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Is My Child's Pink Eye Contagious? · Pediatrics in Practice: A CME Podcast

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  Dr. Sarah Gubara (Host):
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  Welcome to Pediatrics in Practice, a CME podcast.
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  I'm Dr.
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  Sarah Gubara.
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  And today, i'm joined by Jennifer Qayum, pediatric optometrist practicing
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  at Children's Mercy in Kansas City.
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  Today, we're discussing pink eye.
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  Dr.
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  Qayum, thank you so much for taking the time to join us this morning.
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  Dr. Jennifer Qayum:
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  Well, thank you for having me.
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  Host: So when we're talking about pink eye, what are the most common
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  causes of pink eye in children?
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  Dr. Jennifer Qayum:
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  When we're talking about pink eye or conjunctivitis, the most common causes
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  are virus, bacteria, or allergies.
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  With virus, we're thinking typically an adenovirus or molluscum or
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  maybe a herpetic infection.
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  Bacteria in kids is typically a strep or a staph infection, and then allergies
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  typically come with the season changes.
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  Host: That makes a lot of sense.
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  How can pediatricians distinguish between these different types, the viral,
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  bacterial, and allergic conjunctivitis?
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  Dr. Jennifer Qayum:
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  The first thing I like to do with a patient who has conjunctivitis is
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  discuss with their caregivers the presentation of the conjunctivitis.
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  Did it start in one eye and then move to the other?
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  If this is the case where it starts unilaterally and then moves to the other
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  eye, it is likely bacterial or viral.
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  In contrast, allergic conjunctivitis is typically presenting bilaterally.
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  Another question I like to ask families is, did the patient have any other
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  systemic symptoms, such as an upper respiratory infection or an ear infection?
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  If that's the case, I would be leaning more towards a diagnosis
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  of a viral or bacterial infection.
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  But if the patient's been sneezing a lot and has an itchy throat,
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  I'm thinking more about allergies.
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  Other things I ask the family, you know, did the patient have contact
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  with anyone who has conjunctivitis?
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  Because again, then I'm thinking more of a contagion, which
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  would be a bacteria or virus.
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  Or did the red eyes occur with the season change?
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  Again, that would be allergic.
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  Are there any associated rashes around the eye?
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  Then, I'm thinking of maybe a herpetic infection or a molluscum or impetigo.
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  Are there styes?
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  If there are styes associated with the red eye, often I'm thinking of a condition
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  called blepharokeratoconjunctivitis, or we shorten that to BKC.
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  And that's an inflammation of the oil glands of the eyelids
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  that causes a recurrent red eye.
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  So once I've talked to the family more about the presentation of
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  the conjunctivitis and how the patient is feeling, then I'm going
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  to try to examine the patient.
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  And the presenting signs of conjunctivitis can differ slightly based on the cause.
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  If the pediatrician is able to look at the inside of the eyelid, this is called
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  the palpebral conjunctiva, then the types of bumps that you see on the inside
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  of the eyelid are slightly different.
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  Now, for me as an eye care provider, I have extra tools in my exam room
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  that makes it easier to see these.
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  So, it can be tricky as a pediatrician to view these.
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  But for a bacterial and allergic conjunctivitis, the bumps on the
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  inside of the eyelid on that palpebral conch are typically more red overall
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  because the vasculature of those bumps goes over the whole bump.
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  These are called papillae.
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  In contrast, a viral conjunctivitis typically presents with follicles,
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  and these look like little blisters on the inside of the eyelid.
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  Because for follicles, the vasculature goes around the
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  bump instead of over the bump.
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  Now, realistically, like I said, I have extra tools in my exam
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  room to help me visualize these.
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  And also, pediatric patients don't love having their eyelids pulled on.
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  So then, I'm observing for any discharge associated with the conjunctivitis.
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  A bacterial conjunctivitis typically presents with a yellow or green mucus
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  discharge, while the viral conjunctivitis and the allergic conjunctivitis are
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  both usually more watery or teary.
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  So, those are the main things that I'm looking at trying to help me determine
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  what the cause of this conjunctivitis is.
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  It's kind of a funny branching graph in my head of unilateral versus bilateral,
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  what type of discharge, when did it start?
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  But those types of things can help us distinguish between
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  the types of conjunctivitis.
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  Host: Thank you for walking us through the different parts and
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  how to distinguish between them.
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  When are antibiotic eye drops actually needed?
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  Does it depend on the type of conjunctivitis?
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  Dr. Jennifer Qayum:
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  Yes.
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  Really, we want to reserve antibiotic eye drops for when there
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  is a bacterial conjunctivitis.
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  So, that would be the patient who they have a pink eye that started in one eye
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  and maybe it moved to the other eye.
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  It typically has that yellow or green mucus discharge.
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  Antibiotics really are not needed for viral or allergic conjunctivitis.
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  And in fact, using antibiotics unnecessarily can really lead to
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  antibiotic resistance in the future
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  Host: What guidance, Dr.
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  Qayum, should we give families about returning to school or daycare?
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  Because it's that season.
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  Dr. Jennifer Qayum:
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  It is.
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  And this is tough.
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  You know, the easy one, if it's allergic, there are no restrictions
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  on returning to school or daycare.
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  You just need to start some allergy eye drops, maybe some cool
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  compresses, and you're good to go.
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  If it's bacterial, again, that one's not too tough because the
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  patient is not contagious after being on an antibiotic for 24 hours.
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  So, they can easily go back to school after starting the antibiotic.
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  Where things get really tricky is viral conjunctivitis, because these
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  children can be contagious for seven to 14 days, if not longer, depending
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  on the type of conjunctivitis.
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  But really, let's talk about how it's contagious.
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  Because, you know, there are ways to prevent spreading
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  this viral conjunctivitis.
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  For the conjunctivitis to spread, the patient has to rub their eye, get the
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  virus on their hand, then touch something like a pencil, then their friend uses that
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  same pencil and touches their own eye.
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  So, for older patients, I counsel them on how this conjunctivitis is
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  spread, and I advise them on how to have proper hand hygiene, wash hands
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  frequently, don't touch their eyes.
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  And within the household, I really recommend that families change all the
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  sheets on the beds, wash all the towels, make sure that siblings aren't sharing any
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  of those things or stuffies or clothes.
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  But, you know, for younger patients, it gets really tricky.
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  So, I'm thinking of, like, the toddlers, the infants because often these
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  viral conjunctivitis, they're just getting passed around the classroom.
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  And realistically, most parents can't be out of work for two weeks while
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  their child gets rid of the contagion.
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  So, I give them as much education as I can and advise them to use
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  their best judgment possible.
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  Host: I love that.
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  Education is so important.
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  What red flags warrant a referral to an eye specialist when it
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  kind of goes above and beyond?
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  Dr. Jennifer Qayum:
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  The times when I become concerned with a pink eye is if the cornea,
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  that clear front part of the eye, becomes cloudy either in one
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  section or over the entire part.
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  That warrants an immediate referral, because we're thinking at that
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  point maybe there's a corneal ulcer or maybe there's a uveitis.
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  Maybe this is more than just conjunctivitis.
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  Also, if the patient is describing decreased vision, that would be concerning
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  because a typical conjunctivitis or pink eye should not cause decreased vision.
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  And another note is if the treatment you have initiated does not seem to be working
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  or if the pink eye is recurrent, that is again concerning and I think would warrant
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  a referral to an eye care provider.
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  Because again, we just have more tools in our exam rooms to help us look
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  more closely at the eye to maybe help identify what's going on with the eye.
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  Host: Thank you so much for sharing all of this wonderful information with us.
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  We are thrilled to have you.
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  Dr. Jennifer Qayum:
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  Thank you very much.
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  Host: And as a reminder to our audience, claim your CME credits after listening
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  to this fascinating episode today.
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  You could do so by visiting cmkc.link/cmepodcast
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  and then click the Claim CME button.
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  If you enjoyed this podcast, please share it on your social channels
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  and check out the entire podcast library for topics of interest to you.
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  I'm Dr.
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  Sarah Gubara.
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  And this has been Pediatrics in Practice, a CME podcast.