When you hear about infectious diseases in childcare, you may think of influenza, chicken pox, or the common cold. Yet conjunctivitis is an infectious disease that also commonly occurs and may require exclusion from care.

Conjunctivitis is a disorder or irritation in the part of the eye known as the conjunctiva. The conjunctiva is a clear mucous membrane that covers part of the sclera (the white part of the eye that coats the eyeball) and lines the inside of the eyelids.

Conjunctivitis can be the result of allergies or other eye irritants, although the most common form is viral- or bacterial-based. When this type of conjunctivitis is present, the eye appears pink or red (hence, the more common name of pink eye) and may have some discharge.

The same virus that causes a cold or the flu can lead to conjunctivitis. In this case, upper respiratory problems, such as coughing or sneezing, may be present along with the eye-related symptoms.

This viral form of conjunctivitis is of greatest concern in childcare settings because of its highly contagious nature. Although persons of all ages are susceptible to conjunctivitis, newborns are at the highest risk because their immune systems are not yet strong enough to fight off the virus. For this reason, it is important to be aware of the common symptoms of conjunctivitis and to notify the parents or to seek prompt medical evaluation if conjunctivitis is suspected.

Symptoms of conjunctivitis include a red or pink conjunctiva, swelling, and discomfort. Sensitivity to light and frequent discharge may be symptoms of conjunctivitis for some. In the case of allergy-related conjunctivitis, excessive tearing and itchiness are common.

An infection of the tear duct might be confused with conjunctivitis, as both can have discharge and make the eye sore. However, an infection of the tear duct tends to cause redness and soreness in the lower part of the eye near the tear duct rather than affecting the entire eye. A tear duct infection may be accompanied by a fever. Prompt medical treatment is still important.

When trying to determine whether conjunctivitis is possibly present, it is important to watch for these symptoms as well as observe the child’s behavior. Because children in childcare are often too young to verbalize the cause of their discomfort, watch for excessive rubbing or tearing of the eyes.

Redness and puffiness usually are good indicators that there are eye irritations. Closer examination by a health care professional is always recommended when these symptoms are present.

Because viral conjunctivitis is highly contagious, it is important to seek medical care as soon as symptoms appear to determine whether the conjunctivitis is bacterial-, viral-, or allergy-related.

Antibiotics are not helpful in treating viral infections, but can be prescribed for bacterial-based conjunctivitis. For this form of conjunctivitis, an antibiotic eye drop or eye ointment is typically recommended.

For allergy-related conjunctivitis, the treatment is often antihistamines or other anti-allergy medications.

Sometimes an eye problem might mimic conjunctivitis, but actually reflects a more serious condition. Prompt medical treatment is best for all eye issues and especially important if a child complains of a loss of vision, severe pain, or ultra-sensitivity to light. Conjunctivitis with sudden fever or increased inflammation or irritation also should be evaluated promptly.

The method of prevention depends on the type of conjunctivitis. For allergy-related conjunctivitis, caregivers should limit outdoor exposure and keep all windows closed when the presence of allergens such as mold and pollen are high. Keeping areas clean of dirt, dust, and pet dander also is helpful in preventing allergy-related problems.

Like a cold, children can acquire viral-based conjunctivitis simply by being exposed to someone with the virus. By enforcing appropriate health policies in your childcare setting or home, you can limit exposure to this and other infectious diseases.

• Promote thorough hand washing with warm water, soap, and clean towels.
• Eliminate exposure to wet hand towels or dirty utensils.
• Teach children to avoid drinking after one another or sharing food.
• Wipe down toys, books, and other group items after play.
• Have ample tissues on hand for runny noses.
• As much as possible, keep door handles and other frequently touched items clean.

Unfortunately, you cannot guarantee that children will be 100 percent hygienic at all times; so exclusion of a child with viral conjunctivitis is recommended. According to Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care, anyone with purulent conjunctivitis (a pink or red conjunctiva and a yellow or white discharge) should be excluded from childcare until treatment has begun.

For cases of nonpurulent pink eye, refer to your local health authority for recommendations and act accordingly. Should you knowingly allow a child to attend childcare with an infectious disease, you might open yourself up to parental complaints or other legal issues.

To find out the recommendations or regulations for your state, contact your local state department or health authority. Recommendations for exclusion also apply to caregivers. If you have the viral form of conjunctivitis, the same precautions apply. In some states, lawsuits have even been filed (and won!) against caregivers who have exposed children to infectious disease.

Although conjunctivitis is a common illness, this does not have to be the case in your childcare center. Promote consistent hygiene practices, request that any eye-related symptoms be evaluated immediately, and enforce the guidelines for exclusion whenever appropriate. Doing so will help to promote a healthier childcare environment for everyone.

Diona L. Reeves
Consultant, American Academy of Pediatrics, Early Child Care & Education Initiatives

All About Vision, www.allaboutvision.com/conditions/conjunctivitis.htm

Caring for Our Children, nrc.uchsc.edu/CFOC

Kids Health, www.kidshealth.org/parent/infections/eye/conjunctivitis.html

Mayo Clinic, www.mayoclinic.com/health/pink-eye/DS00258