Seeing Through Pink Eye

by Marissa Camilon, MD 2011 | camilon@myhousecallmd.com

While it may be better to see life through rose-colored glasses, acquiring pink eye is not the recommended approach. Anyone who has suffered through this highly contagious and (usually) brief condition can testify to the suffering it causes. You’re itchy, you’re watery and you’re incontestably uncomfortable. Your eyes are your window to the world and, as such, you can’t give them a rest for several days at a time while they heal.  In a nutshell, pink eye sucks.  Luckily, it’s pretty easy to treat and usually lasts for a short amount of time.  What you may not know, however, is that the conventional ways to treat it, the ones passed down from your grandma’s aunt’s nanny, may not be what is the best treatment for your eyes.

What it Pink Eye?

“Pink eye” is more commonly known in the medical world as conjunctivitis, or inflammation of your conjunctiva (the moist layer of tissue that covers most of your eye and the inside of your eyelids). There are many causes for inflammation in this area that are broken down into two major categories: infectious and non-infectious causes. Under the infectious category we have conjunctivitis caused by viruses or bacteria.  Under the non-infectious category we have allergic and non-allergic causes (an example of a non-allergic cause is spilling chemicals in your eyes). While studies show mixed results, most physicians in the trenches will tell you that the most common cause of conjunctivitis is viral.  This makes sense since viral conjunctivitis is extremely infectious (it spreads like fires in the Hollywood Hills in the late summer), spread through any type of bodily secretions, especially secretions from the eye.  That’s where those darn bugs have it figured all out, right?  They make our eyes insanely itchy causing us to rub them all day typically right before we touch phones, doorknobs, and other people’s hands.  That’s also the reason that most of viral outbreaks occur in schools or daycare centers (i.e. places where objects can easily go from eye to hand to mouth to who knows where else).

How do you know if it’s serious?

Historically, you decide to visit the doctor (or more commonly you take your child to the doctor) when you notice the tell-tale pink eyes, complete with extra discharge and dried mucus crusting your eye lid closed in the morning (that seems to be the standard diagnostic criteria in town).  Before you completely write it off as “just another episode of pink eye,” there are a couple of things you should keep in mind. First, there can be more serious causes of pink eye than a simple virus so let your doctor know if you:

  • wear contacts

  • have concurrent headaches and nausea

  • have suddenly blurry vision

  • have a very, very strong feeling that there is something inside your eye

Any of these signs can indicate that something more serious is going on and is worthy of sharing with your doctor during your appointment.

How to Treat Pink Eye

Now we return to your doctor’s appointment.  While we all want the “magic bullet” to cure our medical ails, pink eye is another case where this just doesn’t work.  Since most cases of pink eye are viral in origin, antibiotics (i.e. medications that kill bacteria) won’t do anything for it (this little tidbit of information may not be what you have heard in the past).  Previously, antibiotics were generally given to those with pink eye, even when they were suspected to be viral, to prevent any bacterial infection that could occur on top of the viral infection.  Even as late as 1994, treatment guidelines stated that antibiotic treatment was always necessary for that exact reason (the prevention of a bacterial “super-infection”…not as cool as it sounds).  Since then, new research has shown that these bacterial super-infections rarely occur and that antibiotic treatment may actually be harmful. Giving someone antibiotics without any infectious bacteria means exposing normal, “naïve” bacteria to antibiotics that they can build resistance to.  The result is the evolution of stronger, antibiotic resistant bacteria that are harder to treat in the future. In the words of Homer Simpson, “Doh!”

This strategic change in our approach to treating pink eye is still slowly making its way through American society.  One major issue is the long-standing rule at schools and nurseries stating that children should be treated with antibiotics before returning to school.  Their goal is to decrease the number of children who can potentially become infected. Remember that we are most likely dealing with a viral infection that will not be killed by antibiotics.  The only real way to control the spread of viral conjunctivitis is to not share napkins, utensils or cups and, like we’ve heard so many times, by washing your hands!  The second major battle takes place with people who have heard or seen the previous use of antibiotics during cases of “pink eye.”  These people will go to the doctor expecting to be handed antibiotic eye drops and put pressure on their doctor to prescribe them as they did in the past.  Luckily, these two issues can be rectified with education about the self-limiting, viral nature of this disease.

For those sitting in the waiting room, here’s some good news: in the majority of cases, this is a self-limited condition that can be treated symptomatically. That means using over the counter antihistamines, decongestants or lubricating agents to relieve the dryness and discomfort in your eyes.  So while you may not get the “cure” to pink eye at the doctor’s office, you can definitely get some help with the real troublesome stuff so that you can live your life while your body’s immune system does exactly what it was designed to do.

Questions? E-mail the Author: camilon@myhousecallmd.com

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References:

  1. Azar MJ, Dhaliwal DK, Bower KS, Kowalksi RP, Gordon YJ. “Possible consequences of shaking hands with your patients with epidemic keratoconjunctivitis.” Am J Ophthalmol 1996, June; 121 (6): 711-2.

  2. Bennett C, David S. “Treatment of viral conjunctivitis in children/in reply.” American Academy of Family Physicians 2003; 67 (9): 1873-5.

  3. O’Brien T, Jeng B, McDonald M, Raizman M. “Acute conjunctivitis: truth and misconceptions.” Current Medical Research and Opinion 2009; 25 (8): 1953-61.

  4. Rose P, Harnden A, Brueggemann A, Perera R, Sheikh A, Crook D, Mant D. “Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomized double-blind placebo-controlled trial.” Lancet 2005; 366: 37-43.

  5. Weiss A. “Acute Conjunctivitis in Childhood.” Current Problems in Pediatrics 1994; 4-11.

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