Pink Eye: Is it all the same?

Written by Melissa Arca MD

I get so many questions from parents about this, mostly it goes like this: “ewww…I hope it’s not pink eye!”

Pink eye is one of those afflictions that causes us to squirm, think “oh no!”, and inspire us to wash our hands a million times throughout the day. Most of us tend to hide away inside our homes until the icky looking discharge oozing from our child’s eyes disappears.

So, what exactly is pink eye, and what do we truly need to do about it? Not all pink eyes are created equal. Only half of the cases in children are truly bacterial.

Here are some quick facts about pink eye:

•  Pink eye is a general term for what we pediatricians call conjunctivitis.
• Conjunctivitis is the inflammation of the mucus membrane of the inner eyelids.
• Conjunctivitis can be caused by viruses, bacteria, environmental allergies, or a topical irritant.
• Viral conjunctivitis in young children is very common, especially during the summer.
• Viral conjunctivitis will go away on it’s own, without antibiotic drops.
• Only bacterial conjunctivitis needs to be treated with antibiotic eye drops.

How do we know if it’s bacterial conjunctivitis?

• With bacterial conjunctivitis, the eye discharge is more likely to be yellow/green and “icky”.
• Children with bacterial conjunctivitis often wake up with their eyes “sealed shut”.
• Can be associated with an accompanying ear infection.
• These cases need to be treated with antibiotic drops.
• A child with bacterial conjunctivitis may return to school 24 hours after initiation of treatment and obvious signs of improvement.

Five factors pointing to a non-bacterial culprit for conjunctivitis:

• The child is older than 6 years old
• It’s summer time: viral conjunctivitis is more common during the late spring and summer months.
• The discharge from your child’s eye is clear, watery, and may or may not be associated with allergy symptoms such as sneezing and eye itching.
• No yellow/green eye discharge
• Child does not wake with his eyes “sealed shut”.
• If your child meets most of the criteria above, her conjunctivitis is more likely due to a virus or may be part of her allergy symptoms.

Tips for Treatment and Prevention:

• Be vigilant about hand washing. Both viral and bacterial conjunctivitis are extremely contagious.
• HAND WASHING. It’s worth repeating.
• If it’s bacterial and your child is prescribed antibiotic drops, finish the designated days of treatment.
• In most cases, treat both eyes even if only one appears to be infected at the time. Young children will inevitably spread it to the other eye. Avoid the ping pong effect.

Tip for antibiotic administration: have your child lie down, it’s okay if her eyes are closed. Place the drop in the inner eye, near the nose. Once your child starts blinking, the drops will enter the eye.

Look for the signs above, consult with your pediatrician, and above all…keep on washing those hands.

Dr. Arca is a pediatrician. She works part-time while raising her two young children, Big Brother (age 6) and Little Sister (age 3). She is passionate about writing and writing about motherhood, parenting, and children’s health is what she does best. Dr. Arca blogs regularly at Confessions of a Dr. Mom

Why wasn’t my son treated with antibiotics for his red ear?

By Herschel Lessin, M.D.

Before entering the room, I looked at the chief complaint of my new 15 month old patient: pulling at his ear. I was also  seeing her 6 year old with an earache. Mom was concerned with her children’s frequent ear infections. They were always on antibiotics.

After my exam, I tell her that while her infant’s ear was a little red, it was not infected. Her 6 year old had an ear infection. Neither needed antibiotics.

Mom was most definitely not happy. The antibiotic seems to always help. Why weren’t they being treated this time?

The answer was that I was one of the good pediatricians who only used antibiotics when they were appropriate.

For decades, US physicians have been treating every red ear as an ear infection. There is now compelling evidence that not only is this practice wrong, but it is dangerous as well.

First of all, a mild red ear is absolutely NOT a sign of an ear infection. In order for the infection to be present, the entire structure of the eardrum must be distorted and bulging. In addition, there must be fluid behind the eardrum that restricts its movement with air pressure. The mild red ear does not meet any of these criteria and is not a sign of an infection that requires antibiotics. Most red ears are due to infants’ crying while being examined.

The indiscriminant use of antibiotics has resulted in many bacteria that are resistant to many antibiotics and can cause severe, difficult to treat illnesses that may be life threatening

Current American Academy of Pediatrics Policy is to not treat ear infections at any age unless examination reveals the bulging distorted ear drum that I mentioned earlier. Definite ear infections should be treated in children less than 2 years of age.

The recommendation that has caused the most resistance from both parents and pediatricians alike, is the “Observation Option”. Older kids can be observed with aggressive pain relief. If pain cannot be controlled or symptoms last more than 2-3 days, then antibiotics can be used. This idea has met with significant resistance from both parents and pediatricians alike.

Trying to teach old dogs new tricks has always been difficult. Add to this the fact that parents want us to DO SOMETHING! It is a brave pediatrician who does not give parents what they want. Finally, it takes a lot less time to write an antibiotic prescription than to explain to an angry parent exactly why it is not needed. Not to mention the fact that many adults with simple colds get antibiotics from their own physicians.

The indiscriminant use of antibiotics for viral infections and earaches must cease since it is causing enormous problems with bacterial resistance to our strongest antibiotics.

I explained to the parent that while there is a small chance that her son will go on to develop a real ear infection requiring a second trip to the doctor, that is a small price to pay to avoid exposing our children to unnecessary antibiotics that can cause real harm.

Many of us have used a compromise called the SNAP (safety net antibiotic prescription). A time limited prescription for antibiotics is provided to the parent to only fill if they really need it. We trust our parents to do this. Studies are ongoing to see how many actually do not fill the prescription.

Dr. Lessin has been a practicing pediatrician for 30 years. He is a founding partner and served as both Medical Director and Director of Clinical Research at the Children’s Medical Group.