Pinkeye (Conjunctivitis)—Child Care and Schools

What is pinkeye?

Pinkeye (conjunctivitis) is inflammation (ie, redness, swelling) of the thin tissue covering the white part of the eye and the inside of the eyelids. Pinkeye is similar to a “common cold” of the eye.

What are the signs or symptoms?

There are several kinds of conjunctivitis, including

• Infectious (bacterial or viral) conjunctivitis. Symptoms are similar in children with bacterial or viral conjunctivitis, and can include

  • – Red or pink, itchy, painful eye(s).

  • – Watering eye(s) sensitive to light.

  • – White, green, or yellow discharge.

  • – Infected eyes may be crusted shut in the morning.

  • – May affect 1 or both eyes.

• Allergic.

  • – Itching, redness, and excessive tearing, usually of both eyes.

• Chemical.

  • – Red, watery eyes, especially after swimming in chlorinated water.

  • – Can occur after use of eye drops.

• Caused by the immune system, such as diseases that affect the whole body, like Kawasaki disease.

  • – Red eyes, no discharge, usually affects both eyes.

  • – Can be painful with certain immune conditions.

What are the incubation and contagious periods?

Depending on the type of conjunctivitis, the incubation period varies.

• Bacterial

  • – The incubation period is unknown because the bacteria that cause it are commonly present in most individuals and do not usually cause infection.

  • – Transmission rates of bacterial conjunctivitis are low, and antibiotics are unlikely to reduce its spread.

• Viral

  • – May occur early in a viral respiratory tract disease with other signs or symptoms.

  • – One type of viral conjunctivitis, caused by adenovirus, may be contagious for weeks after the appearance of signs or symptoms. Children with adenovirus infection are often ill with fever, sore throat, and other respiratory tract symptoms. This virus may uncommonly cause outbreaks in early childhood education (ECE) and school settings. Antibiotics for this condition do not help the patient or reduce spread.

  • – The contagious period continues while the signs or symptoms are present.

• Allergic

  • – Occurs after contact with the agent causing the allergic reaction. The reaction may be immediate or delayed for many hours or days after the contact.

  • – No contagious period.

• Chemical

  • – Usually appears shortly after contact with the irritating substance, including after administration of eye drops.

  • – No contagious period.

• Immune mediated

  • – Occurs in response to a condition that stimulates the immune system of the body, often accompanied by other symptoms.

  • – No contagious period.

Pinkeye in a child

MARK PETER HUGHES

A blue-eyed child stares at us with a typical-appearing right eye with a completely white sclera; the left eye is slightly puffy with a pink, irritated sclera.

How is it spread?

Hands become contaminated by direct contact with discharge from an infected eye or by touching other surfaces that have been contaminated by respiratory tract secretions and then touching the child’s eyes.

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition , especially before and after touching the eyes, nose, and mouth.

• Consult a health professional for diagnosis and possible treatment. Recent studies have shown that antibiotics likely do not prevent the spread of bacterial or viral conjunctivitis and may shorten the course of pinkeye only minimally, if at all. Almost all children with pinkeye get better after 5 days with or without antibiotics. Antibiotics can have side effects and can be difficult for parents/guardians to administer.

• Clean or sanitize surfaces that are touched by hands frequently, such as toys, tables, and doorknobs, according to the Routine Schedule for Cleaning, Sanitizing, and Disinfecting in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

What are the roles of the educator and the family?

• Report the condition to the staff member designated by the ECE program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

• Notify child’s parent/guardian to consult with the child’s health professional about diagnosis and treatment by telephone or office visit. Documentation from the child’s health professional is not required.

• One form of viral conjunctivitis, caused by adenovirus, can cause epidemics. Seek advice from the local health department or the program’s Child Care Health Consultant about how to prevent further spread if 2 or more children in 1 room have red eyes with watery discharge.

• Review hand-hygiene techniques and sanitation routines.

• Complete course of medication, if prescribed (not required), for bacterial conjunctivitis.

Exclude from educational setting?

No, unless

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ).

• If 2 or more children in the group have watery red eyes without any known chemical irritant exposure, exclusion may be required, and health authorities should be notified to determine if the situation involves the uncommon epidemic conjunctivitis caused by a specific type of virus (adenovirus). Herpes simplex conjunctivitis (red eyes with blistering/vesicles on eyelid) occurs rarely and would also require exclusion if there is eye watering.

• There is a recommendation from the local health department or the child’s health professional.

Readmit to educational setting?

Yes, when all the following criteria are met:

• When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.

• Antibiotics are not required to return to an ECE program or school; if prescribed, there is no required duration of antibiotics before returning to an ECE program or school. Most children recover within 5 to 6 days without antibiotics, and antibiotic treatment has not been shown to considerably shorten the illness for children.

• Documentation from the child’s health professional is not required.