Conjunctivitis and Other Eye Infections

Eye infections are fairly common in young children. These infections primarily involve the thin membrane that lines the inside of the lids and the eyeball. These structures are known as the conjunctiva and the infections are called conjunctivitis. Conjunctivitis can be of three sorts: infectious, allergic, or resulting from injury such as splashing a chemical in the eye.

The dreaded "pink eye!"

Any inflammation of the conjunctiva, or conjunctivitis, is commonly called "pink eye." The infectious forms of it are the only contagious ones, and infectious conjunctivitis is the disease that gave pink eye its terrible reputation. Childcare providers should understand how infectious conjunctivitis is spread, what the symptoms are, and what treatment should be taken.

Infectious conjunctivitis is spread by contact or touch; it is not airborne. This is why it is usually present in both eyes, as the child rubs first one eye and then the other. Pink eye got its reputation back in the days when there was only one cloth towel in the children's restroom. All the children would wipe their faces on the same towel. Childcare providers should never use the same face cloth or towel on more than one child. Several individual face cloths or paper towels should be available for the children, and cloths should be laundered after each use. Toys passed from one child to another after the first child has rubbed his pink eye also can readily be carriers of infectious conjunctivitis. Likewise, simply touching or holding hands is a common means of transfer when the hands later rub the eyes.

Symptoms of acute infectious conjunctivitis include reddened eyelids, and reddened eyes themselves. There is excess tearing, and the child can be quite uncomfortable. It may feel like there is a speck of dirt in the eyes. Pus usually drains from the inner corners of the eyes. Fever may or may not be present; usually it is not.

Children with infectious conjunctivitis should be excluded from childcare until they have been seen by a physician, treated, and approved by the physician for readmission. The particular germ that causes the infection cannot be diagnosed by looking at the eyes.

Infectious conjunctivitis is rarely serious and in many cases will clear on its own within a few days, although this is not usually recommended. Eye drops or ointments are most frequently prescribed to treat this condition. The caregiver may be asked to insert a couple of drops in both eyes while the child is in their care. This can be very difficult with young children, scared children, or children with special needs. After washing your hands thoroughly and putting on non-latex gloves, use one of these suggested methods:

• Ask the child to lie on his back, pull the lower lid downward, and put a couple of drops on the eyeball.
• Ask the child to lean back in a comfortable chair, pull the lower eyelid down and forward, and put a couple of drops in the space between the lower lid and the eye. Keep him reclining a minute or so.
• Ask the child to lie on his back and look to one side, put a couple of drops in the inner corner of the eye on the side toward which he is looking. Keep him on his back for a minute or so.
• With each method, be very careful to not touch the eye!

If an eye ointment is prescribed, follow a similar course. Pull the lower lid down a bit, exposing its inner surface, and quickly squeeze ointment onto the lid close to the eyeball. Do not touch the eyeball itself. Ask the child to keep the eye closed for a minute. Be sure to follow your childcare program's policy and procedures on administration of eye drops or other medication. All medications should be in the original container, and you should have written instructions on how to administer them. Keep all medications out of children's reach.

Careful hand washing, as with other infectious diseases, diminishes the spread of eye infection. If a child returns to the childcare program before the infection is completely cleared, it would be a good idea to take extra hand washing precautions. Check with the parents to be sure the physician has authorized the child's return to childcare.

Other Forms of Conjunctivitis

Allergic conjunctivitis is, of course, not contagious. It differs from infectious conjunctivitis in that there is no pus draining from the corner of the eye. Characteristically it itches, is usually in both eyes, and is not painful. It just itches! Treatment often involves eye drops and perhaps oral antihistamines. Cool compresses may make the child more comfortable.

Mechanical conjunctivitis can be caused by a foreign body in the eye, such as a speck of dirt. Try to flush the eye with lukewarm water (as described below). Always call the parents so they can get proper medical treatment. Dirt and other debris can scratch the cornea and may require medical treatment.

Chemical conjunctivitis can occur when a child gets something like bleach or another chemical in the eye. This is an emergency! Immediately flush the eye steadily with several quarts of lukewarm water while someone else calls the emergency department or paramedics, the parents, and the program's health consultant. The lukewarm water can be poured from a pitcher or a measuring cup with a lip on it. Have the child lie on his or her side and pour the water so that it flows from the inside corner (by the nose) toward the outer corner. If the chemical is in both eyes, quickly flush one eye, then the other eye, and repeat this continually for at least 20 minutes, or until medical help arrives.

All cleaning agents and chemicals absolutely must be kept out of children's reach, and most states require that such potentially dangerous substances be kept in a locked cabinet or closet.

Other Eye Infections

Occasionally what may superficially seem to be conjunctivitis is a considerably more serious condition called orbital cellulitis. In this case, the eyelids are much more swollen and reddened. The child is sick and usually has fever. This is an emergency, and usually requires prompt hospitalization. It is often accompanied by bloodstream infection or meningitis. The parents should be called immediately and the child should be sent to a doctor's care.

In another condition, the small glands located within the eyelids can become infected, producing a swollen, red and tender little nodule on the lid margin. These are hordeolums, commonly called "styes." They need to be treated with warm compresses several times a day as well as an antibacterial eye ointment as prescribed by a physician. Conjunctivitis also may accompany the stye in the child. Both the stye and the conjunctivitis can be transmitted from one child to another, so the child needs to be home until cleared for readmission by the physician.

By Donald Palmer, MD,
American Academy of Pediatrics
Committee on Early Childhood, Adoption, and Dependent Care

INTERNET RESOURCES

www.kidshealth.org

www.drkoop.com

www.mayohealth.org

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