Originally published on November 13, 2013, in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.
Dear Dr. Johnson: My toddler has been sent home several times from day care due to eye drainage. When does this need to be treated with antibiotics?
Dear Reader: There are multiple reasons that young children have eye drainage. The eye drainage can be watery and clear to thick and purulent (containing pus). The drainage can be one way the body tries to heal or clear irritation.
A health care provider can help you determine the cause of the drainage, but the urgency of evaluation depends on associated symptoms.
The first step is to determine if the drainage is associated with redness or inflammation of the eye. Conjunctivitis (or pink eye) is inflammation of the conjunctiva. The conjunctiva lines the inside of the eyelids and the sclera (white part of the eye).
This inflammation can be caused by various issues, including bacterial infections, viral infections, allergic reactions, trauma or irritation from contaminants (something getting into the eye).
While drainage from the eye can cause irritation and some pinkness to the outside of the eyelid and around the eye, any significant redness, swelling or pain can be a sign of a serious bacterial infection around the eye and should be evaluated immediately by a health care provider.
If your child has drainage and conjunctivitis, they should be seen by their doctor to determine the likely cause and the best treatment. Bacterial infections can be very contagious, so antibiotic eye drops are usually prescribed to treat the infection and prevent spreading to others.
The best way to decrease the spread of infection is to avoid touching the eyes and also to practice good hand washing. Do not share things that come in contact with the face such as washcloths, towels, etc.
Most of these infections are not serious, and many would resolve without treatment. The exception to this is eye infections in the newborn period.
There are other common causes of eye drainage that are usually not associated with redness. During the newborn period, sometimes the duct that goes from the inside corner of the eye to the nose is not fully opened.
This is called nasolacrimal duct obstruction, or blocked tear duct, and is present in up to 10 percent of newborns. The eye continues to make tears, but they are unable to drain into the nose so there are excessive tears draining out of the eye.
After sleep, there can be a small amount of crusting on the eye, but the white part of the eye and the inside of the eyelid should not be red. More than 90 percent of these cases resolve without treatment by the time the infant is 12 months old.
Older children can have a temporary blockage of the nasolacrimal duct due to nasal congestion. With cold symptoms and thick nasal congestion, the duct can become blocked and lead to some drainage from the inside corner of the eyes. There shouldn’t be any inflammation of the eye along with this, and it should resolve as the cold symptoms resolve.
No matter the cause of your child’s eye drainage, it is best to at least discuss it with a doctor to determine if a clinic appointment for evaluation is needed.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Johnson to people submitting questions.