School-Based Telehealth Program
March 2019 

Click the button below to see a video on the great strides that are happening at Mary Bramlett Elementary School in Gaffney, SC! A recent partnership with MUSC now brings specialty care to students while in school.

 

Clinical Focus: The Pink Eye

Image Credit:  Oddbods/Newt’s Pink Eye-YouTube

Why is that eye red? What is Conjunctivitis?
Conjunctivitis is an inflammation or infection of the transparent membrane (conjuctiva) that lines the eyelid and covers the white part of the eyeball. When the small blood vessels in the conjuctiva become inflamed, they are more visible causing the whites of the eyes to appear red or pink. It can be caused by an irritant, an infection (either viral or bacterial) or an allergic reaction.

How can you tell if it is an allergic conjuctivitis or bacterial conjuctivitis? 
Typically, allergic conjuctivitis presents in both eyes but it may affect only one eye. Redness of the conjuctiva, watery discharge, itching and occasional morning crusting of the eyelids are common findings. There may be a cobblestone appearance to the inside of the lids. It often accompanies other signs of seasonal allergies such as watery runny nose and sneezing. Irritant conjunctivitis usually presents with redness of the conjuctiva without additional symptoms. Viral conjuctivitis usually presents with redness and watery OR opaque discharge. Bacterial conjuctivitis may affect one or both eyes. It presents with conjuctival redness and yellow or green drainage that persists throughout the day

The following is a list of key findings that need immediate evaluation by a nurse practitioner or physician as they may indicate a more serious condition: how is it diagnosed?

• Abnormal vision 
• Difficulty opening the eye or keeping it open
• Photophobia (sensitivity to light)
• History of trauma
• Severe pain 
• Hyphema (blood in the anterior chamber of the eye) 
• Significant swelling around the eye 
• Pain with movement of the eye

How is it treated?  
Treatment is determined based on the underlying cause. When a child comes into the nurse's office with any of these symptoms, it is a good idea to flush the eyes with water or sterile saline solution to remove any allergens or irritants. Saline is more comfortable. Children should also wash their face and  hands so they do not reintroduce allergens into the eyes by touching them. Children with allergic conjuctivitis can be treated with oral antihistamines as well as allergy eye drops. If yellow or green drainage is present, and returns throughout the day, it is probably bacterial conjuctivitis and will likely require treatment with antibiotic eye drops. Sometimes bacterial conjuctivitis accompanies other conditions such as an ear or sinus infection. In this case, an oral antibiotic may be prescribed. 

Can a student stay at school with conjuctivitis?
 According to the DHEC Health Care School and Childcare Exclusion List https://scdhec.gov/health/child-teen-health/school-exclusion, students and staff should be excluded if they have fever, severe eye pain, purulent drainage or are too sick to participate in routine activities. Therefore, most students with a pink eye can remain at school.  

Whether you suspect untreated allergic conjuctivitis or bacterial conjuctivitis, or if the diagnosis is unclear, referral for further evaluation is necessary.