Conjunctivitis

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Key points to remember

  • conjunctivitis is a common problem in children
  • it causes red, irritated and sticky eyes
  • it is commonly caused by an infection (virus or bacteria) or allergies
  • if caused by infection it is often very catching (contagious)
  • symptoms can last from two days to three weeks
  • good hygiene (especially hand washing) can help prevent the spread of conjunctivitis

What is it?

Conjunctivitis is inflammation (swelling and redness) of the clear layer (membrane or conjunctiva) which covers the white part of the eye and the lining of the eyelids. Conjunctivitis is sometimes called ‘sticky eye’ or ‘pink eye’.

What causes it?

Conjunctivitis is most commonly caused by:

  • an infection (virus or bacteria) - this is called infective conjunctivitis and is catching (contagious)
  • an allergic reaction – this is called allergic conjunctivitis and is not catching (not contagious)

Other causes include:

  • blocked tear duct - referred to as a sticky eye
  • injury to the eye or something in the eye (foreign body)
  • chemicals splashed in the eye

How long could it last?

The symptoms can develop quickly over 24 to 72 hours and may last from two days to two to three weeks.

What are the signs and symptoms?

It can be difficult to tell whether an allergy, bacteria, or a virus is causing the conjunctivitis as redness and swelling of the conjunctiva occurs in them all.

Bacterial conjunctivitis may start in one eye but often moves to the second eye. The eyes are likely to be red and feel gritty (like having sand in the eye) and have a clear, green or yellow (pus-like) discharge.  This discharge can form a crust overnight and cause the eyelids to stick together.

Viral conjunctivitis is more likely to be in just one eye and often causes red and gritty eyes with a more watery discharge. The symptoms may appear in a mild form together with any flu-like illness.

Allergic conjunctivitis causes red, itchy and watery eyes, and often happens along with other signs and symptoms such as itchy nose and sneezing.

Blocked tear duct (in a newborn baby) stops tears draining properly (this is called epiphora), and can cause a teary or mucous discharge referred to as a sticky eye.

Trauma to the eye or something in the eye (foreign body) - causes irritation, redness and tearing. Small children may not be able to explain what has happened and eye injuries and foreign bodies may go unnoticed.

Chemicals splashed in the eye - causes severe pain and watery discharge.

How is it diagnosed?

Your lead maternity carer (LMC), well child nurse or family doctor will enquire about symptoms and look for signs on examination. Swabs to test for infection are hardly ever done in routine cases.

How can I help my child?

You can help relieve the symptoms of conjunctivitis by:

  • gentle cleaning of the eye with a cotton ball soaked in warm water.  Clean in one direction only, move the cotton ball from the inside to the outside of the eye, and throw away each ball as it is used
  • using a clean cold cloth (cold compress) over closed eyes can relieve irritation and swelling
  • washing your hands very carefully after contact with infected eyes

When should I seek help?

You must seek medical advice for any of the reasons listed in the section below - 'When should I see my doctor?'

Bacterial conjunctivitis may need antibiotic ointment or drops from your doctor, although it can get better without antibiotics.  Treatment should be applied to both eyes, even if only one eye appears to be infected.

If after checking the section 'When should I see my doctor?' you are confident that your child does not have a severe case of conjunctivitis, and there is no history of allergy to antibiotics, you can manage most bacterial conjunctivitis independently. You should talk to your pharmacist.  Medications (such as antibacterial eye drops or sulfa drugs) are available over the counter from your pharmacy.  Remember to follow the instructions provided by your pharmacist.

Viral conjunctivitis usually gets better on its own. Sometimes viral infections can be severe and you may need to see your doctor. Gentle cleaning may help them feel better. See the section above 'How can I help my child?'

Allergic conjunctivitis may be helped by using a clean cold cloth (cold compress) over closed eyes.  If the symptoms are severe and continual, treatments used for hay fever (such as antihistamimes) can provide relief.

Blocked tear duct usually disappears without treatment over the first year of life. In this condition, despite persistent discharge, the eye is not red or inflamed. 

Eye Injury (such as being hit or scratched) - you should take your child to see a doctor as soon as possible.

Chemicals splashed in the eye - this requires immediate first aid. Wash your child's eye with water for at least 10 minutes (this is called irrigation) and then take your child to your doctor straight away. 
 

When should I take my child to a doctor?

You should see your GP (general practitioner) if:

  • you are concerned about the severity of your child’s symptoms
  • your child of any age complains of / has:
  • severe eye pain
  • sensitivity to light (photophobia)
  • any blurred or reduced vision
  • any injury to the eye (such as being hit or scratched)
  • chemicals in the eye
  • is generally unwell and has a fever (temperature over 38 degrees Celsius)
  • increased swelling, redness, and tenderness in the eyelids and around the eye
  • your newborn baby has swelling, redness or a pus-like discharge from the eyes - conjunctivitis in newborns can be caused by an infection from bacteria in the birth canal, and this can cause serious damage to the eyes if it isn't treated urgently

How can this be prevented?

Good hygiene can help prevent the spread of conjunctivitis:

  • keep hands away from the eyes
  • do not rub the eyes
  • wash pillowcases frequently
  • wash hands often and use paper towels for drying
  • do not share eye drops, towels, pillow slips
  • proper use and care of contact lenses

What about staying away from school or preschool?

Children should not attend childcare centres or school when they:

  • have a fever or are unwell
  • have a lot of discharge from the eye
  • are too young to manage clearing the discharge from their eyes hygienically

Older children and young people do not need to stay away from school or work but still need to wash hands thoroughly if the eyes are touched.

Acknowledgements

Starship Foundation and the Paediatric Society of New Zealand acknowledge the work of the Communicable Diseases Team. Community and Public Health. Canterbury District Health Board. 2004. Conjunctivitis.

References

The Ministry of Health, YourHealth topics, ‘Conjunctivitis (eye infection or allergic irritation)’  http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/conjunctivitis-eye-infection-or-allergic-irritation [Accessed 20/09/2013]

The Royal Children's Hospital Melbourne website ‘Kid Health Info’: http://www.rch.org.au/kidsinfo/fact_sheets/Conjunctivitis/ [Accessed 20/09/2013]

 

This page last reviewed 20 September 2013
© Paediatric Society of New Zealand and Starship Foundation 2005 – 2014
Printed on 03 October 2014. Content is regularly updated so please refer to www.kidshealth.org.nz for the most up-to-date version
Content endorsed by the Paediatric Society of New Zealand