April 30, 2009


When I applied to medical school, I kept getting asked the same bunch of interview questions. One of them was what I might do if I didn't become a doctor. My usual response was that I'd like to be a kindergarten teacher. Mostly, I was told that this was not a response they usually heard. The interviewers heard a lot, they told me, of applicants saying that they would become research scientists and selfless public health workers. I, on the other hand, thought it would be fun to play circle games. I got in despite this—or maybe because of it. I have great respect for teachers, and appreciate the work they do.

So when Henry came into my office because of a problem noted by his kindergarten teacher, I took it seriously. His mother said that she was told he had pinkeye, which was well known to be extremely contagious, and he would not be permitted back to school until it was better.

Pink Eye is a disease which can only be diagnosed by kindergarten and preschool teachers. It does not appear in the index of, for example, The Manual of Ocular Diagnosis and Therapy (6th edition).

There are many reasons an eye could be red. Eye infections of all kinds can make an eye red. Though this is often called conjunctivitis, there are many different types of infection that can make an eye look red. Mostly, we get these infections from touching our eyes with our hands. It’s a natural thing to do and trying to keep kids from rubbing their eyes is not a worthwhile or achievable goal. Our tears wash over our eyes continuously, rinsing away bacteria and dust from the air. The tear ducts drain into the nose, which is why people blow their nose when they’re crying.

In babies, these tiny tear ducts can get blocked. They are so small that the twists and turns they take on their way to the nose just don’t allow the free flow of tears. When they back up, the dust particles and dead cells and bacteria will clump up and make for a goopy eye. Usually, a clean moist cloth is all that’s needed to clear away the debris. For any symptoms beyond that, I like to see the baby and make sure. Blocked tear ducts often clear up as the baby gets bigger. If they don’t, a specialist can help.

Allergies are also a reason an eye could be red, but why just one eye? Usually, allergies affect both eyes.

Of course, he could have something in his eye, irritating it and hurting or itching.

Henry had a pink eye, which was crusted with dried stuff. He said it didn’t hurt, didn’t itch. It was a little pink yesterday, and pinker today. When he woke up, it was glued shut. Just his right eye was affected. He wasn’t sick and wasn’t injured.

For his eye infection, he got some drops that didn’t sting and took away the goop and redness within about a day.

Kids his age do all kinds of wacky and unsanitary things. But short of rubbing somebody else’s eyeball, these typical ‘pinkeye’ infections are not more contagious and not more serious than any other minor illness.

I am often asked when a preschooler is not contagious and can return to school. Honestly, I’m not sure I know a preschooler who isn’t contagious. At least with a red eye, I can clear up the teacher’s concern and get the kid back to school.

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