Thursday, March 22, 2012

Conjunctivitis: The Pink Eye

Anna Tielsch-Goddard CPNP-PC
The most common causes of pink or red discoloration in the conjunctiva (the clear membrane which covers the sclera, the white part of the eyes) are bacterial, viral, or allergic conjunctivitis. This condition is also known as "pink eye."
If your child has pink or red eyes, complains of itchiness, and has any sort of crust or drainage around the eyes, you should make an appointment with your child’s primary care provider (PCP) for diagnosis and treatment. Your PCP, a pediatrician, nurse practitioner, or physician assistant, will be able to determine whether or not the pink eye is most likely caused by a bacteria, virus, or allergies.
Pink eye usually causes sleepy crust or "a glue" in the eyes, upon awakening. If your practitioner determines that the pink eye is caused by bacteria, he or she will prescribe a topical antibiotic, usually in the form of eye drops, which will reduce your child’s symptoms, shorten the duration of the illness, and reduce the risk of contagiousness.
If your child has cold symptoms, such as a cough, runny nose, or nasal congestion, the cause of the pink eye is most likely viral. If your PCP thinks that the pink eye is caused by a virus, he or she will recommend cold compresses, artificial tears, and other symptomatic treatment.
Another type of conjunctivitis, allergic pink eye, is usually affiliated with allergies, eczema, and asthma. This type of pink eye causes itchy eyes and watery discharge. Treatment involves avoiding exposure to allergens and using artificial tears or prescription eye drops to alleviate the red eyes.
Other causes of red eyes include subconjunctival hemorrhages and blepharitis.
Subconjunctival hemorrhages are caused by broken blood vessels in the eye that cause redness in the conjunctiva. They are caused by minor trauma such as vomiting or prolonged coughing, are painless, and usually resolve on their own in 2-3 weeks.
Blepharitis, a more severe inflammation of the eyelid, may also make the eyes appear red and will usually be accompanied by a swollen eyelid or crusting in the eyelid margin. Treatment, including warm compresses and a topical antibiotic, is necessary to help with healing. In severe cases a referral to an ophthalmologist is necessary.
In all cases of pink eye, you must teach your family to practice strict hand washing and avoid sharing any personal items that might spread infection. Any time your child touches or rubs the eyes, he or she should wash hands right away or use an anti-septic hand sanitizer. Avoid sharing wash-clothes and other cleansing objects.
Contact lenses should not be worn until the infection clears up. If your child wore the lenses during the course of the pink eye, discarded them and obtain a new lens case. Cross contamination usually subsides after 24 hours of antibiotic therapy.
If you child’s red eyes do not get better in a couple of days after seeing your primary care practitioner, you should make another appointment for a re-evaluation in case there is a re-infection or another cause for the red eyes.

Cronau, H., Kankanala, R., & Mauger, T. (2010). Diagnosis and management of red eye in primary care. American Academy of Family Physicians, 81(2), 137-144.
  1. Hovding, G. (2008). Acute bacterial conjunctivitis. Acute Ophthalmologica,86(1): 5-17.
  1. Leibowitz, H. (2000). The red eye. The New England Journal of Medicine, 343 (5): 341-345.
  1. Sethurama, U., & Keepak, K. (2009). The red eye: evaluation and management.Clinical Pediatrics, 48 (6): 588-600.
Anna Tielsch-Goddard CPNP-PC is a Pediatric Nurse Practitioner for Children’s Medical Center Dallas at Legacy. She practices on the Perioperative Surgery teams in both presurgical assessment and pediatric-surgery.Read More >>

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