Think every pink eye is ‘pinkeye’? You’re wrong 75% of the time.
Welcome to Cold Case, a new, occasional series to help you navigate cold and flu season.
Faulty grammar just had a major moment.
Whether printed on mugs or T-shirts for in-office holiday gifts, or as memes messaged among friends to keep December stress at bay, sayings like “Let’s eat kids” versus “Let’s eat, kids” with a T. rex silhouette were — and are — good for a few welltimed laughs.
Albeit less funny, here’s another:pinkeye vs. pink eye.
“I hate the term. Any pink eye doesn’t mean infection. It doesn’t mean it’s ‘pinkeye.’ There are lots of types of conjunctivitis,” said Michael Petrosky, Allegheny Health Networkpediatrician.
With cold and flu season at full throttle, so is panic when white parts of eyes turn pink or red, with some oozing and irritation to boot. But there’s a trough of mixed messaging around how to respond to this ocular oddity, leaving pediatric practitioners in the difficult position of balancing competing expectations.
“Usually, the issues are school- or day care-related because they usually send kids home, and they either have to come see us or be treated,” he said.
Conflict may also arise, he said, because of parents and other family members remembering how “pinkeye” used to be treated — with antibiotic eye drops, each and every time.
But it’s now understood that conjunctivitis has a viral cause about 75% of the time, rendering antibiotics useless. And while previously
viewed as exclusively its own illness, conjunctivitis is now a known symptom of viral syndromes — such as adenoviruses, a cluster of at least 50 viruses that cause about 10% of all childhood fevers — making it nearly as ordinary as a runny nose.
“It’s a whole paradigm shift,” Petrosky said. “Before when you were sick, people just threw medicine at you. Now, there’s a lot more antibiotic stewardship. Do you really need to treat? How long do you really need to treat? What are you treating for?”
To answer those questions, practitioners like Petrosky first consider the four categories of conjunctivitis: viral, bacterial, allergic and irritant.
The last of those is often the simplest to diagnose, since kids and adults often react distinctively — or can explain the cause — when a foreign substance enters the eyes.
For the remaining three, diagnosis can be tricky, but often hinges on the appearance and frequency of drainage (crusting or goop) and the color of the typically white parts of the eyes.
“Often, you don’t get a lot of eye drainage with colds,” Petrosky said. “If someone has a cold, their eyes were a little crusty this morning, it’s mid-afternoon and they haven’t had any crusty stuff since then, I usually say we should hold off on treatment,” because that story signals a viral origin.
When drainage is produced by the eye or eyes throughout the day — and the eye is dark pink or red, versus a lighter hue of pink — Petrosky assumes a bacterial cause, and treats with antibiotic drops from the get-go.
When that drainage is clear — versus yellow or green — an allergic cause is often the culprit.
And sometimes, there’s another cause of eye gunk.
“Newborns and infants can get drainage throughout the day, but it’s usually because their tear ducts are clogged as opposed to true infection,” Petrosky said. “The big difference is the color of their eyes. If their eyes are still white, it’s usually not infected.”
In bacterial or viral cases, the next goal is to minimize spread.
According to healthychildren.org, a website powered by the American Academy of Pediatrics, good hand washing and sanitation of shared objects (tables, doorknobs, toys, towels, etc.) are vital to keeping other people — kids and adults — free from the virus or bacteria causing those pink eyes.
And while there are rare, serious complications from conjunctivitis, treatment for bacterial cases is more about reducing transmission, since most of the time the body would clear that infection on its own.
Knowing when to return to school or work without infecting others is another step in reducing the spread.
Some schools and day cares may have specific policies related to “pinkeye.” If not, rules of thumb prevail: It’s generally considered safe to be around others 24 hours after beginning antibiotics, for bacterial conjunctivitis or, when 24 hours fever-free, for viral conjunctivitis.
While treating pink eyes is fairly straightforward for medical experts, the social dynamics that accompany it often create the bigger headache, remedied with open minds and trusting relationships with medical providers.
“Sometimes, these are tougher cases because you have to spend a lot of time with families going over things. It’s especially tough because sometimes they can just go to any urgent care, or have a virtual urgent care visit, and they’ll prescribe drops just because it’s the easy thing to do,” Petrosky said. “It’s going to be a tough situation until there is more consistent messaging, but I try to be consistent.
“Not every eye that’s pink is ‘pinkeye.’ And not everything that’s pink needs drops.”