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How Serious Is Pink Eye?

Most of us with kids have battled with pink eye. But when is it safe to send the kids back to school, with any illness for that matter? Listen to House Call Doctor's personal preschool experience.

By
Sanaz Majd, MD,
June 1, 2017
Episode #240

Many of you may be aware that I have rambunctious 5-year-old twins who keep me on my toes. I had an interesting experience at their preschool last week that struck a cord with me. And sometimes the topics I cover in these moments tend to become my most popular (see also: Why is My Doctor Always Late) so I knew it must strike a cord with you as well.

I also must preface that I absolutely love my girls’ preschool. The teachers are the most loving and nurturing that I’ve seen, providing unparalleled care. So my experience here is not unique to one preschool, but that it’s actually quite prevalent across all preschools and daycares everywhere. It's an American cultural reflection.

What could be so controversial to have fired me up so? That dreaded, most feared, shriek-producing disease called…pink eye. Yep, those of you with kids know what I’m talking about. For some reason, this condition sends shivers up and down the spines of all preschool facilitators, akin to the thought of measles or the plague.

Yet it shouldn’t be. Not even close. This is one of those medical myths that have taken on a mind of its own. Let's dispel them.

Pink Eye Madness

So one of my girls had been stricken with a bout of pink eye for about 7 days, and despite understanding the benign nature of it, I still kept her away from school during this time in order to save the unnecessary parental/teacher fears and raised eyebrows. Her pink eye was nearly resolved when she returned to school on this particular day, albeit still visible. But I knew.

When I came to pick my girls up at the end of the school day, however, I was greeted with the 3rd degree. How can I send my kid to school with such a contagious disease? Unfortunately, I was accosted in the open where another parent was in ear shot. I could have said that she has allergies. Or that she ran a lap in the pool before school. But I am a physician and an educator.

“It’s Pink Eye. Yep. But it's unlikely to be contagious now,” I pleaded for my case akin to a trial for murder.

The nearby parent whom I did not know innocently asks, “Well, why don’t you get antibiotic drops? Then they can come back to school the next day.” My anti-antibiotic views took a strong hold of me as I did all that I could to keep my mouth shut.

“Pink eye is viral,” I simply responded. The look I received in return clearly shouted ‘so what?’

“Antibiotics won’t do a thing for viruses,” I went on, as I was still met with two confused sets of eyes glaring back at me. I think it was the first time either one of them had heard this. How can that be?

‘That quack of a doctor,’ they must be thinking as they watched me walk away.

At this point I had realized that I was fighting a non-winning battle that is more powerful than I can take on then and there – the power of medical myth. Taking care of kids in my office, I am quite aware of the general public’s lack of awareness on this topic. I am often met with great surprise and minimum 20 minutes of a detailed explanation to win my case every time I send my pediatric patients home without any prescriptions to treat this illness.

But I still found myself walking away from the school with my kids in tow and a horrible gut feeling, as if I knowingly spread the plague or something. I must be a horrible parent. Why in the world did I feel so guilty? I know better. The truth is, I knew my child was unlikely to be contagious. And I know some of you may gasp at this -- but even if she was contagious…so what?! It’s just pink eye.

Yes, please everyone repeat after me – IT’S JUST PINK EYE.

But it’s not their fault. It’s ours…it’s the medical community’s responsbility. Why aren’t we finally setting the record straight on these viral illnesses? One of my personal pet peeves as a physician is seeing antibiotics prescribed for viruses, whether it’s drops for pink eye or a z-pack for a cold. And I’ve delved deeper into the reasons why in a prior episode. But patients and schools expect it and ask for it. I must be a horrible doctor when I don’t go along with the norm, right? 

Let’s also consider the consequences of this -- do we really need more unnecessary missed school days and work days for benign and self-resolving illnesses like this? Kids this age group must and will get sick…and frequently. This is how they build their immune system. It's a rite of passage.

And do we really need to expend health dollars and unnecessary time at the doctor’s office in order to simply obtain a note to return to school? Dr. Claire McCarthy, a pediatrician who blogs on the Huffington Post has shared the same sentiments.

As a side note, Chloe's pink eye had completely resolved the very next morning.

What is Pink Eye

“Conjunctivitis” is the medical term that describes the tiny blood vessels in the white part of the eye that become more pronounced and visible, and render the eyes pink (or red actually).  Allergies, chemical exposure (think chlorine in pools), and very rarely bacteria can cause conjunctivitis. But the contagious pink eye that we are all familiar with that is rampant amongst kids is actually viral and by far the most common cause of pink eye, so we refer to this as “viral conjunctivitis.”

So why does pink eye create such havoc?

The visible color change is perhaps part of the reason for the hoopla – meaning that there’s tangible evidence of an illness; whereas other cold and flu viruses create non-visible symptoms, such as stuffy nose, sore throat, cough, etc.

The other possible reason for the craze is the fact that it’s contagious. But yawning is also contagious. And does that mean that everything contagious is serious or harmful? Pink eye will not kill you (unlike the flu virus).

Pink eye also doesn’t cause eye pain or vision loss – two red flags of other more serious eye illnesses. Most people feel just fine and can go about their daily activities without any issues. The most annoying potential symptom is awakening with goopy eyes, sometimes to the point of having to pry the eye open. A quick face/eye wash with plain water takes care of the problem, however.

The other potential annoyance is that depending on the type of virus causing it, it can sometimes cause other viral symptoms such as cough, runny/stuffy nose, etc. which are all self-resolving and benign just like the pink eyes.

To put it into perspective, in order of seriousness of common preschool viruses, from the most serious to the least, it goes like this:

Influenza (the Flu) --> Gasteroenteritis (stomach virus) --> the Common Cold --> Pink Eye.

Physicians are all aware that prescribing "antibiotic eye drops" is really to appease the parents or the school that incorrectly "requires" it before kids return to school -- and is a horrible practice habit and culture that needs to change. It’s much easier to prescribe it than to have to explain all of what I am explaining here in this article in a 15 minute visit. But we really must. We don't need to throw antibiotics at every little thing. Pink eye is a virus...not a bacteria. Antibiotics only fight bacteria, not viruses.

It’s also time that preschools and daycare facilities stop the requirement of antibiotic drops prior to the return to school.  I’ll tell you this – it will not diminish the contagiousness in the least.

Many viruses are passed off to others 1-2 days before the onset of any symptoms -- that means before the patient even appears sick. My advice to a parent with a child who has "pink eye" is to tell them to send the kid to school as long as the kid feels well, most especially when it’s at the end stages of the illness.

Shocking I know, right? But nonetheless…truthful.

When Should You Keep Your Child Home?

Here's when a child should stay home, in general for any illness:

1. An active fever -- they are no longer contagious 24 hours after the fever breaks.

2. Nausea/Vomiting/Diarrhea

3. An unknown systemic rash (all over, not just one localized spot)

4. If the kid just doesn't feel well 

That last one is likely the most important to keep in mind. If the child appears ill, has diminished energy, is not eating/drinking or acting like their energetic selves, by all means keep that child home. It’s also more likely that they are most contagious at this stage, which is often the beginning days of an illness. Please refer to my prior article that reviewed the typical viral course – a must to know for any parent, or adult for that matter.

Cough, runny, stuffy nose, etc. are more vague symptoms that can occur any time during the illness, even weeks after the offending virus has cleared out of the system. So they aren’t an accurate gauge of how contagious an illness is.

American Academy of Pediatrics (AAP), the largest governing body who sets both parental and physician practice guidelines for kids present the 2 main questions to ask when deciding to keep kids at home:

1.       Does the illness keep the child from comfortably engaging in activities?

2.       Does the child require more care than the staff can provide without affecting the health and safety of other kids?

Share your ideas and learn more quick and dirty tips with us on the House Call Doctor’s FacebookTwitter, and Pinterest pages! If you learned anything here today, or simply enjoy all-things-medical, you can also listen and subscribe to the House Call Doctor podcast on Apple PodcastsSpotifySoundcloud, and Stitcher.

Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.

Well, thanks again for listening to this episode of the House Call Doctor.  If you have any future topic suggestions, you can email me at housecalldoctor@quickanddirtytips.com.  Have an eye healthy week!

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