What is conjunctivitis in children?

Conjunctivitis is a common medical name for all eye conjunctival inflammation which is inside the eyelids and on the eye surface, but does not affect the visual portion (cornea). Conjunctivitis in children is one of the most common problems that takes a family to a doctor. While everyone knows what the pink eye is, there are so many other reasons for your child to have eye inflammation. Some of them are benign and can be treated at home, while other issues are reason for significant concern and needs to be seen in the doctor’s office right away.

Types of newborn conjunctivitis

Eyes are a very sensitive zone for a newborn. While all the skin is fragile, the eyes are still undergoing an adaptation to an open state, so the conjunctiva is extremely sensitive to all mechanical and chemical irritation, as well as other environmental dangers. Chemical conjunctivitis Chemical irritation is one of the most common reasons why newborn may have red and teary eyes. What can cause irritational conjunctivitis? Here are the most common chemical irritants:

• Cream
• Shampoo
• Any cosmetic product on mom’s skin
• Detergent
• Baby wipes
• Baby powder
• Scents

To avoid irritation of the eyes you need to:

• use the most hypoallergenic products
• do not use adult products for babies
• try to avoid using cosmetic products and scented creams for your care (for Mom)
• use only scent-free organic products in the baby’s environment, which means laundry, car seat, baby toys, bassinet etc.
• use mostly water for the baby wash, do not use wipes to wipe eyes
• use only baby body wash that is trusted by all – Johnson&Johnson

These rules are simple and ease your mind about selecting the best products for your baby. The closer to nature you are the better it is for the baby. Commercial perfumes and fragrant creams can cause significant irritation of the eyes. While you might enjoy fresh aroma, instead of looking beautiful perfect baby eyes you will see red puffy eyelids and tears.

Gonococcal conjunctivitis. This is an eye infection that was caused by a gonococcal bacterium. Usually, this bacterium enters baby’s eyes during the passage through a birth canal in a woman who has untreated sexually transmitted infection (STD). baby develops yellow eye discharge on the first days after being born. Inclusion conjunctivitis. Chlamydia is the most common bacterial sexually transmitted infection worldwide. The estimated global incidence of chlamydial infection is approximately 131 million new cases annually. Although chlamydial infection typically affects sexually active adults, it can be passed on to newborns by their infected mother during delivery. Approximately 30% to 50% of infants born to a mother with active chlamydial infection will develop neonatal conjunctivitis, also known as ophthalmia neonatorum (ON). Infection in neonates commonly affects the conjunctivae, but it can occur also in the nasopharynx, lungs, vagina, urethra, and rectum. Neonatal conjunctivitis caused by Chlamydia trachomatis is an acute infection of the conjunctiva that is characterized by erythema and edema of the eyelids, palpebral conjunctivae, and purulent eye discharge. It typically occurs between 5 and 14 days after delivery, although it can present earlier.

Infection from other bacteria. Pus, swelling, and redness of the eyelids with redness of the conjunctiva are suggestive of infectious conjunctivitis. Discharge can be purulent in bacterial conjunctivitis and watery in viral etiology. Gonorrhea has profuse purulent discharge, Pseudomonas has greenish discharge, and chlamydia can be watery followed with purulent and bloody discharge. Conjunctivitis in both eyes is most often is seen with:

• Staphylococcus aureus,
• Pseudomonas aeruginosa,
• Herpes simplex,
• Adenovirus.

Bilateral conjunctivitis is seen with infection caused by N. gonorrhea or by use of ocular prophylaxis. Chlamydia usually develops in one eye but involves the other eye after 2 to 7 days if left untreated. Childhood conjunctivitis. This is also called neonatal conjunctivitis. Most of the problems are because of blocked tear duct that creates an abnormal accumulation of the mucus and tear in the eye. an infection may then enter the eye either during the birth or immediately after.

Risk factors include:

• premature rupture of membranes,
• prolonged delivery,
• prematurity,
• poor prenatal care,
• maternal STI, HIV-infected mother
• mechanical ventilation,
• poor hygiene conditions.

Neonates at higher risk of congenital lacrimal duct obstruction include those with Down syndrome, Goldenhar Syndrome, clefting syndromes, midline facial anomalies, hemifacial microsomia, and craniosynostosis.

What causes conjunctivitis in a child?

Allergy, blocked tear duct, bacteria and viruses are the most common causes of conjunctivitis in a child.

Is pink eye contagious?

Pink eye is transmitted by the unwashed hands when a person sick with infection rubs the eyes and touches something else. A very strict hygiene is required in the classroom, childcare or at home when the child gets sick with pink eye.

Which children are at risk for conjunctivitis?

Any child who is exposed to other kids can get a pink eye. children with allergies who tend to rub their eyes due to itching are at risk for contagious eye infections.

What are the symptoms of conjunctivitis in a child?

You may first see goopy eyes – increased mucus or pus discharge on the ridges of the eyelids and on the eyelashes. Symptoms of bacterial pink eye roll out within hours. Child might first complain of the irritation in the eye (“sand”). Pretty fast the swelling and pain develop. There might be also systemic symptoms of illness – a headache, fatigue and sleepiness. Pink eye is extremely painful and usually comes with photophobia – inability to open eye in the bright eye. the child might be holding the eye shut and not even letting you look inside. If it is an allergic conjunctivitis, symptoms in the child might be very similar to an infection, only there is no pain and symptoms are symmetrical. One of the first symptoms is itching. Children may rub their eyes so badly to develop abrasions and scratches. Allergic eye can present within few minutes of rolling on the grass or petting a cat. They tend to self-resolve if the allergen is not present.

How is conjunctivitis diagnosed in a child?

Taking a very good and detailed history helps a doctor to set the diagnosis right. For a primary care pediatrician conjunctivitis is one of the very frequent diagnoses, so it is easy to recognize the symptoms and prescribe an appropriate care. If the symptoms did not resolve, you might want to see a specialist. A pediatric allergist can help you determine if your child’s red eyes are because of some indoor or seasonal allergy. Most of the time, an allergy test that takes 30 min can give you precise result and save a poor cat who might not be responsible.

How is conjunctivitis treated in a child?

Viral conjunctivitis is self-resolving and need only support measures to help with pain and discomfort. If symptoms are very bothersome, an eye compress can help with pain. Bacterial infections are treated with topical antibiotic ointment or drops. A child with the eye that hurts is a challenge even for experienced nurse to apply eye drops. So, an ointment sometimes is much easy to apply while the eye is closed. In rare occasions children need to be hospitalized for intravenous antibiotics and rehydration. Children are significantly affected by the allergy. They may have also other “hidden” symptoms of the allergy – inability to concentrate, poor night sleep, headaches and hyperactivity. Eyes can be just the first sign of a bigger problem, so symptoms should be addressed and the cause of allergy must be figured out.

What are possible complications of conjunctivitis in a child?

In rare situations when symptoms were not treated on time, an ulcer of the cornea can develop. This is one of the most common preventable causes of blindness.

Key points about conjunctivitis in children

As a parent you should remember the key facts about red eye in children:

• Conjunctivitis in children is very common
• The most frequent cause of conjunctivitis in babies and children are: infection (pink eye), allergy, contact irritation.
• If you know for sure that a contact with substance caused the eye inflammation, the first action should be to wash thoroughly the face and the eyes with warm water.
• If the problem did not resolve within 1-2 days, the next action should be to call your pediatric clinic

Next steps

It is not normal to have daily goopy eyes or red eyes for a child or a baby. If the initial treatment of the conjunctivitis is not successful, it is reasonable to see a specialist – an ophthalmologist or allergist. Pediatric ophthalmologist can help you figure out if there is a real eye problem, such as a blocked tear duct, a foreign body or an eye scratch that needs treatment. A pediatric allergist can help you figure out the environmental allergens and give you a specific recommendation that will stop the problem all together. Your child eyes are beautiful, and the problem will be resolved – just find the best doctors whom you can trust!