What can parents do if their child has conjunctivitis?

If your eye is red, watering a lot and itchy, it's often because of conjunctivitis. This can be caused by things like viruses and bacteria.

It is often difficult for parents to distinguish between the two types. «Bacterial conjunctivitis occurs mainly in infants and young children. The discharge is slimy, yellow and purulent, and sticks the eyes together. With viral inflammation, the eyes are red and burn. The discharge is watery and clear, but can also be greenish,» explains Markus Zehnder, owner of the Central paediatric practice in Horgen, Zurich, explaining the differences.

Both forms would usually heal spontaneously, which is why, in milder cases, it does not matter whether the cause is viral or bacterial.

It is important to wipe away the purulent secretion regularly with lukewarm tap water and a clean cloth, working from the outside inwards. Hands should be washed thoroughly before and after wiping, as conjunctivitis is highly contagious.

Careful hand hygiene is the best protection against the spread of conjunctivitis.

Markus Zehnder, paediatrician

«In severe cases, antibiotic drops may be prescribed to shorten the duration of the illness,» says Zehnder. Depending on the cause, it takes 7 to 14 days for conjunctivitis to heal. Careful hand hygiene is particularly important during this time. It is also the best protection against spreading the infection.

When can the child start school?

«Exclusion from nursery and school is only mandatory in cases of epidemic keratoconjunctivitis,» says Zehnder. This form of inflammation, colloquially known as «eye flu», is particularly contagious. «It is caused by adenoviruses and is very pronounced, with severe redness, swelling, eyelid spasms, a foreign body sensation and watery discharge.»

Initially, only one eye is usually affected and the child has no flu-like symptoms. As the infection progresses, it can spread to the other eye. The school medical service of the canton of Zurich has clear rules in the case of eye flu: «A return to school is possible from the 15th day after the onset of the disease in one eye. If the second eye is infected later, another 15 days from the onset of the disease in the second eye applies,» according to the official website.

Ophthalmological examination

Mild viral infections can also be contagious, but are generally less dangerous than epidemic infections – therefore, there is no blanket ban on attending school in such cases. The attending physician will make an individual decision depending on the severity of the symptoms.

In the event of severe pain, eyelid spasms or swelling of the entire eye, the child should be taken to see a paediatrician to rule out inflammation of the cornea, for example due to herpes viruses or a bacterial, purulent inflammation of the entire eye. If the conjunctivitis does not heal despite anti-inflammatory treatment, it is advisable to consult an ophthalmologist.

«In rare cases, conjunctivitis can also be caused by an underlying condition,» says Rike Michels, head of Michels Augenärzte am See in Feldmeilen, Zurich. One particularly severe form is vernal keratoconjunctivitis, a chronic allergic inflammation that exclusively affects children.

«This special form of allergy can cause scarring of the eye, which can affect vision development. Children with this condition must be treated consistently so that they do not suffer any long-term impairment,» explains the doctor. The good news: «Special eye drops are now also approved in Switzerland, which have achieved very positive results against this stubborn disease,» says Michels.

The main trigger is pollen

«The main symptom is itching. Allergic conjunctivitis without itching is practically non-existent,» says Peter Eng, allergist and immunologist in Lucerne. Typical symptoms include watery eyes, reddened eyes and swollen eyelids, often accompanied by sneezing and/or a runny nose (hay fever).

One specific form is known as chemosis, in which the conjunctiva swells up and which occurs almost exclusively in cases of allergy. «Although chemosis is relatively harmless, it can look alarming to the children affected and their parents,» says the doctor.

Chamomile tea is a popular home remedy, but should be avoided in cases of conjunctivitis as it can cause allergies.

If an allergic cause is suspected, the trigger is first identified by means of allergy tests or blood tests. «The number one trigger is pollen. This can be grass, tree or herb pollen. The second most common cause is house dust mites, followed by hair and dander from pets or farm animals,» explains Eng.

Consequently, the primary treatment for allergic conjunctivitis is to consistently avoid the trigger. This is not always easy in practice, especially if you are allergic to your own pet or to pollen, which is almost impossible to avoid in spring.

Do not rub your eyes

In addition to avoiding the trigger, eye drops or rinsing with saline solution can help. «If this is not possible in combination with preventive measures, antihistamine tablets are available, and in very severe cases, corticosteroid drops are used,» says the allergist. These contain cortisone and should only be prescribed and used after careful consultation with an ophthalmologist.

Even though it may be difficult, rubbing your eyes should be avoided as much as possible. «This can cause allergic conjunctivitis to lead to a bacterial superinfection,» warns Eng. In this case, the secretion changes and is no longer watery but greenish-yellow, and yellowish crusts form around the eyelids. «Symptoms that should always be taken seriously include pain in the eye, sensitivity to light, excessive blinking and blurred vision,» says the specialist. At this point at the latest, medical advice should be sought.

Even the youngest children can suffer from repeated conjunctivitis, albeit for different reasons. «In newborns and infants up to the age of two, recurrent conjunctivitis often occurs as a result of a blocked tear duct.

It is worth cleaning thoroughly and massaging the tear ducts regularly,» explains Rike Michels. To do this, gently stroke down from the inner corner of the eyelid to the nostril with your finger, applying gentle pressure. «Two to three times a day for one minute at a time is sufficient. You can apply a little Vaseline to your finger to avoid irritating the skin too much,» she advises. The narrowing or blockage usually opens up on its own within the first two years of life and no further action is required.

Especially if you have sensitive or already irritated eyes, it is worth taking a close look at what comes into contact with them on a daily basis, be it contact lenses or cosmetic products. Mascara, eye shadow, eyeliner or make-up remover can promote conjunctivitis in sensitive eyes or if they are poorly tolerated.

This is especially true if the products are contaminated or expired. Manufacturers therefore recommend replacing mascara every three to six months to prevent the formation of germs. Incidentally, unlike bacterial or viral conjunctivitis, allergic or mechanically induced irritation is not contagious.