WHY DOES MY CHILD HAVE A RED EYE?


There are several conditions that can cause a red eye in your child. Some of these require urgent attention, and others can wait a few days before being assessed by a medical professional.

BUT HOW DO YOU KNOW WHICH IS WHICH?

In this article, I will discuss the most common causes of a red eye and give pointers as to which require emergent treatment and which do not. Remember that any case of a red eye, must be seen by a doctor.

WHEN SHOULD I BE WORRIED?
TRAUMA

One of the more common causes is trauma which can be divided into blunt or penetrating injuries. Examples of each includebeing punched in the eye or hit by a squash ball andhaving a pencil or bullet from a BB gun pierce the eye.

If the object is still in the eye, do not pull it out as this will cause further damage. Penetrating injuries require urgent assessment in casualty. Once your child has been seen in casualty an ophthalmologist will be called to examine and treat your child.
Blunt trauma should also be assessed. An eye that fills with blood is easy to identify as a problem, but don’t be fooled by the eye that looks perfectly normal. The channels that help drain fluid produced in the eye can become blocked, causing pressure to build up in the eye. If the pressure is high enough, the optic nerve and blood vessels at the back of the eye can be compressed causing irreparable damage and loss of vision.The pressure usually peaks at 10 days. Don’t ignore this form of trauma. Have your child assessed by an ophthalmologist. It does not however, require a casualty visit in the middle of the night.

Chemical injuries can be divided into those caused by acidic substances, such a snake venom, and alkaline substances such as bleach..

Did you know that certain tree saps can cause more damage to the eye than snake venom?

Contrary to what one would think, alkaline substances cause far more damage than acid ones due to the way in which they “melt” the tissue.

Therefore, snake venom spat into an eye has a lower chance of causing damage than bleach. Tree sap can also play havoc with the surface of the eye.The rule of thumb is that opaque saps are more toxic than clear ones. You may think it is innocuous, but an eye with tree sap in it needs urgent medical attention.

Fireworks in the eye are a double whammy; they cause both chemical and thermal damage. The chemical injury is due to the gunpowder particles that become lodged in the eye and the heat “cooks” the eye tissue. It is for these reasons that children should not be allowed to handle any form of firework nor should they be near the lighting of fireworks.

After suffering a chemical and or thermal injury, the eyes need to be thoroughly irrigated with clean, cool water. If only one eye is affected, turn the child’s face towards that eye before starting to irrigate. This will prevent the chemical from being flushed into the unaffected eye causing more damage. Once a thorough irrigation has been carried out, seek urgent medical attention.

In all cases of trauma, ensure that your child has adequate pain relief as eye injuries can be extremely uncomfortable.

INFECTION

Another common cause of a red eye in a child is infection. The most likely pathogen here is viral, but bacterial, fungal and rarely amoebic disease, can also occur. The type of infection can also be classified according to which part of the eye is affected.

For example, if the conjunctiva is involved, the condition is termed “conjunctivitis”. If the cornea is affected, it is termed “keratitis” and if the sclera is involved, it is called scleritis.
Newborns can contract eye infections as they pass through their mother’s birth canal during delivery. Any newborn conjunctivitis occurring within the first month of life is referred to as Ophthalmia Neonatorum. The most common infections are sexually transmitted diseases (STD) such as Gonorrhea, Chlamydia and Herpes Simplex Virus, but non-STD bacterial infections like Staphylococcus aureus and Haemophilus also occur. In most hospital settings, a dose of antibiotic ointment is inserted in both eyes, after birthto eradicate these infections.

However, should your infant develop a red eye within the first month, especially when accompanied by a discharge from one or both eyes, an urgent appointment needs to be made with a peadiatrician or peadiatric ophthalmologist as infections such as Gonorrhea can cause severe ocular damage in a very short space of time.

Babies, toddlers, children and teens are all susceptible to viral and bacterial conjunctivitis. One or both eyes may be affected. The patient may rub their eyes and complain of pain especially when exposed to light. They may have a watery discharge which can become opaque and purulent. You may notice crusting on their eyelashes.

If the cause is viral, the child will need supportive eye medication and eye hygiene. In cases of bacterial conjunctivitis, topical antibiotics will need to be included in the treatment plan, and occasionally oral antibiotics will be prescribed.

If there is a discharge, your peadiatric ophthalmologist will take a sample and have it tested to establish which organisms are infecting the area and which antibiotics are best suited to treating it.

It is important that you follow the instructions for each medication correctly. Do not touch the surface of the eye with the bottle tip. With your child lying down or tilting his or head upwards, ask him or her to close their eyes. Instill the prescribed number of drops in the corner of the eye closest to the nose. When your child opens his or her eyes, the medication will flow into the eye.

Even if the infection appears to have resolved before the end of the treatment period, complete the course. Any left over topical medication must be thrown away.

Conjunctivitis is highly contagious, so remember to insist on goodhygiene such as no rubbing of the eyes, regular washing of hands and ensure that your child has a specific towel and face cloth allocated to him or her during the period of the infection.

Corneal infections are often secondary to trauma. The protective surface is damaged giving access to a variety of pathogens. The infection can destroy the top layers of the cornea creating an ulcer.

Abrasions caused by an object that is made of vegetable matter, like the branch of a shrub, can introduce fungi into the cornea. Fungal infections of the cornea are rare, but can be difficult to treat, so have your child assessed if they complain of having had something “scratch” the front of their eye, even if you can’t see evidence of it.

Did you know that by cleaning your contact lenses with unsterile water, you run the risk of developing an amoebic corneal ulcer?

Children and teens that use contact lenses need to be educated thoroughly about the care of their lenses. A rare cause of infection is due to anamoeba. If unsterilewater is used to clean the lenses, amoeba in the water can become lodged on the lens surface and then transfer to the front of theeye when the lens is inserted.The amoebae damage the top layers of the cornea to create an ulcer, which can be difficult to diagnose and to treat.

ALLERGY

A common condition is that of allergic eye disease. Air born particles, such as pollens andsmoke or allergens that are accidentally rubbed onto the eyes, like cat dander, initiate an immune response in the eye. This causes the eye to become red and itchy. This is not an emergency.

The child, however, still needs to be assessed. Chronic severe allergies cause papillae(fleshy cobblestone like lumps) to develop on the underside of the eyelid, which can scratch and damage the cornea. Continuous rubbing of the eyelids can result in a change in the shape of the cornea over time resulting in errors in vision.

Treatment includes identification and removal of the allergen, which is often difficult to do. Encourage good hand hygiene and limit eye rubbing. Washing the face at night with warm water in order to remove allergenic particles before going to sleep.Eye drops may be prescribed to ameliorate the allergic reaction and lubricate the eye surface.

GLAUCOMA

Here, the outflow of fluid produced within the eye, is prevented from leaving the eye. This increase in fluid raises the pressure inside the eye, which can damage the optic nerve and nerve fibre layer at the back of the eye. In addition to the red discolouration of the eye, you may notice a watery discharge and a cornea that appears larger than normal. The cornea may also have ahazy appearance.
This condition is vision threatening and must therefore be diagnosed and treated by a specialist in peadiatric ophthalmology. The condition can be treated surgically and or with pressure lowering eye drops.
AUTO-IMMUNE

Auto-immune disorders in children may result in the “middle layer” of the eye being affected. This includes the iris and its surrounding structures and is called ‘anterior uveitis’. Roughly eighty five percent of cases occur in children with juvenile idiopathic arthritis. Other conditions include diseases such a psoriasis, ankylosing spondylitis and Kawasaki disease. The child may complain of pain and blurred vision and the parent may notice a red, watering eye with a subtle “cloudiness” in the eye. This may come on suddenly and progress quickly, so medical attention should be urgently sought.

Remember that should your child develop a red eye, they need to be assessed by a medical professional and ideally by a peadiatric ophthalmologist.


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