Scott Webb (Host): Whether it's caused by a virus or bacteria, pink eye is very common in kids. And I'm joined again today by Dr. Lauren Strelitz. She's a pediatrician with Stanford Medicine Children's Health. And she's here today to tell us more about pink eye, signs, symptoms, treatment options, and when it's important that we seek medical attention immediately.

 This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Doctor, it's so nice to have you back again. Today, we're talking about pink eye. And I think, you know, maybe every kid ever has had pink eye. I don't know if it's some sort of rite of passage of being a child, but I certainly had pink eye. My kids had pink eye. Everybody seems to have had pink eye at some point in their life. So, let's just start there. Nice, easy, basic one. What is pink eye?

Dr. Lauren Strelitz: You know, pink eye is just when the white part of the eye, the conjunctiva, becomes pink. And it's caused by a lot of different things. So, I think what you're talking about is more of what people usually think of when they think of pink eye, which is bacterial. But the most common cause of pink eye is viral, especially in school age kids, but even preschoolers, even up to middle schoolers and high schoolers. So, the most common cause of pink eye is a virus, usually adenovirus, which is the same type of virus that causes a cold. But COVID can cause pink eye. It can even cause pink eye that has a lot of green and yellow drainage. And the allergies can also cause pink eye. And then, there can be more serious causes of a pink eye, such as like an injury to the eye or a scratch on the cornea or something like that.

Host: Right. All right. So, you're saying that, yeah, in my mind, it's mostly bacterial, but that's why we have experts on because you're saying it's also viral, maybe more viral than bacterial. So in general, because I don't see a lot of adults with pink eye, and I don't know if it's because we just get different types of viruses that kids do, or we wash our hands better than kids do, but who gets pink eye?

Dr. Lauren Strelitz: Mostly kids. And I think the reason adults don't get as much pink eye is because, you know, we've been exposed to these viruses already, and so our immune system is a little better at fighting them.

Host: Yeah, that's interesting. When I knew that we were going to talk about pink eye, I was like, I don't remember the last time I saw an adult with pink eye, but a teenager and younger, absolutely. And I remember like when my kids would come home from, you know, Montessori school or kindergarten, and we would hear the news that so and so had pink eye, you know, and it was like the alarm started going off in the house. "You didn't touch them, did you? You wash your hands," you know?

So, just in general, do people know, do kids know, can we spot pink eye before you really get pink eye? Is there sort of like an incubation period or is it just you go to bed and you wake up and your eyes pink? How does that work?

Dr. Lauren Strelitz: It usually happens pretty fast. I think you need to take the whole clinical picture into account to determine whether it's like a bacterial or a viral pink eye. You know, usually viral or allergic pink eye is going to be both sides. Usually, they're going to have viral symptoms, stuffy nose, runny nose, cough. But sometimes it can start off, one eye is a little pink and has some discharge and then the next eye is pink and has some discharge, and then they develop the symptoms.

You know, that said, with viral pink eye, we do sometimes still treat with the topical antibiotic drops, because they're so low risk. When a child has even a viral pink eye, they are often like rubbing and scratching on their eye, which could increase the risk of getting a bacterial pink eye.

Host: Yeah. And for any parents in the audience who had pink eye as a kid, which I'm pretty sure is really all of us, the battle was always if you only got it in one eye, was trying to get it not to spread to the other eye, but it was impossible not to scratch that itch and then rub the other eye. It was just, like I said, a rite of passage. And, you know, I think about the things that kids get that just drive parents crazy, lice, pink eye, you know, those things.

Let's talk about how it's spread, because you're saying, you know, it's viral, it's bacterial. So, there's lot of ways it can get in our eyes, right?

Dr. Lauren Strelitz: Yeah. So, the viral types of pink eye are spread by the way that viruses are spread. So, you know, COVID is airborne. If you're in a room with somebody who has COVID and you don't have a mask on, you could potentially get pink eye from that. Other types of viruses are typically spread by droplets. So if you're in a room with somebody who's coughing or sneezing, and a droplet gets on the surface of the eye or in your nose or in your mouth, that's a way to get it. Bacterial is usually from touching something that has the bacteria on it and then touching your eye.

Host: Yeah, my son learned the hard way. You know, when your hands are dirty, wash them before you scratch your eyes. I know it's tough because your eye's itching, but you got to wash those hands. So, let's talk about the treatment options. Obviously, those of us parents, you know, who've gone to the pediatrician, let's say, hoping it was strep because there'd be some treatment for strep. We understand viruses and how they work. You know, there is no magic pill necessarily. But in general, is there different types of treatment depending on what kind of pink eye you have?

Dr. Lauren Strelitz: Yeah, absolutely. So I mean, if it's a bacterial pink eye, the treatment is either antibiotic eye drops or antibiotic ointment. if it's a viral pink eye, depending on, you know, if there's a lot of like goopiness and discharge, we may still use the antibiotic ointment or the antibiotic drops. But it may just be, you know, supportive care and treatment for the virus. And then, there's also allergic pink eye that's triggered by things like pollen dust, pet dander, mold, that's usually going to cause itchy watery eyes as well with a lot of puffiness around the eyes, but there may not be the puffiness. And that would be treated by allergy medicines such as Flonase or antihistamine eye drops or other allergy eye drops.

Host: And I'm assuming, Doctor, that goopiness is a word you learned in medical school.

Dr. Lauren Strelitz: Purulence is a little harder for people to understand.

Host: You know what? This is your fourth time on. We're going to go with goopiness because we all know what that means. Are there any complications, Doctor, if we just simply ignore pink eye, if that's even possible?

Dr. Lauren Strelitz: With viral pink eye, it's going to be self-resolving. With bacterial pink eye, there's rarely a risk of developing an infection in the skin around the eye called preseptal cellulitis. That would need oral antibiotics. And even more rare, much less common, would be something called orbital cellulitis, which is an infection of the muscles around the eye and the eye itself. And that orbital cellulitis is a medical emergency and requires IV antibiotics. There are a few things that are like reasons you have to see a doctor for pink eyes, and it would be pain, sensitivity to light or vision changes, worsening swelling or redness of the eyelid, symptoms lasting more than two weeks, or if there's any concern that it could be related to herpes or chickenpox, because pink eye caused by herpes or chickenpox require emergency antiviral treatment to prevent serious complications like blindness. And then, I would also say, you know, even if we think it's viral and it's lasting beyond two weeks, they still need to see a doctor, but anytime a family is worried, they should see a doctor. I mean, that's what we're here for.

Host: Doctor, I want to ask you about contacts. I know kids wear contacts, of course, and just wondering if there's any special sort of complications or concerns when we think about pink eye and contacts.

Dr. Lauren Strelitz: Yeah. So, I would say first, do not shower or swim with contacts on because water that contains bacteria can get behind the contacts and cause pretty serious infections. And then, if you do have pink eye and contacts, see a doctor right away because it could be a more serious infection and dispose of the contacts.

Host: Just want to finish up here, whether we're talking about viral or bacterial, what are our best defenses in terms of avoiding pink eye?

Dr. Lauren Strelitz: Yeah. So, hand washing with soap and water. ideally you're not touching your eyes too much in general, but always washing your hands before you touch your eyes. When you're around sick people, wearing a mask. Wearing eye protection can help. That's a little harder for the younger kids. And then for allergy, allergic pink eye, you know, trying to avoid the allergens that you know are the triggers for you.

Host: Yeah, knowing the triggers. Well, it's always a pleasure to have you on. I'm going to be just sort of smiling about goopiness. I'm going try the rest of the weekend here to try to slide in goopiness as much as I can, because it's just such a great word. I appreciate your time as always.

Dr. Lauren Strelitz: Thanks so much.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.