Pinkeye (Conjunctivitis)—Child Care and Schools

What are the signs or symptoms?

There are several kinds of conjunctivitis, including

• Bacterial

  • Red or pink, itchy, painful eye(s).

  • More than a tiny amount of green or yellow discharge.

  • Infected eyes may be crusted shut in the morning.

  • May affect one or both eyes.

• Viral

  • Pink, swollen, watering eye(s) sensitive to light

  • May affect only one eye

• Allergic

  • Itching, redness, and excessive tearing, usually of both eyes

• Chemical

  • Red, watery eyes, especially after swimming in chlorinated water

• Immune mediated, such as that related to a systemic disease, like Kawasaki disease

  • Red eyes, no discharge, usually affects both eyes

What are the incubation and contagious periods?

Depending on the type of conjunctivitis, the incubation period varies.

• Bacterial

  • The incubation period is unknown because the bacteria that cause it are commonly present in most individuals and do not usually cause infection.

  • The contagious period ends when the course of medication is started or when the symptoms are no longer present.

• Viral

  • Sometimes occurs early in the course of a viral respiratory tract disease that has other signs or symptoms.

  • One type of viral conjunctivitis, caused by adenovirus, may be contagious for weeks after the appearance of signs or symptoms. Children with adenovirus infection are often ill with fever, sore throat, and other respiratory tract symptoms. This virus may uncommonly cause outbreaks in child care and school settings. Antibiotics for this condition do not help the patient or reduce spread.

  • The contagious period continues while the signs or symptoms are present.

• Allergic

  • Occurs in response to contact with the agent that causes the allergic reaction. The reaction may be immediate or delayed for many hours or days after the contact.

  • No contagious period.

• Chemical

  • Usually appears shortly after contact with the irritating substance

  • No contagious period

• Immune mediated

  • Occurs in response to a condition that stimulates the immune system of the body, often accompanied by other symptoms

  • No contagious period

How is it spread?

Hands become contaminated by direct contact with discharge from an infected eye or by touching other surfaces that have been contaminated by respiratory tract secretions and then touching the child's eyes.

How do you control it?

• Consult a health professional for diagnosis and possible treatment. The role of antibiotics in preventing spread of bacterial conjunctivitis is unclear. Antibiotics shorten the course of pinkeye only minimally, if at all. Most children with pinkeye get better after 5 or 6 days without antibiotics.

• Careful hand hygiene before and after touching the eyes, nose, and mouth.

• Careful sanitation of objects that are commonly touched by hands or faces, such as tables, doorknobs, telephones, cots, cuddle blankets, and toys.

What are the roles of the teacher/caregiver and the family?

• Report the infection to the staff member designated by the child care program or school for decision-making and action related to care of ill children. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

• Notify child's parent/guardian to consult with the child's health professional about diagnosis and treatment by telephone or office visit. Documentation from the child's health professional is not required.

• Seek advice from the local health department or the program's health consultant about how to prevent further spread if 2 or more children in one room have red eyes with watery discharge.

• Review hand-hygiene techniques and sanitation routines.

• Complete course of medication, if prescribed (not required), for bacterial conjunctivitis.

Exclude from group setting?

No, unless

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4).

• There is a recommendation from the local health department or the child's health professional.

Readmit to group setting?

Yes, when all the following criteria have been met:

• When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.

• Antibiotics are not required to return to care.

Comments

• It is helpful to think of bacterial conjunctivitis like the common cold. Both conditions may be passed on to other children but resolve without treatment. We do not exclude for the common cold. Bacterial conjunctivitis generally results in less symptoms of illness than the common cold. The best method for preventing spread is good hand hygiene.

• One form of viral conjunctivitis, caused by adenovirus, can cause epidemics. As indicated in the third bullet in the section What Are the Roles of the Teacher/Caregiver and the Family?, if 2 or more children in a group care setting develop conjunctivitis in the same period, seek the advice of the program's health consultant.