Viral vs. Bacterial Conjunctivitis (Pediatric Nursing)

00:01 Now let's talk about pink eye or conjunctivitis.

00:03 Conjunctivitis is inflammation of the conjunctiva.

00:07 This is also known as pink eye and it's a very common eye disease especially among children.

00:13 It can be unilateral, affecting one eye, or bilateral, affecting both eyes.

00:17 And there are 4 common causes including viral, bacterial, allergic, and irritants.

00:23 Let's first talk about viral. This is infectious and this is often associated with a cough or a cold.

00:30 And it's spread by coughing or sneezing.

00:32 Common viruses include the adenovirus, the herpes simplex virus which can cause a more serious problem in the eye, and enteroviruses.

00:41 The modes of transmission are the same as the common cold, coughing and sneezing.

00:46 So this virus can also spread within the patient from their mucous membrane and move into the eyes.

00:53 Viral pink eye usually starts unilaterally and then spreads to the other eye within days.

00:58 And the discharge is going to be watery and this is a typical defining feature.

01:02 The children may have itchy eyes and may have photosensitivity so it's a little bit irritating when they look at the lights.

01:09 This is usually self-limiting in a few days and goes away without intervention and no medication is needed.

01:16 The next type is bacterial pink eye and this is infectious.

01:19 It's typically caused by Staph. aureus, Strep. pneumoniae, or Hemophilus influenzae.

01:26 And this is the goopy pink eye that you think of when patients come in and their eyes looks like they're glued shut with Elmer's glue.

01:32 The mode of transmission is through physical contact with others or fomites.

01:37 And I always make sure to educate my patient and their families that this will live on the surfaces in their house and then they can go along and touch it, and they'll be fine unless they touch their eyes.

01:47 Once they touch their eyes, they too will have pink eye.

01:50 This can also be due to poor hygiene or contaminated eye makeup or lotions.

01:54 So please educate your patients to throw out any makeup or creams that might have touched their eyes in the days preceding the infection.

02:02 This also happens when patients wear improperly cleaned contact lenses.

02:06 This usually starts unilaterally and then it will spread to the other eye within days so when you treat your patient, I have them start treating both eyes.

02:15 This gets them back into the community sooner. The discharge is classic.

02:19 It's gonna be yellow or green, and thick and purulent.

02:22 And the eyes can be glued shut or matted shut in the morning.

02:25 Often when the patients come in, they are wiping at their eyes with a Kleenex or a wash cloth and they're trying to get that exudate out of the way.

02:33 Sometimes this occurs with ear infections and this is called conjunctivitis otitis syndrome.

02:38 And this occurs in about 25% of pediatric patients with pink eye.

02:43 This can occur in the absence of ear pain so the child might not have any ear pain.

02:48 So every patient that comes in to be evaluated for conjunctivitis should also have a thorough ear exam.

02:54 And this condition, Hemophilus influenzae, is the most common pathogen and it's responsible for both the pink eye and the ear infection.

03:02 These patients require oral antibiotics because eye drops are not gonna be effective and the medication needs to cover beta-lactamase producing organisms.

03:11 So Augmentin is the recommended first line of treatment in these patients.

03:14 Bacterial pink eye will go away without any intervention.

03:18 It is self-limiting in 1-2 weeks but we treat with antibiotics because this can shorten the length of the infection and reduce complications, and decrease the spread to others.

03:27 Eye drops are prescribed but it can be difficult to get eye drops into a child's eyes.

03:32 So you want to educate the parents about techniques and the way that I describe it is I ask them to have their child lay flat on a couch or on a bed or on the floor and have the child close their eyes. That part's pretty easy.

03:44 Then the parent takes the eye drop and puts it right at the inner canthus while the child has their eyes closed. There's no need to pry the eye open.

03:52 Then if the child is able to follow directions and is old enough, you have them blink 5 or 10 times as they're laying down and this will wash the drop into their eyes.

03:59 If it's an infant or a younger child, they can simply sit the child up and this will cause a blinking reflex and the drops will go in.

04:06 I educate young children saying it's just gonna feel like water is going into their eye.

04:10 It shouldn't sting but remind them that it is medication.

04:14 So you wanna use a topical broad-spectrum antibiotic and encourage patients to throw at anything that's touched their eyes.