Chemosis and appearances in the classroomroom.

[arlingtonnurse]

Yesterday I had a student with the worst case of chemosis I had ever seen.  A known seasonal allergy sufferer, he came in with one eye quite red and draining quite a bit of clear fluid.  Within minutes the conjunctiva had swelled so much it was covering portions of the iris and spilling over the eye lid.  Face wash, cetirizine, an ice pack and a call to dad later, slowly the swelling lessoned and eventually he went back to class.  Student was nonchalant throughout.  I had kept him nearly an hour, however, and this was partially because I knew his teachers and classmates would be alarmed by his eye's appearance.  In the past I have sent students back to class with the classic 'goose egg' and had teachers push back (or call home and insist student should be picked up🙄).   Would you send a student back to class if they looked bad, even if you knew they were doing well clinically?  Our focus has really been on trying to keep kids in class so I don't want to exclude for superficial reasons, but I also don't want them to be a distraction to the classroom.

[k1p1ssk, BSN, RN]

I think I would have kept them until the swelling had started to subside as well. I think I recall that you are also in the Northeast US and the allergies are BRUTAL right now. I thought last week was bad, but this week has seemingly been worse. And it's causing all kinds of weird reactions!! I've had the coughs, post-nasal drips, congestion/runny nose, periorbital swelling, and today, I have a kid with a bad skin reaction to the pollen! Teacher wants me to send him home, too, but he's improving with meds on board. I told her we would give it a couple hours and re-evaluate before recess... 

[arlingtonnurse]

Yes, I am in Massachusetts as well as you and agree that allergies are brutal and I've been getting more extreme reactions too.  I had a different kid that had welts forming on their eye lids!  Poor kiddo-- so itchy it was uncomfortable to even look at.  Fortunately, they didn't last long after treatment.  I am glad we have cetirizine now for our standing orders so I can dose them up without knocking them out completely!