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All About Pinkeye

Pinkeye: how do we know when we need to react to real pinkeye and when we can leave it alone because it isn’t actually pinkeye? What even is “pinkeye”?

Warning: there is a gross picture of an eye coming up for the ommetaphobics out there.

To start, “pinkeye” is a blanket term used to describe all forms of conjunctivitis: an inflammation or infection of the conjunctiva – the clear membrane that covers the eye and and also the inside of the upper and lower eyelids. It can be a viral infection, bacterial infection or allergic. Viral and bacterial conjunctivitis are very easily spread by physical contact with the drainage from the person’s eye while allergic conjunctivitis is not. Conjunctivitis can also be caused by an irritant such as chemicals, foreign bodies in eye or in infants by a blocked tear duct.

Some main symptoms of pinkeye are:

  • Redness of the whites of the eye (the sclera)
  • Itching of the eye
  • Thick sticky mucusy drainage that tends to “glue the eye shut” in the mornings – more than just the normal eye boogies we all get
  • A “gritty” feeling in the eye like there is dust in it,
  • There can be swelling of the eyelids or even the sclera
  • Increased redness and swelling of the inner lower eyelid if the eyelids are pulled down gently as pictured below.

So you have a student standing in front of you with a complaint of “red eye”. What can you do with this? We can not diagnose the type of conjunctivitis of course but we should know when to send them to the doctor and when we can send them back to class.

  • How does the eye feel? is it itchy? painful? gritty? normal?
  • Did they have lots of goop this morning? Do they have lots of goop now?
  • Did they get anything in their eye just now like eraser dust, regular dust, dirt/sand, chemicals (soap, sanitizer etc), pool chlorine, cigarette smoke or other environmental pollutants?
  • Do they have other cold symptoms like a runny/stuffy nose, coughing, or increased allergies?
  • Do they wear contact lenses and do they take proper care of them?
  • Have they just had an injury to the eye such as getting poked or hit in it?
  • With a gloved hand you can gently pull down the lower eyelids and compare if the red one is also swollen and red inside the lower eyelid compared to the normal eye or if both eyes are affected they could both be excessively red and/or swollen.

If you’ve determined that it is probable infectious pinkeye based on the questions and exam then the student should be sent home to be seen by a doctor for official diagnosis and treatment (if applicable). For my district and many others the student must be treated for 24 hours before they can return to school if they are diagnosed with bacterial conjunctivitis. For viral and allergic they may return to school immediately if desired.

Treatments for bacterial conjunctivitis may include:

  • Antibiotic drops or ointment such as Erythromycin, Ciprofloxacin, or Tobramycin
  • Discontinue use of contact lenses until treatment course is finished, use new lenses after treatment is finished.
  • Artificial tears eye drops
  • Steroid eye drops such as Tobradex (combo Tobramycin and Dexamethasone) or Prednisolone drops.
  • Warm compresses to remove the excessive drainage.
  • Ibuprofen can help with pain and inflammation
  • If available a parent may choose to use fresh breastmilk on a cotton ball as a compress to treat bacterial conjunctivitis, especially in infants less than 6 months old. Obviously this is not a treatment to be used at school but at home if the parent chooses to. https://pubmed.ncbi.nlm.nih.gov/33098117/
  • Bacterial pinkeye often is accompanied by a strep throat or otitis media infection. If a child has one they may also develop the others as well.
  • Prevent it from spreading to others by avoiding touching your eyes, washing hands frequently, not sharing eye drops or makeup with others.
  • Change pillow cases and face towels often and throw out any mascara or eyeliner that may be contaminated in order to prevent reinfection.

Treatment for viral conjunctivitis may include:

  • There is no specific medication to treat a viral infection.
  • Steroid drops if the symptoms are severe
  • Warm compress for comfort
  • Artificial tears for comfort
  • Antiviral medication if the doctor determines that the infection is related to Herpes Simplex virus.
  • Discontinue contact lenses and use a new pair once infection is cleared up.
  • Ibuprofen can help with pain and inflammation
  • Allow the symptoms to run its course.
  • Viral pinkeye usually accompanies a cold.
  • Prevent it from spreading to others by avoiding touching your eyes and washing hands frequently.

Treatment for allergic conjunctivitis:

  • Allergy medications such as Zyrtec, Allegra, Claritin etc.
  • Allergy eye drops such as Pataday or Systane
  • Avoiding exposure to the possible allergen if possible.

Treatment for other non-infectious conjunctivitis (chemical or foreign body exposure):

  • Remove contact lenses if applicable
  • Flush eye well for several minutes with water. You can use an eye wash found here or here.
  • call poison control if unsure about the chemical exposure https://www.poison.org/articles/help-for-poisons-splashed-in-the-eye
  • Seek emergency care as per poison control recommendation or if symptoms are severe. Certain chemical exposure to the eyes can cause scarring, damage to the eye, and possible loss of sight or eye if not properly addressed.

For all types of conjunctivitis it is wise to avoid using any oils, herbs, folk remedies etc (except for the breastmilk – that one is scientifically proven!) as most of these are not sterile or researched or doctor approved and could potentially cause permanent damage to the eye.

At the end of the day, we nurses cannot diagnose or treat conjunctivitis on our own and need a physician’s input. We should be aware of when a student needs to be referred for treatment and what types of treatments we should expect the student to have after they’ve seen the doctor.

Check my TPT for letters to send home informing parents of pinkeye exposure and other great resources!

click the picture to go to TPT

https://www.cdc.gov/conjunctivitis/clinical.html

https://www.cdc.gov/conjunctivitis/index.html#:~:text=People%20often%20call%20conjunctivitis%20%E2%80%9Cpink,Causes

https://kidshealth.org/en/parents/conjunctivitis.html?ref=search

https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/conjunctivitis?sso=y#:~:text=Careful%20flushing%20of%20the%20eyes,need%20to%20use%20topical%20steroids.

https://www.mayoclinic.org/diseases-conditions/pink-eye/diagnosis-treatment/drc-20376360

https://www.aao.org/eye-health/diseases/pink-eye-conjunctivitis

https://the-eyedoctor.com/blog/2021/9/8/6-things-you-never-knew-about-pink-eye-mysteries-revealed

https://www.healthline.com/health/how-to-get-rid-of-pink-eye-fast

Published by Emme Mauer M.Ed., BSN, RN, CSN

Mom to two preemies, anxiety sufferer, postpartum depression survivor, and school nurse extraordinaire.

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