Pink Eye: What Parents Should Know

By Dr. Sidney Weiss, pediatric ophthalmologist at CHOC Children’s

‘Pink eye’ is a common term for a viral infection of the conjunctiva of the eye- also called viral conjunctivitis. When a child gets pink eye, this means there is an inflammation of the membranes covering the inner eyelid and the whites of the eye. This can occur in one or both of the eyes. It may appear alone, or as part of a generalized upper respiratory infection involving fever, sore throat and nasal blockage.

It has also been called ‘swimming pool conjunctivitis’ because the infection is often spread in swimming pools.  Chlorine in swimming pool water does not effectively kill viruses nor does it prevent the spread of this infection.

Besides being characterized by pink or even red eyes, there is often some drainage from the eye that may include a colored discharge, or clear tears. The infection is contagious so long as the eye is red and especially so long as discharge is coming from the eye. Your child may complain of sensitivity to light, eye discomfort and blurry vision. Pink eye may be uncomfortable, but very rarely will it threaten vision. If the child’s cornea becomes affected, the vision may be affected more significantly. If you suspect this, consult your child’s pediatrician.

Viral conjunctivitis usually resolves on its own within a few days. If you do consult your pediatrician, they may recommend supportive care, such as increased hygiene, removing the discharge as it appears, and frequent hand washing. They also may prescribe a topical antibiotic for the eye in order to prevent a super-infection by bacteria.

pink eye
Dr. Sidney Weiss, pediatric ophthalmologist at CHOC Children’s

There are several other potential causes of pink or red eyes.

Bacterial infections of the eye are less common than viral infections, but the signs and symptoms are quite similar, including a red or pink coloring, sensitivity to light, and eye discomfort. The discharge associated with bacterial infections tends to be thicker and more colorful. Antibiotic drops are generally quite effective in resolving these infections.

Eyes that appear to have a pink tone do not necessarily mean that a virus is present.  Dry eyes, environmental toxins, and eyes allergic to environmental irritants may appear pink, and may even have a clear discharge.

Allergies are also a very common cause of pink or even red eyes, with itching being a common characteristic. The whites of the eye may even appear swollen, and a clear or off-white discharge is common. Topical over-the-counter antihistamines are generally effective in moderate cases, but prescription topical steroid drops may be necessary to resolve the tougher cases.

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Meet Dr. Rahul Bhola

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Rahul Bhola, an internationally recognized expert in pediatric ophthalmology.

Dr. Bhola comes from a family of physicians. His parents practiced internal medicine for more than 40 years in India, and the empathetic and holistic care they provided to their patients inspired him to pursue a career in medicine.

“Very early on in medical school, I developed a special interest in pediatrics, and the surgical finesse of ophthalmology later cemented my passion for pediatric ophthalmology. A gift of vision is the most important sense a child can have,” Dr. Bhola says. “Giving a ray of light to those who struggle with vision is very gratifying to me. Treating children is important to me because they have their entire lives ahead of them and improving their vision positively impacts their entire family.”

Dr. Bhola attended medical school and completed an internship at University College of Medical Sciences in Delhi, India. He completed two residencies in ophthalmology at Maulana Azad Medical College in New Delhi, India and the University of Louisville, Kentucky. He pursued fellowships in pediatric ophthalmology at the University of California Los Angeles and University of Iowa.

“The biggest reason I was inspired to join CHOC was the mission of the hospital. I feel that CHOC’s mission to nurture, advance and protect the health and well-being of children is in close alignment with my personal goals as a physician,” Bhola says. “I seek to nurture the healthcare of children by delivering state-of-the-art ophthalmology care to our fabulous community. CHOC has the resources, reputation and experience to provide great care.”

At CHOC, Dr. Bhola will provide comprehensive eye care, treating patients with a variety of eye disease and disorders. In addition to treating refractive errors (the need for glasses), Dr. Bhola will provide more specialized care for diseases like amblyopia (lazy eyes), pediatric and adult strabismus (crossing or drifting of eyes), blocked tear duct, diplopia (double vision), pediatric cataracts, pediatric glaucoma, tearing eyes, retinopathy of prematurity, ptosis (droopy eyelids), traumatic eye injuries and uveitis.

Dr. Rahul Bhola
Meet Dr. Rahul Bhola, pediatric ophthalmologist at CHOC Children’s.

The Need for Regular Eye Screenings

Dr. Bhola is passionate about providing education on the need for regular eye screenings. For example, kids complaining of headaches may be taken to a neurologist. However, eye problems like refractive errors (the need for glasses), convergence insufficiency and strabismus can result in headache from excessive straining of the eyes, which may affect school performance and even social withdrawal in some children. These conditions are likely to be identified at regular vision screenings.

Unique Approach To Treating Pediatric Glaucoma

Dr. Bhola is among the very few surgeons nationally skilled in treating pediatric glaucoma surgically using the illuminated microcatheter. This highly-specialized, minimally-invasive approach of canaloplasty has been used for treating pediatric glaucoma only within the last five years. The onset of juvenile glaucoma often occurs between the ages of 10 and 20. It can be secondary to genetics, or traumatic.

“Even though childhood glaucoma is an uncommon disorder, it often goes undetected and can eventually result in blindness, underscoring the importance of regular eye screenings,” says Dr. Bhola.

As a Level II pediatric trauma center, and the only one in Orange County dedicated exclusively for kids, CHOC’s trauma team treats a variety of critically injured from across the region. This includes children who have sustained sports injuries, during which damage to the structure of the eye can cause glaucoma.

Patient-Centered Care

Dr. Bhola’s philosophy of care is to treat his patients as if they were his own children.

“My main philosophy is to provide patient-centered care, delivered with compassion and excellence. I remember their life events, and celebrate their achievements with them. It’s important that a patient remembers and trusts you completely with their care. I love when my patients send me holiday cards and copies of their school photos and let me know how they are doing. They became part of my family. I always treat every patient of mine like they are my own child,” Dr. Bhola says.

He also focuses on treating the whole person rather than the disease, and involving patients in their care.

“I don’t treat the disease, I treat the individual. Healing is more than treating the disease. I want to be at their level so I always talk to them directly and not only talk to their parents. I involve their entire group during treatment,” he says.

At CHOC, Dr. Bhola is eager to provide holistic eye care for his patients.

“My practice will offer complete comprehensive vision care to all patients, which includes both medical as well as surgical care. Our patients come to us for glasses, contacts, regular vision screenings, and we also provide more specialized care like glaucoma, cataract and strabismus surgeries,” Bhola says. “Systemic disorders such as diabetes, sickle cell anemia, juvenile rheumatic disease and lupus, have coexisting eye issues that may go undetected if children aren’t seen for regular eye screenings. CHOC patients with systemic disorders such as diabetes now have better access to holistic care.”

As division chief for CHOC Children’s Specialists ophthalmology, Dr. Bhola is passionate about providing state-of-the-art care to patients and training the next generation of pediatric ophthalmologists.

“My main goal is to build a state-of-the-art ophthalmology division, not only delivering excellent patient care but also engaging in vital research and disseminating education to the next generation of ophthalmologists and referring providers,” Bhola says.

When not treating patients, Dr. Bhola enjoys cooking, practicing yoga and meditation and spending time with his wife and two daughters.

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Contact Lenses: Is Your Child Ready?

You might think your child’s glasses are adorable, but she could very well disagree. Is your child ready for contact lenses though? In honor of Children’s Eye Health and Safety Month, we chatted with Dr. Sidney Weiss, a CHOC Children’s ophthalmologist, about how parents can find out.

 With the advent of low-maintenance contact lenses that are replaced daily, children as young as 8 might be able to wear lenses, Dr. Weiss says. Children ages 12 and older are better equipped to wear and maintain contact lenses designed to last for two weeks or a month, though he still recommends one-day lenses for children this age.

contact lenses
Dr. Sidney Weiss

But age isn’t the first criteria for knowing a child is ready for contacts. Most importantly, the child needs to show enthusiasm for wearing them, Dr. Weiss says.  Along with that, children must understand that contact lenses require responsibility and rigorous hygiene.

“Children must have the cognitive ability to understand that wearing contact lenses imposes a serious responsibility to protect the health of the eye,” Dr. Weiss says.

Hygiene is Key

Parents must be able to judge a child’s ability to maintain good personal hygiene, which is key to ensuring safe contact use. Users must be vigilant about washing hands before inserting, removing or simply adjusting contact lenses.

Poor hygiene and improper lens handling pose several risks to users, Dr. Weiss says.

“Corneal infections are the prominent threat to children wearing contact lenses,” he says. “Even with proper hygiene and technique, infections can and do occur. Far less common are fungal and even more exotic sources of infections.”

A scratch on the cornea can result during insertion or removal; if a foreign object gets between the lens and the cornea; or if a child too vigorously rubs his or her eye, Dr. Weiss says.

“The most common signs of trouble are the presence of a red eye or the observation of a white spot on the affected cornea,” he says. “Symptoms of pain, light sensitivity, and decreased vision are common. These should alert the child and family to seek professional help.”

Proper Materials

In addition to frequent hand washing, contact lens wearers must use proper materials to clean and store the lenses. Never use water or saliva to clean a lens. If the child uses eye drops, only use clear drops rather than any product that appears milky. Swimming in contact lenses is discouraged, but if undertaken, lenses should be removed and thrown out afterward. Don’t share lenses with others and don’t sleep in lenses.

In addition to good hygiene, children must have basic small motor skills to wear contacts. Though Dr. Weiss says parents can assist children in inserting the lenses, the child must be able to remove them in case of an emergency.

Parents should supervise insertion and removal for at least several months after a child begins to wear contacts. Following hand washing, a basic insertion technique requires the child to look up, pull the lower eye lid down and forward, and place the lens onto the eye with the other hand. Removal also begins with hand washing, and essentially requires a pinching motion to pluck the lens from the eye.

Astigmatism’s Effect

Even with enthusiasm and good hygiene and motor skills, some children may still not be ready for contacts, especially if they have astigmatism. Astigmatism is a defect in the curve of the eye that creates a football-like shape and can be harder to fit for contacts.

“The common spherical contact lenses available do not correct astigmatism,” Dr. Weiss says. “This circumstance may lead to disappointing vision in these children as opposed to their vision when wearing glasses, and consequent failure. Astigmatism-correcting contact lenses are more expensive and hard to fit well, and are best fit on older children and adults.”

Astigmatism or not, proper fit is crucial for contacts. That’s why all appointments with ophthalmologists or optometrists must be kept and repeated on a timely basis, and children should not procure lenses from non-professionals, Dr. Weiss says.

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Tips to Make Eye Drops Easier for Kids – and Parents

Administering eye drops to small children can be difficult for parents and kids alike – and rest assured, it isn’t always easy for doctors, either.

“It’s daunting at times for parents and physicians,” says CHOC Children’s ophthalmologist Dr. Sidney Weiss.

Eye drops may be prescribed for a variety of conditions including infections, allergies and dry eyes, pupil dilation in advance of an ophthalmologist appointment, and medical diagnosis therapies, he says.

And because eye drop administration can be challenging, Dr. Weiss has a few tips to help smooth this process.

Working with a partner

With the help of a parent, older children can receive eye drops while seated or standing, with their head tilted back so that their eyes create a horizontal plane, Dr. Weiss says. After age 10, children can try with supervision to administer the drops themselves.

However, giving drops to infants and children up to age 3, as well as some older children with developmental delays, can be especially challenging and often requires restraining the child. In these cases, parents should try to find a partner to help.

Try laying the child on the floor, in a chair or in someone’s lap. While one person holds the child’s arms and legs still, the other can administer the drops. Dr. Weiss recommends asking the child to open his eyes and look back as far as possible, as if he were trying to see the back of his head.

While gently holding the child’s upper eyelid open, lightly pinch together the bottom eyelid to create a small pouch. Squeeze the drops into the pouch and ask the child to keep the eye closed for 30 seconds.

The drop administrator should also put a finger over the closed eyelid near the inner corner to prevent absorption of the medicine into the tear duct, which can be harmful.

Going solo

Should a parent need to restrain the child to administer drops and another person isn’t available to help, Dr. Weiss suggests this method:

While sitting on the floor, the parent should lay the child in his or her lap, with the child’s head at the parent’s abdomen facing the ceiling and the child’s legs extending along the parent’s legs. Place the child’s arms under the parent’s legs. The parent can also wrap one leg around the child’s legs to keep him or her still.

Administer the drops using the method described above.

Working around closed eyes

Sometimes, even with another grownup to help, kids just won’t open their eyes, Dr. Weiss says.

In these cases, take advantage of closed eyes with this technique: Have the child lie down with their eyes closed. Place the drops in the inner corner of their eyes to create a little pool of medicine. Once the child opens his or her lids, the drops will dribble into their eye, Dr. Weiss says.

“This may waste some medicine, but any port in a storm,” he says, adding that this method can also work while the child sleeps.

General eye drop tips

Besides positioning, parents can try a few other techniques to make administering eye drops easier and safer, Dr. Weiss suggests:

  1. Before administering, parents should take a minute to double check that they are using the correct drops.
  2. Gather all necessary materials (drops, tissues, wash cloths, etc.) and wash hands before and after administering eye drops to a child.
  3. To avoid contamination, don’t touch the tip of the bottle to any surface, including the eye, eyelid or eye lashes. Use alcohol to sanitize the tip if there’s any chance of contact.
  4. Try to appear as relaxed as possible. Babies and children can tell if their parent or caregiver is distraught and will respond accordingly.
  5. Try to create a calm, soothing environment and explain to older children what you’re doing and why.

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Tips to Protect Your Child from Eye Injuries

Bet you didn’t know October is Eye Injury Prevention Month? While most children’s eye injuries are minor, others, like those that often occur in sports and recreational activities, can be serious and require medical attention.

Check out the following tips to protect children’s eyes from injury:
• Keep all chemicals and sprays out of reach of small children.
• Only purchase age-appropriate toys.
• Avoid projectile toys such as darts.
• Along with sports equipment, provide your children with the appropriate protective eyewear.
• Ensure there are no sharp corners on the edges of furnishings and home fixtures.
• Provide appropriate lights and handrails to improve safety on stairs in the home.
• Beware of items in playgrounds that pose potential eye hazards.
• Remind your children not to play or run with sharp objects such as scissors, a fork or pencil.

Should your child suffer an eye injury, keep these guidelines in mind.

If you think your child has small debris in the eye or a minor irritation, be sure to:
• Wash your hands thoroughly before touching the eye area.
• Tilt the child’s head over a basin or sink with the affected eye pointed down.
• Gently pull down the lower lid.
• Gently pour a steady stream of lukewarm water over the eye.
• Flush the eye for up to 15 minutes, checking every 5 minutes to see if the foreign body has been flushed out.

Seek medical care if your child has:
(Even if the injury seems minor at first, as a serious injury is not always immediately obvious)
• been struck or poked in the eye with a ball or other object
• a swollen, red, or painful area around the eye or eyelid
• an eye that’s very sensitive to light

Seek emergency medical care if your child has:
• trouble seeing
• been exposed to chemicals
• something embedded in the eye
• severe eye pain
• blood in the eye
• nausea or vomiting after an eye injury

While seeking medical help, remind your child not to rub his or her eyes. A cut or puncture wound should be gently covered. Do not apply ointment or medication to the eye.

More articles about protecting children’s eyes and vision:

  • Eye Infections in Kids
    Pink eye isn’t the only eye problem found in babies and children that parents should be aware of, a CHOC Children’s infectious disease specialist says. Here are some other eye ...
  • Tips to Make Eye Drops Easier for Kids – and Parents
    Administering eye drops to small children can be difficult for parents and kids alike – and rest assured, it isn’t always easy for doctors, either. “It’s daunting at times for parents ...
  • Protect Your Child’s Vision
    An eye injury can occur at any time, in any place. Adequate prevention is important because most eye injuries can be prevented. Almost half of all eye injuries occur in sports ...

 

Protect Your Child’s Vision

An eye injury can occur at any time, in any place. Adequate prevention is important because most eye injuries can be prevented.

Almost half of all eye injuries occur in sports and recreational activities, and more often in children and teens than any other age group, according to the American Association for Pediatric Ophthalmology and Strabismus. The American Academy of Ophthalmology also says sports deserve particular attention because eye injuries occur fairly often in children and young adult athletes.

Dr. David Sami, a CHOC pediatric ophthalmologist and pediatric eye surgeon, recommends that children playing certain sports wear protective goggles, sport goggles or a mask of some kind to protect the eyes. Dr. Sami notes that certain sports in particular carry a higher risk for eye injuries, such as sports that use a small ball or puck, like golf and hockey. Paintball and racquet ball also are a concern.

When it comes to eye and vision protection, the sun’s rays and excessive screen time, especially on a small cellphone screen, also tend to raise parents’ concerns, says Dr. Sami.

“Parents often worry about the sun damaging eyes,” says Dr. Sami. “The boney rim above the eye, the eyelashes, eyebrows and pupils all provide natural defenses against the sun. There is no problem against wearing sunglasses but I’m a bigger fan of kids wearing hats or caps because hats also protect the skin from future skin cancer, as well as protecting the eyes from the sun. Sunglasses are an effective measure but a hat offers greater protection,” he says.

What about the concern over children spending several hours a day looking at small screens on mobile device? Dr. Sami says there is no evidence to date that looking at a screen for long periods of time will damage your eyes. However, he says, excessive screen time does limit kids’ world experience because it stops them from doing other healthy activities like playing outside.

“There is no known danger to the eyes from a screen but you’re missing out on playing and the physical and emotional development that is so important.”

Here are some other tips to protect children’s eyes from injury:

• Keep all chemicals and sprays out of reach of small children.
• Only purchase age-appropriate toys.
• Avoid projectile toys such as darts.

More articles about protecting eyes and vision:

  • Eye Infections in Kids
    Pink eye isn’t the only eye problem found in babies and children that parents should be aware of, a CHOC Children’s infectious disease specialist says. Here are some other eye ...
  • Tips to Make Eye Drops Easier for Kids – and Parents
    Administering eye drops to small children can be difficult for parents and kids alike – and rest assured, it isn’t always easy for doctors, either. “It’s daunting at times for parents ...
  • Tips to Protect Your Child from Eye Injuries
    Bet you didn’t know October is Eye Injury Prevention Month? While most children’s eye injuries are minor, others, like those that often occur in sports and recreational activities, can be ...

Tips for Buying Reading Glasses

Is buying new reading glasses for your child part of your back to school checklist? Glasses come in many shapes, sizes and prescriptions, and buying them can be a confusing process. Here are a few tips from our CHOC Kids Health resource that you can use while making your first purchase:

1. Lenses
• Thickness: The thickness of the lens depends heavily on the type of prescription your child has. If the prescription calls for thick lenses, it is important to keep the frames smaller in order to reduce the overall lens thickness. Smaller lens thickness also reduces the likelihood of distorted peripheral vision.
• Material: Children’s lenses should be made from Polycarbonate or Trivex (as opposed to glass), because they are the safest materials. In addition to being lightweight, they also offer protection against harmful ultraviolet rays.

2. Bridge Fit
• Ensuring that your child’s glasses have a proper bridge fit is crucial, because it will prevent the glasses from sliding down the nose. Your optician will be the best judge as to whether glasses have a proper bridge fit.

3. Frames
• The frames for children’s glasses are usually made  out of plastic or metal. Plastic frames tend to be lighter and more durable, but many manufacturers are making metal frames with similar advantages. Children under the age of two should wear plastic frames. For older children that might wear metal frames, make sure that they have spring hinges, because it makes them more durable.
• Be sure to ask your optician for a hypoallergenic frame material if your child has shown sensitivity to different substances or alloys.

4. Style
• This may be just as important as every other feature – make sure your child likes the style of the glasses! Since he or she has to wear them every day, it’s important that the child feels a level of confidence while wearing them.

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Tips to Maintain Good Vision

It’s Children’s Eye Health and Safety Month! Healthy eyes and vision are an important part of a child’s development. Check out these easy tips recommended by the Centers for Disease Control and Prevention for maintaining both your and your child’s good vision.

1. Protect your eyes.
• Just like when you wear pads to protect your joints during sports, you also need to protect your eyes. Wearing a pair of sunglasses is one of the best defenses. Not only does it keep give another layer of protection, but buying a pair of sunglasses with ultraviolet (UV) protection also blocks UV light, which can cause long term damage to the eyes.
• Wear protective eyewear during activities that have potential to harm your eyes. A few examples may include science labs, workshops, and contact sports.

2. Know your stuff.
• It’s important to know your family’s eye health history, since many eye diseases are hereditary. Talk to your family members so you can find out if you’re at a higher risk for a certain eye disease.

3. Don’t strain your eyes!
• Activities like watching TV or staring at a computer screen have the potential to strain your eyes if you do them for too long. When we stare, our blink rate goes down from 10 times a minute to 2 or 3 times a minute. It helps to change your focus from time to time- look away from the TV for a few seconds before resuming your program.
•  If your eyes start to feel dry or irritated while watching TV or using a computer, use artificial teardrops to add back some moisture.

4.  Eat well, see well.
• It’s important to maintain a healthy, balanced diet in order to maintain good vision. You’ve heard that foods rich in Vitamin A are good for your eyes, which is true. Spinach, kale, and carrots are all known for their high levels of Vitamin A. But it is also important to eat foods high in omega-3 fatty acids- like salmon, tuna, and almonds. Maintaining a healthy weight is also important.

5. Stay clean.
• Most eye diseases are spread through physical contact, so it is important to always wash your hands thoroughly before touching your eyes or putting in contact lenses.
• Avoid sharing eye drops or makeup with anyone else, and never touch the top of the bottle of eye drops with your hands, as the germs from your fingers can spread to your eyes.
• If your eyes start to become irritated, red, or you begin to notice other changes, contact your doctor to have them checked.

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CHOC Recommends Sports Eye Safety Tips

Bet you didn’t know April is Sports Eye Safety Awareness Month? Check out the following safety tips for your athlete at home. Eye protection, just like helmets and other safety gear, is a must for many sports.

  • Facemasks or polycarbonate guards or shields that attach to a helmet are worn in sports such as football, ice hockey, and softball and baseball when batting.
  • Goggles are often worn for soccer, basketball, racquet sports, snowboarding, street hockey, baseball, and softball when fielding.
  • If your child wears glasses, you’ll probably need prescription polycarbonate goggles.
  • All eye protection should fit securely and have cushions above your eyebrows and over your nose.

Here are a few common injuries, and how to treat them. Keep in mind that although most sports eye injuries are minor, a few could require medical attention.

Black Eye – Although typically a minor injury, a black eye can also appear when there is significant eye injury or head trauma. A visit to the doctor may be required to rule out serious injury, particularly if you’re not certain of the cause of the black eye. What to do:

  • Apply cold compresses intermittently. If you use ice, make sure it’s covered with a towel to protect the delicate skin on the eyelid.
  • Prop your child’s head with an extra pillow at night, and encourage him or her to sleep on the uninjured side of the face. Call your doctor, who may recommend an evaluation to rule out damage to the eye.

Irritations – You can treat most minor eye irritations by flushing the eye with water. Remember to wash your hands before examining or flushing your child’s eye. Do not try to remove any foreign body except by flushing, because of the risk of scratching the surface of the eye. If a foreign body is not dislodged by flushing, it will probably be necessary for a medical professional to flush the eye.

Embedded Foreign Object – If an object, such as a piece of glass or metal, is sticking out of the eye, take your child to the emergency room. Keep your child – and yourself – as calm and comfortable as possible until you can get help.

Seek Emergency Care If Your Child Has:

  • Trouble Seeing
  • Been Exposed to Chemicals
  • Something Embedded in the Eye
  • Severe Eye Pain
  • Blood in the Eye
  • Nausea or Vomiting After an Eye Injury

Remember, the equipment your child wears while participating in sports is key to ensuring your child has a fun – and safe – game. Talk to your kids about sports safety and how to prevent injuries.

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