Conjunctivitis Confusion in Kids

This episode of Charting Pediatrics tackles the common yet complex condition of conjunctivitis in children, offering pediatricians a clear framework for diagnosing and managing pink eye. Dr. Allison Brent is joined by Dr. Becca Edwards Mayhew, a pediatric ophthalmologist, who emphasizes that conjunctivitis is a clinical diagnosis requiring careful history-taking and physical exam to differentiate between bacterial, viral, and allergic causes. Key differentiators include unilateral vs. bilateral presentation, discharge type (mucoid vs. watery), associated symptoms like ear infections or preauricular lymphadenopathy, and chronicity. The discussion highlights the growing consensus on watchful waiting for most cases of bacterial conjunctivitis, given that 60% resolve without antibiotics, to combat antimicrobial resistance. However, red flags such as corneal involvement, severe pain, vision changes, or systemic illness require urgent referral. A critical insight is the underrecognized condition blepharoceratoconjunctivitis, which mimics recurrent pink eye but can lead to corneal scarring and amblyopia if mismanaged. The episode concludes with practical guidance on treatment, testing, and school return policies, stressing shared decision-making with families and the importance of context-specific school rules.