ASK THE DOCTOR: Conjunctivitis clears up spontaneously
By DR. JIM MITTERANDO
The Patriot Ledger

Q. I am frustrated. My day care tells me my child cannot attend when she has conjunctivitis until she is treated with antibiotic drops but our doctor says that she does not need antibiotics for conjunctivitis. What should I do?

A. Your doctor is right! Conjunctivitis most of the time clears spontaneously and rarely requires treatment with antibiotic eye drops or ointment.

Conjunctivitis, also called pink eye, causes red, irritated eyes often with drainage from the eyes and crusting of the eyelids. The inflammation of conjunctivitis makes it an irritating condition, but it's usually harmless to vision.

Viruses, bacteria or allergies are the most common causes of conjunctivitis.

The majority of conjunctivitis is due to viral infections such as the common cold. Just as you get a runny nose with a cold, runny eyes often occur, as well. Conjunctivitis associated with a cold illness is no more contagious than the cold itself.

Your day care center is well intentioned but misinformed. But it's not the only one. We often receive phone calls from parents frantically requesting antibiotic eye drops for their child's conjunctivitis so their child can return to daycare. We need to inform day care centers that this policy is medically incorrect.

The most contagious form of conjunctivitis called epidemic keratoconjunctivitis is a type of viral infection that rapidly spreads through a school or family in just a few days. This viral conjunctivitis is not associated with other cold symptoms and gives conjunctivitis its bad reputation. Antibiotics do not help because it is a viral infection; antibiotics only kill bacterial infections.

If young children have conjunctivitis without cold or allergy symptoms, that's the only time they should be kept out of day care or school until the symptoms resolve since this may be contagious. If a child has conjunctivitis with cold symptoms they can attend daycare or school.

In fact The Centers for Disease Control do not recommend excluding children with cold symptoms from school since cold viruses are likely to have spread even before symptoms appeared.

Conjunctivitis typically will clear in three to seven days. If it does not improve by five days, follow up with your health care provider for evaluation and possible treatment. Cleaning the eyes with wet wash cloths frequently will help it to clear sooner and help relieve symptoms.
It is important to wash hands frequently to avoid spreading to others as well as using separate towels.

Eye irritation, burning and itching are common but if you have eye pain, blurry vision or light bothers your eyes then you should follow up with your physician.

In my practice, I find that only a minority of cases of conjunctivitis do not resolve spontaneously and require treatment with antibiotic eye drops or ointment.

In the past, bacterial conjunctivitis was always treated with antibiotics as were bronchitis and sore throats. Times have changed and antibiotics are not used as much. Recent studies reveal that bacterial conjunctivitis resolves without antibiotic treatment most of the time.

Furthermore, antibiotic eyedrops can create problems such as allergic reactions or irritation.
Instead of a prescription for conjunctivitis, I often write a note to the daycare stating it is OK for the child with conjunctivitis associated with a cold illness to return to daycare.

People who wear contact lenses should remove them if they have conjunctivitis. If you have disposable lenses then discard them. If you have permanent lenses, then sterilize them and wait for the conjunctivitis to clear for several days before using again.

Allergic conjunctivitis typically occurs during times of high pollen counts associated with sneezing and itchy eyes. Do not rub your eyes; this will release more histamine and cause more itching and redness. Avoid over the counter treatments such as Murine or Visine eyedrops which simply take the redness away with out treating the symptoms or problem.

alk to your health care provider regarding treatment of allergic conjunctivitis with antihistamine eye drops or allergy preventing drops such as Cromolyn or Patanol.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2002 The Patriot Ledger
Transmitted February 26, 2002