My random thoughts on pink eye. . . So this appears to be happening this week, kiddos coming in to the office with one pink eye and that is about it. No injury, no hairs stuck in there. Maybe a little itching, but nothing else. No massive eye boogers, no eyelashes stuck together with seemingly impenetrable petrified goo. Just a pink eye. And as a pediatrician this situation stinks because I know a couple of things about that pink eye. First, I know that very likely some virus that has decided the lining of your little ones eye is particularly hospitable is to blame and second that your child will not be allowed anywhere near school or daycare or church nurseries because of that one little ole pink eye. What is a poor, beleaguered pediatrician to do? So what you need to know is this, your eyeball is covered by an almost invisible membrane called the conjunctiva which extends from around the iris (colored ring of the eye) outward, covering the white part of the eye all the way around the back of the eyeball where it makes a hairpin turn and attaches to the lining of your eyesocket and ends at your eyelids. Your conjunctiva is what keeps your contact lenses from floating somewhere around your medulla oblongata. And like I said the conjunctiva is virtually invisible until it gets irritated. Then the microscopic blood vessels in this virtually invisible membrane swell and this invisible membrane becomes blood shot, or puffy and swollen or a pretty pink color. And there are lots and lots of things that will irritate a conjunctiva, fingers, eyelashes, chemicals, pollen, dust, viruses and bacteria and amoeba (oh my!) And if I had to change that list so that it read in order of most common irritants it would look like this: fingers, dust, eyelashes, viruses, pollen, chemicals, bacteria and amoeba. But rarely a day goes by that I dont get concerned calls that someones little one has a pink eye. AND somehow the term has become synonymous with the worst plague to befall mankind and truly, I just dont get it. How exactly did your bodys natural reaction to an irritant become so feared? If there are any medical anthropologists in the audience I would love to know, truly. I assure you that if there is something really bad going on with your conjuctiva it is not something subtle. It is horrifically painful and that innocuous virtually invisible membrane gets blood red and swells up to about one thousand times its usual size. You are not going to miss something truly bad that will result in horrific blindness. You just arent. A bacterial infection will cause the eye to produce liters of green goo and the eyelids to swell a lot and pain with any movement of the eyeball. It looks and is really nasty. So back to me and my 3 patients with one little old pink eye each. What did I do? I took a history and made sure it was not fingers or chemicals. Looked at the eyes and made sure both eyes werent effected and that there werent worms buried in there (ick) or a big laceration or hematoma in there and that the inside lining of the eyelids were irritated looking too and I put them on antibiotic eye drops. (Please note, that I said antibiotic eye drops, not steroid eye drops which in my opinion should pretty much only be prescribed by a trained and competent eye doctor) And the very astute among you are asking yourself Well, Dr. Becky, you are always preaching that you should not take antibiotics for a virus (not to mention fingers, eyelashes, pollen, dust, chemicals and amoeba) and the reason is this. I want your little one back in school or daycare or the church nursery as soon as possible because I know that you cant get done ANY of the things of varying degrees importance that you had to do before you little one developed that darn pink eye and I want to keep your child from being treated like the 4th horseman of the apocalypse when you do go back with that little old pink eye. So I put your little one on the safest, most comfortable, cheapest and least likely to cause problem antibiotic drop available and presto, in about 24 to 48 hours the eye is better (although in the case of a virus, the other one starts up) and everyone is happy, mostly. Because deep down, I know that it was not the drops that got that conjunctiva better, but your own little ones super competent and efficient and amazing immune system and not my antibiotic eye drops. Promise.
Posted on: Wed, 01 Oct 2014 02:24:18 +0000
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