Speaker 1 00:00:04 Hello and welcome to a Wonder Care podcast, formally known as WBA Podcast. I'm Sheena Mitchell, pharmacist and mom of three. I combine healthcare and practical advice to support you on your parenting journey. I bring you this episode with the support of Cell plus Breathe Z cell therapy device. This week I'm gonna be talking all about conjunctivitis. I'm gonna be explaining what it is, what causes it, how you treat it, explain some of the medicines that are used to treat conjunctivitis and when you need to see the doctor. And of course, at the end I will be answering some listeners' questions. What is conjunctivitis? Well, it's the inflammation of the conjunctiva. <laugh>. What's the conjunctiva? You may ask. Well, the conjunctiva is the little membrane which covers the white part of the eye, so it's like a little coating that covers the white part of the eye. There are three different things that can cause inflammation of the conjunctiva. There's infection, there's allergy, and there's irritation. Today I'm gonna speak a little bit about all three, but really I'm focusing on infection and more specifically bacterial infection.
Speaker 1 00:01:20 The symptoms of conjunctivitis vary between these three different causes, but in essence, you get redness of the eye, and this is of the white of the eye. That happens because the blood vessels that are over the white part of the eye swell, you get discharge due to the inflammation which is on the inside of the eyelids. You get inflammation because the little coating on the inside of your eyelids is actually there to produce mucus and tears, and when that gets inflamed, it starts overproducing. So when it's allergic conjunctivitis, you can kind of identify that because your eyes get very itchy. There's a watery discharge. Sometimes the little membrane over the white of eyes can almost seem a little bit swollen. It's usually accompanied with other symptoms of allergy, like a runny nose or itchy throat. There are two different types of infection that cause conjunctivitis.
Speaker 1 00:02:19 The first one is viral. Viral conjunctivitis is the most common, and it's really important to know that no treatment is normally needed. The eyes can feel a little bit gritty and irritated with viral conjunctivitis, and you can often identify it because it comes around the time when you have a cough or a cold. The discharge for viral conjunctivitis is usually watery for bacterial conjunctivitis, which is more common in kids, whereas viral is more common in adults. So for bacterial conjunctivitis, the difference is that the discharge is purulent. So basically this means it's sticky and thick. You'll notice this because you may see your child wake up in the morning and be barely able to open their eyes because their eyelids are stuck together. It's not normally as itchy as other forms of conjunctivitis, both viral and bacterial. Conjunctivitis usually affect one eye first, but it does frequently spread to both eyes.
Speaker 1 00:03:19 There are four main types of bacteria which cause acute bacterial conjunctivitis. This is the type of conjunctivitis that your child just wakes up with or develops quickly. Over 50% of cases are caused by staphylococcus bacteria. Around 20% are caused by streptococcus pneumonia, and around 5% are caused by the markella species, and 5% are caused by hemophilus influenza. The most common bacteria that affects children is the streptococcus pneumonia, hemophilus, influenza, and moraxella species. Acute bacterial conjunctivitis is frequently self-limiting with around 65% of cases resolving within two to five days. That is actually really, really important to know because as parents, as soon as we see something wrong with our child, we tend to want to fix it, and it's important to know that it will fix itself. It just takes a little bit of time. However, treatment with antibiotics can speed up the resolution of symptoms, but they will generally clear up themselves.
Speaker 1 00:04:23 And not treating conjunctivitis with antibiotics is not thought to cause any worsening of symptoms or harm. There has been a little bit of controversy over several years on whether or not antibiotic eyedrops are necessary for conjunctivitis, but in the most recent Cochran review of antibiotic eyedrops, it suggested that the use is associated with modestly improved rates of clinical microbiological remission compared with placebo, and so that they should be considered to speed up the resolution of symptoms and infection. So that's where the evidence currently lies. So you do have a choice and you're not making the wrong choice. No matter what you do. With the information that we currently have, you can decide that you want your child to have treatment to reduce their symptoms and speed up their recovery, but equally, there is no harm in adopting a watchful waiting approach. With watchful waiting, you're just reviewing their symptoms to make sure that there's no severe pain and that your child isn't suffering any loss of vision or discomfort to light.
Speaker 1 00:05:28 If either those symptoms happened, then absolutely you need to seek urgent medical attention. But if conjunctivitis just continues with sticky eye and you're happy enough to sit it out for the two to five days, then do know that you're not doing any harm by not treating it with an antibiotic. If you choose the watchful waiting option, and even if you have chosen to use antibiotics, sensible advice in either case includes cleaning the eye with boiled cooled water. And this is particularly helpful in the morning when your child's eyes are quite sticky because it can be quite uncomfortable and gritty for them. Cleaning your child's eyes with boiled cooled water is really, really useful. A lot of guidelines and you know, recommendations in various health websites will recommend using tissue or cotton wool. I personally would strongly advise against that because tissue or cotton wool both shed little particles of material as you wipe across the eye, and that could be irritating to the eye.
Speaker 1 00:06:32 So I recommend using a non shedding material such as a piece of gauze. Gauze is not expensive and could be picked up in your community pharmacy in a pack of a hundred pieces. It doesn't need to be completely sterile, it's just something that you can keep in a little container in your first aid kit. So with the gauze, you're only using each piece once, so you're just doing a single wipe from the nose side of the eye, straight over to the ear side of the eye, and then you're dumping that piece of gauze because that now contains infectious fluid. You can repeat the process gently and as many times as you need to relieve your child's symptoms. It's also really important to do an awful lot of hand washing when you're dealing with conjunctivitis. Make sure that your child isn't sharing any towels or pillows.
Speaker 1 00:07:19 And one thing to say is more for adults than children, but avoid using contact lenses during treatment or just during the watchful waiting phase. And for 24 hours after you finish treatment, this is actually really, really important. Fyi, you can actually cause eye ulceration if you leave them in. Do not do that. Another little home remedy, which might be helpful to some breastfeeding mamas out there. If your child has bacterial conjunctivitis, instead of of using boiled cooled water on gauze, you can actually use breast milk. It's certainly not gonna do any harm, and anecdotally, it does an awful lot of good. I just want to take a little break for a second to say that I'm delighted to partner again with one of my all-time favorite products. Salon Plus, this is the world's first hundred percent natural dry salt therapy device. It's clinically proven to relieve a wide range of allergens in respiratory conditions. The soil therapy method has been trusted for generations and is now hugely popular worldwide. As more and more people recognize the superb results achieved from a natural and non-invasive method, this device will help you breathe these easier and sleep better.
Speaker 1 00:08:34 So if you do decide to treat the conjunctivitis, what are your options? Well, the first one is an over-the-counter product, which is called Proline. It has been having some supply issues, but I know it's on the shelf in my pharmacy right now, so hopefully it's on the shelf in yours, and if not, you just visit Wonder care.ie, and you can order it there. Brolin contains propone. It's an aromatic diamone antiseptic. This basically means that it's not an antibiotic, but it has been used for decades to treat bacterial conjunctivitis. Clinical trials are lacking to substantiate its effectiveness, but this could be down to issues with the licensed dosing and yeah, other things, certainly a lot of people find it helpful, and that's what I find in the pharmacy. The dose with the Brolin drops is one drop four times a day. If you're using anointment form, then it will be twice daily because it stays in contact with the corneal surface for longer.
Speaker 1 00:09:34 Keep using this kind of product for 24 hours after symptoms clear. Then for a prescription eyedrop, you're talking about Chloramphenicol, which is an antibiotic eyedrop. It's brand name is Chloromycetin. It is kept in the fridge, so important to be aware of that. One thing I'd say is it's a little bit irritating if you use it when it's straight out the fridge. So maybe warm it up by just rolling the little bottle in your hands before administering it so that it warms up a little bit and then administer your drops and pop it back in the fridge afterwards. Treatment normally takes around five days. Usually you just continue it for 48 hours after the resolution of symptoms. When you're administering an eyedrop to an adult, you are just washing your hands and basically tilting your head back a little bit, pulling down on your lower eyelid by just pressing your finger just above your cheekbone and under your eyelid and pulling down gently, and then you're administering one drop into that space in your lower eyelid between your eyelid and your eye.
Speaker 1 00:10:36 Once you have administered the drop, close your eyes gently and it's useful to do a figure of eight motion. So while your eyes are closed, look up, down, right, left, and all around in a figure of eight motion. And this helps to disperse the antibiotic drop all over your eye. For a child, it's obviously a little bit trigger and look, I'm no stranger to a bribe. So <laugh>, find out what is gonna be motivating for your child and absolutely use that. One thing that is important to know that if you can't successfully get the eyedrop into that space between the O lower eyelid and the eye, it is an option to have your child lie just completely flat on the couch with their head ever so slightly tilted to one side so that the side of the infected eye is more dominant to you. Then use a drop and just pop it in that little well, which is in the very corner of the eye between the nose and the eyeball.
Speaker 1 00:11:34 There's a little bit of a dip there, and if you can even get the drop in there and then ta tell your child to open their eyes slowly, it'll automatically fall down into their eye. Then you just tell them to close their eyes again, which to be honest, they probably will anyway. And they usually do have quite a bit of fun looking right, left up down all of that. And yeah, then repeat the same on the other side if needed. I think that is all of the tips and advice I have about bacterial conjunctivitis for you. Just remember with viral, you don't need to treat it at all. So if the discharge is watery and your child is suffering from cold or flu-like symptoms, then you can continue doing the gentle wipe with a piece of gauze, but you don't actually have to get any medical treatment for it.
Speaker 1 00:12:21 If there is irritation in the eye and you think that redness in the eye is being caused by something that has gotten into the eye, in that case in a small child, I would definitely recommend seeing the doctor if it doesn't resolve by itself or even just using the gauze and boiled cooled water within about 24 hours or sooner if it's causing a lot of discomfort. And for allergic conjunctivitis, I've spoken a lot about that in my Hay Fever podcast, which you will find if you just flick back through the episodes. And there's a whole section there on the different kinds of eyedrops and what age they're suitable and other treatments that might help. Now I'm gonna answer the listeners' questions. Many of the questions that came in were wondering when Brolin is coming back in stock, people have had a lot of difficulty buying it in their local pharmacies over the last several months because of supply issues.
Speaker 1 00:13:17 The supply still seems to be a little bit unstable, but there is small amounts coming in. As I said earlier, we have it available and if you're having trouble finding it in your local community pharmacy, wonder care.ie is a registered pharmacy with Society of Ireland for online sales. So you can visit Wonder care.ie. And if you search bro drops, you will find them there. Unfortunately, there's no ointment available, so it's just the drops. Um, but they are there if you're stuck. A lot of people then were asking about recurrent conjunctivitis. So say one person was saying, my three-year-old has had sticky eyes on and off since Christmas. Every time he has a dose, it's this normal yet. Look, as we said there, anytime you get a viral illness, you can develop viral conjunctivitis, which unfortunately can sometimes develop into bacterial conjunctivitis. So it is relatively normal to get conjunctivitis when your child is feeling unwell or going through phases of illness.
Speaker 1 00:14:20 What I would say is that if it isn't clearing up in a timely manner, then do see the gp. So if you have received antibiotic eyedrops and there's no improvement within 48 hours of starting the eyedrops, or if after a week it hasn't cleared up, then you need to go back to the doctor, someone else saying that their son seems to be prone to it. Um, perhaps because they're in crash. Is there anything you can do to help him from suffering from recurrent infections? So what I would say is any child that's suffering from ongoing infections or infections that aren't clear clearing should see the doctor. There can be some underlying conditions, which is very unlikely, but it's no harm to rule it out when you have recurrent conjunctivitis such as autoimmune diseases that can, I suppose, make you more susceptible to infection. And there's another type of condition which can cause recurrent conjunctivitis, which is blepharitis.
Speaker 1 00:15:16 So it's basically a low grade infection on the actual eyelids. If blepharitis is the case, then both the conjunctivitis and the blepharitis need to be treated at the same time. One more question that came in, someone was asking if a red eye is definitely conjunctivitis and no. One thing that can sometimes get mistaken for conjunctivitis is something called a sub conjunctival hemorrhage. And this is basically when you get a tiny little blood vessel bursting in the eye and you get a lot of redness on the white of the eye. This can happen due to trauma and you might think, oh, my child has had no trauma. Why do they have this? But actually just a severe change in pressure in the head can cause it. And that can happen if someone is laughing really, really hard or even if they've had the vomiting bugger or something recently.
Speaker 1 00:16:07 Good thing to know about that kind of thing is that it is harmless. It generally doesn't cause any pain and it just resolves itself, but it could take a few weeks. That kind of sums up all of the main questions I got in there. Were a lot <laugh> about the Brolin, so I hope you're all relieved to know that we have plenty of it in
[email protected]. And hopefully supply issues will resolve. And I'm gonna take this little opportunity to have a day at our government to say that they have not agreed to meet me to discuss solutions where pharmacists could help to play a more active role in treating minor conditions like conjunctivitis in a triage system to try and take the pressure of gps and make healthcare more accessible for families. And if you follow my Instagram, you know that I have a petition running about this.
Speaker 1 00:16:57 If you haven't seen my Instagram and you just found me through the podcast, please do check out Wonder Care underscore i l. And the petition is in my highlights. And I would be really grateful if you could give it a sign because I am like a dog with a bone when I believe passionately in something. And I do believe very, very passionately in accessible healthcare. And I think that's clear after I've spent the last decade of my life committed to producing content for parents, which will help them to navigate their family's health. So yes, please give that a sign. I think I have answered all of the questions there. If you have found this episode helpful, I would be so, so grateful If you could give us a little review on Spotify or Apple or wherever you listen to your podcast and keep an eye on my question boxes where you'll get to ask questions about the upcoming topics. I absolutely love hearing from all of you. Do subscribe and follow the show to keep up to date on everything family health. Thank.
