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August 22, 2012 at 12:17 AMComments: 0 Faves: 0

Pink Eye! Do You Need and Antibiotic?

By Jeffrey VanWingen M.D. More Blogs by This Author

Pink eye tends to freak out daycares and schools, but while many eye conditions freak me out too (acute glaucoma, iritis and foreign bodies in the cornea) I must say, conjunctivitis does not. 

This blog will highlight the three types of conjunctivitis and cover practical treatment options.

Do You REALLY Need Antibiotics for Pink Eye?

As a doctor, I’m often thrust between a patient and their daycare or school. They have a goopy eye and get sent home, not to return unless they are on an antibiotic. But truth be told, an antibiotic is usually the wrong solution in this case. Suddenly, the patient is not only victim to conjunctivitis, but also a policy without much practical consideration. In the face of conjunctivitis, the best treatment is to seek out the cause.

Not all red eyes are conjunctivitis. Concerning symptoms include:

  • Eyeball pain
  • Pain with looking into light and
  • A foreign body sensation (like a piece of sand is in the eye). 

If these symptoms exist, call your doctor to rule out more serious eye conditions.

The Three Types of Pink Eye

Conjunctivitis is inflammation of the conjunctiva, the fleshy part of the eye behind the lid. It does not involve the eyeball itself. Symptoms involve red, itchy conjunctivae along with a discharge.  Infection is a cause, but not the sole cause, of conjunctivitis. The three types of conjunctivitis in order of prevalence are viral, allergic and bacterial. 

  • Viral Conjunctivitis: Viral conjunctivitis is commonly known as an “eye cold.” Besides the basic components of conjunctivitis, the viral variety may also involve the symptoms of a viral upper respiratory infection (a cold).  These symptoms include a runny nose, cough, sneezing, plugged ears and perhaps a fever.This infection travels up the tear duct to affect the conjunctivae. The eye discharge is characterized by its thin, perhaps crusty mucous quality. This type of conjunctivitis is more prevalent during the typical cold season of late fall, winter and early spring. One or both eyes may be affected by the virus.
  • Allergic Conjunctivitis: When a person is exposed to an allergen, it causes a reaction in their mucous membrane.  What ensues is a miserable syndrome of mucous production that causes, itchy, watery eyes, sneezing and hacking.  As the conjunctivae are also mucous membranes, allergy can also cause a mucousy eye discharge along with the other typical symptoms. The quality of this discharge is typically thin and more watery than the other varieties of conjunctivitis.  Typically both eyes are affected equally at the same time.
  • Bacterial Conjunctivitis: When bacteria infect the conjunctivae symptoms are most often limited to the eyes. One type can also cause a coinciding ear infection.  The conjunctivae typically produce a large quantity of discharge. I often hear that the discharge accumulates again soon after it is wiped away. This is the kind of discharge that leaves its victim with glued or stuck eyelashes upon waking in the morning.  The discharge is typically sticky in quality. Often one eye is infected first and then the other eye is secondarily infected.

Pink Eye Treatment

As there is no cure for the common cold, there is no cure for viral conjunctivitis. All you can do is manage symptoms.

The best treatment is a warm, moist compress to help mobilize the secretions and clear the discharge. This also goes for allergic conjunctivitis in addition to the typical allergy remedies such as antihistamines or decongestants. 

With bacterial conjunctivitis, antibiotic drops or ointment is often necessary applied topically into the eyes. While most adults prefer drops, I recommend ointment for children. The drops sting a bit and parents are usually in for a fight after the first application. In contrast, the ointment is soothing, although a bit messy.

Can Pink Eye Be Prevented?

Prevention boils down to avoidance of known allergens or sick individuals. Viral and bacterial conjunctivitis is quite contagious, thus the concern by daycares and schools. Hand washing, however, can prevent infection quite readily. 

Conjunctivitis is common, but not all cases require antibiotics.  In fact, most don’t.  Look at other coinciding symptoms as well as the quality of the discharge to determine the cause.  Eyeball pain, pain with light exposure or a foreign body sensation should prompt concern for something more serious. 

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