Pink Eye

[Aneroo, LPN]

When do you send them home for pink eye? I'm fighting it out with a Dad this morning about coming to get his daughter (who graduates in four weeks, but whatever).

Sudden onset of redness, tearing, itching/burning, and some mild purluent drainage this am (was fine when she woke up). Other eye is perfect. She does an internship in the main office, so she deals with the phone a lot, and could have easily picked up a virus or bacteria that way.

I had a student with the other thing the other day and was sent back with a dx of allergies (which it probably was since it was improving the next day). I would think that if it were allergies, it would affect both eyes?

I feel like a doofus since pink eye seems like such a simple thing. I'm playing it safe with all of these and sending them to the doctor. I don't feel like it's my call to say "well, that's allergies" or not in this case, b/c it just isn't clear to me! (I have had some that were super clear- runny nose, itchy/watery eyes bilaterally, strong history of seasonal allergies).

What would you do? What do you think?

[Purple_Scrubs, BSN, RN]

I struggle with this also. I saw one already today that from afar, the entire eye appeared pink, but upon closer inspection, it was just very bloodshot and the conjunctiva was not pink. He had clear discharge and itch, and per mom a history of allergies. I sent him back to class.

For the symptoms you describe, I would have dismissed home. Any purulent drainage or stickiness warrants a trip to the doc from me. If the child says their eyes stuck together when they woke up in the AM, that is another red flag for me. I have also got the notes back that say allergic conjunctivitis, but I don't worry about it. Our job is to assess the symptoms and refer, not to diagnose, and the symptoms can be very similar. When in doubt, refer!

[Maine17]

If the student was at the elementary level and had those sx, I would send them home. At the high school level, hopefully they know enough to wash their hands if they touch their eyes(???). If dad is planning on taking the student to physician after school-I would let her stay thru the day. I would not feel bad about having the other student go to MD's only to find out it was allergies-it could have been an eye infection or scratch from makeup etc.

[Keepstanding, ASN, RN]

Where I work, if there is drainage of any kind, they go home. We don't do drainage or oozing here

Good luck !

Praiser :heartbeat

[NurseLoveJoy88, ASN, RN]

Since she was fine in the AM I would suspect allergies. My golden standard for suspecting pink eye is if they woke up in the morning with drainage or their eye and felt like the eye were stuck and hard to open. I also suspect if the eye is teary. If I called for every teary, red eye my school will be empty. I look for oozing and redness. Now if a student is really uncomfortable with their eyes I'll call just for the parent to administer eye drops.

[Maine17]

I just read Purple Scrubs reply. She is right-if there is any drainage, then send her home and to the doc.

[guest83140]

Yes, it can affect only one eye at first and that is why I tell them to medicate both eyes if it is truly pinkeye bc it usu. goes to the other one. I usu. wash the eye and have them come back to see if it clears up if they think it is allergies. I have a pre-printed Pink Eye letter that I give the parent/student that says in a nutshell that " I don't diagnosis but if the student has 3 symptoms out of 5, due to the severe contagiiousness of pinkeye we have to send the child home. Someteimes, it could be allergies but when there is pus-like substance in the eyelids along with other signs we have no choic but send them home. We have been wrong about pinkeye but sometimes it is a hard thing to call between allergies and pink eye. All we can do is tell you what we see. We are obligated to send the child home if we think he/she has the above symptoms and could possibly be contagious. It is up to your doctor to diagnose. If he/she feels the student is contagious, then we need a written note from the doctor to let your child return. (the 5 symptoms listed on the letter is red eyes, tearing, itching, burning and pus-like substance in the corners of the eyes, sometimes making them stick shut in the morning). Thank you, School Nurse_____________ Date___________ ISD Health Services

[Purple_Scrubs, BSN, RN]

That is a great letter! I wish my district had one! I just might use yours as a draft and see if it flies with the powers that be.

[Artistyc1]

Unless there is a lot of stickiness, with the eye stuck shut in the AM, we don't necessarily send them home. If it is not itchy, and they can keep their hands off of it, and will keep their hands well washed, they may stay. If it is viral, it is caused by the same virus that causes colds. Antibiotic ointment or drops will very likely be given to the parents if they go to the doctor, but it is just to keep the nurses and staff from panicking, it does no good. If we don't exclude children for colds, why should we for viral conjunctivitis? It has to run its course the same way. If it is a very small child that will rub, not wash hands, etc, we do send them home.

[cowgirlBSN]

Not that I know for sure, but my thoughts are determining whether it's allergies or pink eye is almost impossible, and doctor's probably treat for pink eye even though it may not be some times. I know there are differences between the two but with some people it's hard to determine. I send home if pink eye is suspected. It is very contagious. I've read where other school's do not send home for this illness. I let the parent know that it is hard to determine, and that I am NOT a doctor and the safest bet would be to have them examined by a doctor, that it is difficult to differenciate the two. Seriously, these kids are scratching their eyes, turning door knobs and touching so much through the day that I want to be on the safe side.

[LovingOBFutureFNP]

I'm about to wrap up my school nurse gig to return to my true nursing love, obstetrics, but since I'm a still school nurse for 2 more weeks...

I look to see if one eye or both eyes are red, ask if the eye was matted shut or crusty in the morning, ask if the eye has been draining, ask about allergies, and evaluate the conjunctiva. If the eye was matted/crusty in the morning, I automatically send them home without further ado. If not, I look for any foreign body in the eye (eyelash, mascara) and ask if they're wearing contacts since those things might have irritated the eye somehow. I'll try to rinse out the eye with saline and have them rest with their eyes shut for a little while, and several times I've lucked out and everything looks fine after a little while. Even if the eye wasn't matted, if my other tricks don't work, I send them home. Better safe than sorry when you have a population of students who can't seem to keep their hands away from their eyes!

[SchoolNurseBSN]

For me any oozing= adios!

History is important also! I have been sending 7th grade girls home right and left for eye symptoms once I found out they were sharing eyeliner and non-prescription colored contacts!!!! Some of them had no drainage at all - just red and itchy!