Conjunctivitis can be triggered by allergies, infections

"I think he has an eye infection," the mother said, offering her diagnosis on the bright spring day. Her 10-year-old sat quietly, squinting at us uncomfortably from his perch on the exam table.

Yes, the whites of his eyes were pink, but on closer inspection, the pink was limited to the part of the whites that were exposed to the outside environment. When the boy widened his eyes, the normally protected surfaces were completely white.

Given the time of year, the lack of thick discharge and the distinctive pattern of inflammation, I concluded that the boy was reacting to something in his environment and was not contagious.

Fast forward to late fall. A toddler was looking at me soulfully, cute despite his snotty nose, red eyes and goopy lashes. His mother wondered if her son had simply scratched his eyes during the night. I explained that it was not likely that the little boy had been unlucky enough to scratch the corneas of both eyes simultaneously.

In addition, corneal abrasions lead to acute redness, light sensitivity and clear, watery eye discharge. My patient came in with a history of more than two weeks of nasal congestion, and within the last 24 hours had developed thick puslike discharge from both eyes. His eye problem appeared to be an infectious one, most likely caused by the same bug that was causing his sinus disease.

Both boys had conjunctivitis, the first allergic or environmental and the other infectious or contagious. Both conditions are common and treatable. Allergic conjunctivitis is largely seasonal (spring and fall), but can develop at any time, depending on the allergen involved. Infectious conjunctivitis can be seen year-round, but pops up more frequently during the winter cold and sinus season.

Conjunctivitis occurs when the conjunctiva or lining of the eye and inner eyelid becomes inflamed. Infectious conjunctivitis is an unpleasant condition, but medically speaking, not usually a big deal.

From a parental point of view, it is a big deal because the condition is easily spread from person to person, especially among infants and younger kids who can't or won't wash their hands. Siblings and classmates are likely targets, and day care center and school rules prohibit the infected child's return to class until he has been on medication for 24 hours.

The "pink eye call" is often the first page a pediatrician receives on Sunday morning as anxious parents seek a quick treatment that will allow their little one to attend school as scheduled the following day. The day care/school issue is also the reason some kids are given antibiotic eye drops for infectious pink eye, although a good number of these cases are caused by viruses and as with the common cold, will not respond to antibiotics.

In the case of infectious pink eye, experts advise keeping hands away from the eyes; setting aside a towel for use only by the affected child; frequent hand washing by the child and parents, too, if they are applying the eye drops; avoiding contact lenses and makeup use until the eye condition improves, and discarding any disposable contact lenses that were worn during the peak of the illness.

Allergic conjunctivitis is usually more uncomfortable than its infectious counterpart as affected eyes become extremely itchy and watery after exposure to the inciting allergen. Redness can be restricted to the exposed conjunctiva but, more commonly, affects the entire conjunctival lining.

As with all allergic conditions, avoidance of the allergen is advised. Since this is often impossible, over-the-counter or prescription allergy eye drops are usually recommended to help alleviate symptoms. When gently applied to the eyes, cool compresses can also provide some temporary relief for kids suffering from allergic conjunctivitis.

If your child's eye condition does not respond to treatment, notify a physician. Certain conditions may require a change of medication, use of steroids, or consultation with an ophthalmologist. If the child appears ill, or if the conjunctivitis is accompanied by marked redness, swelling of the surrounding eyelids, or a significant fever, the doctor should also be informed, as these may be signs of more serious infections such as periorbital or orbital cellulitis.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.