Somewhere in the back of your mind, you search for a quick solution. You remember this happened to you as a kid, but it’s been so long ago. Then you remember. Warm water on a wash cloth. Gentle compression. That will separate those eyelids and get her seeing again… But then what?
The right answer depends on the underlying problem. Several conditions result in red, watery eyes and matted eyelids in the morning, and because treatment depends on the diagnosis, it’s important your child sees a pediatric provider to get the right answer and the correct advice.
Classic Pink Eye
Classic pink eye is caused by a viral conjunctivitis. The conjunctiva is a thin mucous membrane that covers the outer surface of the eye and the inside surface of the eyelids. When the conjunctiva becomes infected, the body increases blood flow to the surface of the eye and sends inflammatory cells to fight the invaders. This results in redness, an uncomfortable itchy sensation and increased tear production. Matting occurs because the water portion of excess tears evaporates during sleep, leaving a sticky layer that glues the lashes together.
Viral conjunctivitis is extremely contagious and almost always spreads from one eye to the other. Because it’s a viral infection, antibiotics don’t help. Fortunately, viral conjunctivitis gets better on it’s own—usually after a few days, but sometimes as long as two weeks! It’s important your child stays home from school until the symptoms have completely resolved to avoid passing the infection to others.
Treatment for viral conjunctivitis consists of comfort measures, such as warm compress and anti-inflammatory medication (ibuprofen, for example). If herpes virus is suspected, a special antiviral medication and referral to an ophthalmologist is required.
Children with pink eye tend to rub their eyes with their hands. This should be discouraged because rubbing introduces bacteria from the skin, resulting in a mixed infection with both virus and bacteria. Antibacterial eye drops or ointment are needed to treat the bacterial component of these mixed infections. They may also be used to prevent bacterial infection in a child with pink eye who constantly rubs despite best efforts to discourage it. However, it’s important to remember the viral component of the disease is still contagious, even when using the antibiotic drops or ointment.
Bacterial conjunctivitis is caused by a bacterial infection of the conjunctiva. This may happen as a complication of viral conjunctivitis or on it’s own. When bacteria invade, the eye drainage becomes thicker and more pus-like. Young babies with bacterial conjunctivitis may be infected with bacteria from the birth canal, and older babies and toddlers may have an ear infection along with the eye problem. Special consideration is taken for each case, which means it’s important kids with bacterial conjunctivitis see their doctor right away to get started on the right treatment.
Environmental allergies are another common cause of red, watery, itchy eyes. Allergic conjunctivitis tends to follow a seasonal pattern and is usually accompanied by other allergy symptoms, such as runny nose and sneezing (although viral and bacterial conjunctivitis can come alongside viral upper respiratory infections, which may mimic the symptoms of seasonal allergies). If your child suffers from allergic conjunctivitis, typical treatment includes oral allergy medication and antihistamine eyedrops to relieve redness and itching.
Foreign Bodies, Injuries and Glaucoma
While conjunctivitis of any sort may be uncomfortable, true and persistent eye pain should always be checked by a medical provider right away. A retained foreign body, corneal abrasion (surface scratch) and even glaucoma can result in eye pain, redness and tearing.
Yes, Pink Eye is Common… But You Should Always Have it Checked Out
Here’s the bottom line: pink eye is common. It’s usually caused by a virus, and there’s usually not much that can be done to chase it away faster than leaving it to get better on its own. However, bacterial conjunctivitis, allergic conjunctivitis, foreign bodies, injuries and even glaucoma may result in similar symptoms, which require treatment that is dependent on the underlying problem.
So go ahead and grab the warm compress. Help your daughter open her eyes. But your next step should be to pick up the phone and call your doctor. Make an appointment. Have those eyes checked. It’s the only way to ensure the right diagnosis and the right treatment… every time.
For more information on pink eye, check out our Helping Hand.
Dr Mike Patrick is an Assistant Professor of Pediatrics at the Ohio State University College of Medicine and Medical Director of Interactive Media for Nationwide Children's Hospital. Since 2006, he has hosted the award-winning PediaCast, a pediatric podcast for parents. Dr Mike also produces a national podcast for healthcare providers—PediaCast CME, which explores general pediatric and faculty development topics and offers free AMA PRA Category 1 Credit™ to listeners.
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