What is conjunctivitis in children?

Conjunctivitis is an inflammation of the conjunctiva of the eye. The conjunctiva is the membrane that lines the inside of the eyelids and covers the eye. Conjunctivitis is also known as “pink eye” because the eye looks pink or red.

In children, the condition is often grouped into either newborn conjunctivitis or childhood conjunctivitis. There are different causes and treatments for each group.

Types of newborn conjunctivitis include:

• Chemical conjunctivitis. This is a rare condition caused by irritation from eye drops that are given to newborn babies to help prevent a bacterial infection. The eyes are often red and inflamed, starting a few hours after the drops have been put in the eye. The symptoms last about 2 to 4 days. This type of conjunctivitis often doesn’t need treatment.

• Gonococcal conjunctivitis. This is caused by bacteria called Neisseria gonorrhoeae. A newborn baby can pick up this type of bacteria during vaginal birth from an infected mother. This severe type of conjunctivitis may be prevented with the use of eye drops in newborns at birth. The condition causes severe redness of the eyes with swelling and thick fluid leaking from the eyelids. Symptoms often start about 2 to 5 days after birth. Treatment often includes IV (intravenous) antibiotics.

• Inclusion conjunctivitis. This is the most common type of bacterial infection. It is caused by an infection with Chlamydia trachomatis. The symptoms include red eyes, swollen eyelids, and fluid leaking from the eyelids. Symptoms often start 5 to 14 days after birth. Treatment often includes antibiotics taken by mouth (oral).

• Infection from other bacteria. After the first week of life, other bacteria cause conjunctivitis in a newborn. The eyes may be red and swollen with some drainage. Treatment depends on the type of bacteria that have caused the infection. Treatment often includes antibiotic drops or ointments, warm compresses, and correct hygiene when touching the infected eyes.

Childhood conjunctivitis is a swelling of the conjunctiva and may also include an infection. It is a very common problem in children. Large outbreaks of conjunctivitis are often seen in daycare settings or schools. The most common causes of childhood conjunctivitis are:

• Bacteria

• Viruses, including the herpes virus

• Allergies

If the condition is caused by an infection, it’s important to know that the infection can spread from one eye to the other by touching the affected eye or fluid from the eye. The infection can also spread to other people. Fluid from the eye is still contagious for 24 to 48 hours after starting treatment.

What causes conjunctivitis in a child?

There are many different causes of conjunctivitis. The most common causes are:

• Bacteria such as:

  • Staphylococcus aureus

  • Haemophilus influenzae

  • Streptococcus pneumoniae

  • Neisseria gonorrhea

  • Chlamydia trachomatis

• Viruses such as:

  • Adenoviruses

  • Herpes virus

• Chemicals in newborn eye drops

• Allergies

Which children are at risk for conjunctivitis?

A child who has had contact with any of the below are at risk for the condition:

• Staphylococcus aureus

• Haemophilus influenzae

• Streptococcus pneumoniae

• Neisseria gonorrhea

• Chlamydia trachomatis

• Adenoviruses

• Herpes virus

• Chemicals in newborn eye drops

What are the symptoms of conjunctivitis in a child?

Symptoms can occur a bit differently in each child. They can include:

• Itchy, irritated eyes

• Swelling of the eyelids

• Redness of the conjunctiva

• Mild pain when the child looks at a light

• Burning in the eyes

• Eyelids that are stuck together in the morning

• Clear, thin fluid leaking from the eyes, most often from a virus or allergies

• Sneezing and runny nose, most often from allergies

• Stringy discharge from the eyes, most often from allergies

• Thick, green drainage, most often from a bacterial infection

• Ear infection, most often from a bacterial infection

• Lesion on eyelids with a crusty appearance, most often from a herpes infection

The symptoms of conjunctivitis can seem like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

How is conjunctivitis diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. They will give your child a physical exam. In some cases, a sample of the fluid leaking from the eye may be tested to help confirm the cause of the infection.

How is conjunctivitis treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on the cause of the condition, for example:

• Bacterial infection. This may be treated with antibiotic eye drops.

• Viral infection. Viral conjunctivitis often doesn’t need treatment. In some cases, antibiotic eye drops may be used to help prevent a secondary infection.

• Allergic reaction. The allergies may be treated with oral medicines or eye drops.

• Herpes infection. Your child may need to see a special corneal eye care provider (ophthalmologist) depending on the severity. Your child may be treated with both oral medicine and eye drops. 

If the condition is caused by an infection, it’s important to know that the infection can spread from one eye to the other by touching the affected eye or fluid from the eye. The infection can also spread to other people. Fluid from the eye is still contagious for 24 to 48 hours after starting treatment.

To help prevent the spread of the infection, scrub your hands with soap and water for at least 20 seconds before and after caring for your child. Make sure your child doesn’t touch their eyes. Have your child scrub their hands for at least 20 seconds throughout the day, especially after using the bathroom, touching pets, playing, and before eating. Change your child's towel and washcloth daily, and don't let anyone else use them. Sanitize objects that are commonly touched, such as tables, doorknobs, phones, blankets, and toys.

What are possible complications of conjunctivitis in a child?

Conjunctivitis caused by herpes is a serious infection. If untreated, it may lead to scarring of the eye and vision loss. Any type of vision problem should be checked by your child's healthcare provider.

Key points about conjunctivitis in children

• Conjunctivitis is an inflammation of the conjunctiva of the eye. The conjunctiva is the membrane that lines the inside of the eyelids and covers the eye.

• In children, the condition is often grouped into either newborn conjunctivitis or childhood conjunctivitis. There are different causes and treatments for each group.

• Symptoms can include red, swollen, burning, irritated eyes

• Treatment will depend on the cause of the condition and may include oral medicine and eye drops.

• If the condition is caused by an infection, it can spread from one eye to the other by touching the affected eye or fluid from the eye. The infection can also spread to other people.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.