By Dr. Charles J. Bock

Conjunctivitis (Pink Eye) and Ocular Allergies

Conjunctivitis is a general term used to describe any problem that causes the mucous membrane covering the eye (the conjunctiva) to become inflamed or irritated ("-itis" means inflammation). Below, some of the more common causes of conjuntivitis are discussed.

Viral Conjunctivitis

When most people speak of pink eye, they are referring to viral conjunctivitis. The tissues of the mouth, nasal cavities, pharynx (throat), and eye are all covered with mucous membranes. Virtually any virus that can cause cold symptoms by infecting the nose or throat can cause conjunctivitis.

The symptoms of viral conjunctivitis include watery, runny eyes, often accompanied by an itching or burning sensation. There may be a moderate amount of white or light yellow mucous discharge. Enlarged lymph nodes may be found just in front of the ear (roughly at the jaw joint).

In viral conjunctivitis, as in any cold symptom caused by a virus, antibiotics are not helpful. Cool compresses can be very soothing, because they actually help decrease the release of histamine (histamine is the chemical the virus causes the conjunctiva to release, which causes the irritation). A clean washcloth soaked in cold water should be placed over the closed eyes for several minutes. This can be repeated as often as the child wants. In some cases, Dr. Bock may prescribe an allergy eye drop to help block the histamine reaction. Commonly, symptoms will begin in the second eye a day or two after the first eye.

Viral conjunctivitis should be considered contagious for two to three days after the onset of symptoms. Family members should wash their hands and avoid sharing cups, towels, or pillows during this time.

There is a specific type of viral conjunctivitis, known as Epidemic keratoconjunctivitis (or EKC), which is much more severe than the typical viral conjunctivitis. EKC is characterized by a tender, swollen lymph node at the jaw joint and tiny changes in the cornea, which can be seen during Dr. Bock's examination. The eyes can be unbelievably red and irritated. EKC is uncommon, but it is highly contagious for two weeks after the onset of symptoms. EKC can last four weeks or longer, and can spread from one eye to the other.

Viral conjunctivitis can also be caused by other viruses, including chickenpox and herpes simplex (HSV, the same virus that causes cold sores). Conjunctivitis due to HSV may be accompanied by corneal problems and may need treatment. Treatment varies based on severity and the age of the child. Any child with conjunctivitis and small bumps or sores on their eyelid should be evaluated.

Allergic Conjunctivitis

Allergic conjunctivitis can look much like viral conjunctivitis. Your pediatrician may distinguish between the two based on whether your child has other symptoms consistent with allergies or a viral infection. Dr. Bock's examination microscope can help differentiate between the two, as well. Unlike viral conjunctivitis, allergic conjunctivitis is not contagious.

Fortunately, the two are treated similarly. Cool compresses and an antihistamine eye drop are usually all that is needed. Some children may find that treatment with an allergy pill alone helps improve their conjunctivitis. Occasionally, a mild steroid eye drop is needed.

There is a specific type of allergic conjunctivitis, known as vernal conjunctivitis, which is most common in boys and may require different treatment. An eye exam will determine if this type is present.

Bacterial Conjunctivitis

Bacterial conjunctivitis is very uncommon in children and is characterized by lots of mucous discharge from the eye, which is usually dark yellow, green, or brown. If your child appears to have true bacterial conjunctivitis, Dr. Bock will probably try to perform a culture to be sure that the antibiotic drop or ointment he prescribes is correct.

Conjunctivitis in the Newborn

Newborn children with conjunctivitis need to be seen by their doctor promptly. There are many infections that can be passed from mother to child during birth and each requires different treatment.

If you have questions

Feel free to call our office at 503-656-4887 at any time with your questions. Our goal is that you understand completely your child's condition and treatment.