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Pharmamum’s Ultimate Guide: Conjunctivitis
Have you ever tried putting eye drops into a toddler’s eyes? From personal experience, It is by no means an easy task. Just trying to hold your child down, whilst you steady your hand to place an eye drop in their eye is an almighty challenge, let alone the actual eye drop ending up in the affected eye. In this post I aim to explain the difference between the main types of conjunctivitis babies and children may present with, as well as share some insights to treating conjunctivitis and offer some useful tips with administering eye drops and eye ointments.
What does it mean when your baby/child has been diagnosed with conjunctivitis? Any medical term that ends with ‘itis’, means that part of the body is inflamed ie conjunctivitis is when the conjunctiva in the eye is inflamed. The conjunctiva is like a film that covers the whites of the eyes and lines the inner eyelid. The conjunctiva helps to lubricate the eye by producing mucus and tears and helps to prevent bugs entering the eye. Conjunctivitis is usually caused by an infection or allergy which causes the eye to look red and irritated.
The three main types of conjunctivitis in babies and children are:
You can differentiate between the three types by the symptoms your child presents, however the symptoms do cross over and at times can be difficult to work out if the conjunctivitis is bacterial, viral or allergic. Bacterial and viral conjunctivitis is highly contagious and will be contagious until the discharge from the eye has ceased. Allergic conjunctivitis is not contagious. Sometimes your child may present with some discharge in the corner of the eye when they have head congestion. This can be confused be with bacterial conjunctivitis but it is just another way mucus can be excreted.
Bacterial conjunctivitis– Presents in one eye and often spreads to the other eye. The eye may appear red and feel gritty producing a yellow/green thick discharge that can cloud vision upon waking and can form a crust on the eyelid. Over night if enough discharge builds up, the eyelids can stick together.
Viral conjunctivitis– Also causes a red and inflamed eye but the discharge is usually clearer and more watery.Viral conjunctivitis usually goes hand in hand with a respiratory infection. The eye may be itchy and sometimes confused with allergic conjunctivitis.
Allergic conjunctivitis– presents with an itchy, burning and inflamed eye and a more watery discharge. Children with allergic conjunctivitis usually also have hayfever symptoms ie itchy runny nose, itchy scratchy throat.
Usually bacterial conjunctivitis does not need treatment and it will resolve on its own within 5 days, however symptoms can last longer. No harm will occur if bacterial conjunctivitis is left untreated, however treating with an anti-bacterial eye drop/ointment will speed up the recovery. As a mother, I know how difficult it is to avoid treating when you are constantly wiping away the discharge from the eye and looking at your child with red and irritated eyes. 5 days can seem like a long time to wait especially when your child is not allowed to go back to daycare/school until the discharge has ceased.
First line treatment is Chloramphenicol eye drops/eye ointment. Brands include Chlorsig or chloromycetin eye drops/eye ointment.
Directions of use:
Eyedrops: from birth- 18 years- 1 eye drop every 2 hours for the first day, then gradually decrease to every 6 hours as improvement occurs.
Eye ointment: Birth (at term) – 18 years- use eye ointment at night if drops are used during the day, or as a single agent 3 or 4 times daily. It is recommended to use the eye drops/ointment for two days after the symptoms have improved but If treating you should try limit the use of chloramphenicol drops/ointment to 3-5 days.
Chloramphenicol is safe to use in children from birth, however if you do go into a pharmacy, a pharmacist may be apprehensive to dispense it for a child who is under 2 and that is because in infants, the eyes are still developing and it is difficult to exclude serious causes of a red eye that could potentially cause serious or long term damage to the eye without a proper examination by a doctor or optometrist.
If you are currently pregnant, a topical course of chloramphenicol (chlorsig) is category A, meaning it is safe to use in pregnancy and a single course of chloramphenicol is safe to use whilst breast feeding.
Upon waking and several times during the day when the eyes may stick together, you will need to clean the eye. The best way to clean your baby/child’s eyes is with warm (not hot) water and a cotton pad/ball. If you are having to clean their eyes a few times a day, it is not recommended to clean their eyes with saline as constantly wiping away the same area with saline can be quite irritating to the skin. Use a separate cotton pad for each eye dipped in warm water and wipe away the discharge sweeping in one direction. If you can not remove the discharge after the first attempt, keep the warm cotton ball soaked in water on the eye for a few seconds to loosen the dried discharge and keep wiping away the discharge gently.
Unfortunately there is no treatment for viral conjunctivitis and it will clear on its own. You can treat the symptoms and if your child allows you, use a cold compress several times a day or artificial tears (ie Tears Natural, Poly-tears, Re-fresh eye drops) to soothe the eyes. If your child is very young (ie <6 years old), just keeping the eye clean and wiping away the discharge is about all you can do.
In babies and children, an antihistamine can relieve the itchy eyes and discomfort. Telfast liquid can be used from 6 months and Claratyne (Loratadine), Aerius(Desloratadine) and Zyrtec(Cetirazine) liquids can all be used from 1 year of age. Claratyne also make a chewable tablet from 2 years of age. Oral antihistamines should control the allergy symptoms and avoid the need for eye drops.
Applying eye drops:
Have your baby/child lying down, open their eye with your index finger and thumb and ask your child to look up and to the side and put the eye drop in with the other hand. If it’s easier get your child to close their eyes and drop 1 drop in the inner corner of their eye. The drop will run into your child’s eye once they open their eyes. Wipe away any excess from your baby’s eye with a clean tissue/ cotton pad.
Applying an eye ointment:
Have your baby/child lying down and ask your child to look up and to the side. To stabilise your hand, place your wrist that you will be applying the ointment, resting gently on your child’s forehead and just like you apply eyeliner to your lower eye lid, pull down gently the lower eye lid and apply 1 cm of ointment along the lid. Rotate the tube slightly to detach the ointment from the tube. Ask your child to blink to disperse the ointment. If this is too difficult ask your child to close their eyes and apply a small amount in the corner of the eye and with your child blinking the medication will disperse into the eye.
- Ensure you are not applying cold drops in your baby/childs eyes. Keep the bottle in the palm of your hands for a couple of minutes to warm them up. Applying eye drops straight from the fridge may give your child a fright or feel like a sting in the eye compared to room temperature eye drops.
- Some eye drops can give an after taste because eye drops, just like tears drain into the back of the nose and then down to the back of the throat. In particular Chlorsig/ chloromycetin (chloramphenicol) eye drops for bacterial conjunctivitis can leave a bitter taste not long after you apply the eye drops. A good idea is to give your child something to eat or drink straight after applying the eye drops or a breast or bottle feed straight after to avoid the bad aftertaste.
- If your baby is very active and at an age where reasoning with them just does not work, you may need to kneel on top of them holding them in position with your knees either side of them. What worked well with my children, was playing a little game of peek-a-boo to get your toddler to close their eyes whilst sneakily dropping an eye drop in or moving the eye drops from side to side and getting them to follow the bottle with their eyes before administering them as hovering over your child may cause them to become anxious.
- All eye drops once dispensed and opened need to be discarded after one month.
- Your child/baby will be contagious and needs to excluded from child care until there is no longer any discharge being produced.
- Ensure good hygiene practice to avoid the spreading of bacterial and viral conjunctivitis ie washing hands regularly, avoid sharing face towels and dispose of tissues appropriately.
Blocked tear ducts
Approximately 5% of newborns are born with blocked tear ducts which can increase the risk of your baby contracting conjunctivitis, however if you see a build up of mucus in your child’s eye, it doesn’t necessarily mean your baby has an infection, it is more likely that the tear duct is blocked and mucus from the tear film accumulates instead of clearing naturally. Often a blocked tear duct will resolve on its own by approximately 6 months of age. Gentle massage from the corner of the eye down towards the nose can help the duct open up. If that does not work, your paediatrician may organise a gentle procedure under anaesthesia that will resolve the blocked tear duct. The best way to manage a blocked tear duct is keeping the eye clean and wiping away the discharge regularly. For purulent discharge antibiotics are not indicated unless signs of conjunctival inflammation is present and a doctor would need to diagnose this. My youngest daughter had a blocked tear duct for the first 3-4 months of her life and because the tear duct was blocked she would constantly have a watery eye and when she awoke she would have crusty eyes that needed to be cleaned. The best way to clean your babies eyes is with warm (not hot) water and a cotton pad/ball. If you are having to clean their eyes a few times a day, it is not recommended to clean their eyes with saline as constantly wiping away the same area with saline can be irritating to the skin. Use a separate cotton pad for each eye dipped in cooled boiled water and wipe away the discharge sweeping in one direction.
When to see a doctor-
i)If the baby/child is sensitive to light, ie they can barely open their eyes when light is present
ii) If there is swelling around the eye
iii) If there is any pain in the eye
iii)loss of vision
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.