Eye infections in children are especially common in kindergartens and schools, and in most cases are not caused by bacteria at all but by viruses. Not every red eye requires antibiotics, and in many cases, gentle treatment and monitoring can begin without rushing to a prescription.
Redness in the eyes, discharge, and mild swelling can appear all at once and create immediate concern for parents. This often happens in the morning, just before heading to school or daycare, leading to familiar questions: Is it a contagious infection? Should the child stay home? And is the solution a medication right away?
In practice, eye infections in children mostly appear during periods of illness in group settings. The combination of crowding, close contact, and daily habits such as rubbing the eyes with unclean hands allows them to spread quickly. In most cases, it is not dangerous, but it causes significant discomfort and can disrupt the child’s and the family’s routine.
How to distinguish which infection it is?
Not every red eye comes from the same cause. In children, viral and bacterial infections are common, and sometimes the condition is not infectious at all, such as a blockage in the tear ducts, especially in early childhood. Allergy is a known possibility, but at a young age it is less common and tends to appear more from school age onward.
Despite the differences in causes, symptoms can look similar: Redness, swelling, discharge, and sometimes pain. Therefore, diagnosis in the clinic is usually based on the clinical picture, and in some cases also on a culture, mainly when there is no improvement or the situation is not clear-cut.
Why not rush to antibiotics?
In the past, the appearance of eye discharge often led almost automatically to an antibiotic prescription. Today it is clear that a large part of eye infections in children are viral, and therefore antibiotics are not necessarily the solution. In addition, overuse of antibiotics can contribute to the development of bacterial resistance and unnecessary exposure to medications.
If in the past there was a tendency to give antibiotics almost immediately, both to prevent and to treat, today there are better alternatives that can address both viral infections and bacterial infections without the cost of overusing antibiotics, which can lead to bacterial resistance.
This means a gradual treatment approach: Start gently when possible, monitor changes, and escalate treatment only if there is no response or if warning signs appear.
Reducing and limiting contagion
Alongside supportive treatment like artificial tears, there are also gentle over-the-counter products that can provide broader coverage. Among them are ‘Dropsept’ eye drops, based on chlorhexidine combined with a derivative of vitamin E. Chlorhexidine is an antimicrobial agent with broad activity, and the vitamin helps reduce discomfort and support the eye’s mucous membrane.
The practical advantage is the possibility to start treatment at the onset of symptoms, when redness and discomfort appear, as long as the condition is not severe and there is no significant worsening. At the same time, simple steps can reduce contagion and speed recovery: Hand hygiene, a separate towel for the child, changing bedding, and avoiding rubbing the eyes.
It is important to remember that contagion does not only occur through direct contact between children. In educational settings, infectious agents can survive on toys, tables, chairs, and various surfaces for days. Cleaning toys and surfaces during illness periods, along with handwashing and using personal towels, is a key part of preventing mass contagion.
When is it important to get checked?
Not every case requires an immediate doctor visit. If the condition is mild, the child feels well, and there is no worsening, gentle treatment and monitoring can begin. If there is no improvement within two to three days, or if there is deterioration, a check-up is recommended.
It is very important to know that children must never use eye drops containing steroids – this is a critical safety rule because incorrect use can complicate the situation and therefore should only be under medical supervision.
When significant pain, noticeable eyelid swelling, strong light sensitivity, vision decrease, rapid worsening, or poor general condition appear, do not wait and seek medical evaluation. In some cases, the infection can even spread to the eyelid area.
Dr. Yonina Ron is a specialist in pediatric ophthalmology and head of the pediatric eye and strabismus department at Rambam Hospital.