So, you think your child has pink eye. Now what?

Children's Health

by Wendy Lai, MD

Jun 3, 2021

When a child wakes up with a crusty eye, many parents worry about pink eye and call their pediatrician immediately for antibiotics. After all, pink eye is extremely contagious. Unfortunately, diagnosing pink eye is a little more complicated and typically requires a physical exam in your pediatrician’s office.

The good news is, it’s not always pink eye. There are other causes to consider if your child wakes up with a crusty eye. Here I’ll outline some helpful information to help parents decide when crusty eyes need evaluation and what to do if you think your child does have pink eye.

To begin, there are three main causes of eye crusting, and treatment varies depending on which of these is the cause. Each also has unique symptoms that can help differentiate what’s causing your child’s eye crusting.
– Bacterial conjunctivitis (also known as “pink eye”)
– Viral conjunctivitis
– Allergic conjunctivitis

Bacterial conjunctivitis (“pink eye”)

Bacterial conjunctivitis, or “pink eye,” is caused by bacteria. The classic finding is not just eye crusting, but also thick green-yellow drainage from the eye when your child is awake. Contrary to the name “pink eye,” children do not always have eye redness, but this colored discharge during the day is a key finding of bacterial conjunctivitis.

Pediatricians should evaluate bacterial conjunctivitis in office because it is commonly associated with ear infections. This is important for your physician to differentiate because regular pink eye only needs antibiotic eye drops for treatment, whereas an associated ear infection needs oral antibiotics for treatment. Antibiotic eye drops will not treat an ear infection if there is one present.

If you’re worried about your child having pink eye, it’s best to schedule an appointment with your pediatrician.

Other causes of crusty eyes

Viral conjunctivitis

Viral conjunctivitis is caused by a virus, typically one that causes upper respiratory infections (the common cold). Viral conjunctivitis is usually associated with nasal congestion, runny nose or cough. It causes eye crusting after sleeping but does not cause a colored discharge throughout the day like pink eye.

These infections will resolve on their own with time as the immune system fights off the viral infection. Antibiotics will not help or speed up recovery. Over the counter saline eye drops, however, can help alleviate any eye redness or discomfort due to viral conjunctivitis.

Allergic conjunctivitis

Allergic conjunctivitis is caused by seasonal or non-seasonal allergies. It is typically associated with allergy symptoms such as sneezing, runny nose, congestion and postnasal drainage. The classic findings for allergic conjunctivitis are itchy, watery eyes. Unlike pink eye, allergic conjunctivitis causes a clear, watery eye drainage, not a colored thick discharge.

Kids with allergic conjunctivitis tend to rub their eyes constantly throughout the day due to the itching. The frequent rubbing can cause the eye to become red. Allergic conjunctivitis can be treated with over-the-counter allergy eye drops.

As always, talk to your child’s pediatrician about any concerns or worries. Whether it’s pink eye or not, we can help your child get to feeling better. Find a doctor near you today.

About the Author

Wendy Lai, MD, is a pediatrician on the medical staff at Baylor Scott & White Family Health Center – Mesquite.

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