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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7909
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Our 5y.o. daughter woke up in the morning yesterday and could

Resolved Question:

Our 5y.o. daughter woke up in the morning yesterday and could not open her left eye, with her lashes and eyelids stuck together and a yellowish (even a bit greenish) discharge in the corner of the eye and around. The eye was swollen too, so after we cleaned it, she could open it one-third of a normal. After a while, it got back to normal, so in an hour or so it looked like nothing happened, just looking a bit red and inflamed. Still there was the same discharge from the corner of the eyes (both eyes) during the day. No pain, no discomfort, no itching, only fever of 38C/100.4F which started in the evening and disappeared as soon as she fell asleep.

Today she woke up unable to open her both eyes at all. Eyelids and lashes stuck together and this yellow-greenish discharge again. Actually, the left eye (which was bad yesterday) has been better than yesterday, with just lashes stuck together and not much of discharge there. And now the right one (which was ok yesterday) had a lot of this discharge. But comparing with yesterday, the eyes were not swollen, so when we cleaned the discharge and she could open her eyes, they look normal, not even red.

Actually, some time ago, maybe a month ago or so, we noticed that sometimes she has some small crusts on her lashes, especially in the mornings. We would clean it, but not really worry about it, as my husband remember having the same thing with his lashes in childhood and it was very minor too.

But now I guess, it may have been the beginning of what we see now. I guess it looks like conjunctivitis.
We live in a island country, where specialised medical help is very limited, with the only one ophthalmologist who can see my daughter in July. As I understand the conjunctivitis (if that is what she has) seriousness can vary, so we want to understand whether it is something that needs special tests and treatment.

I have a photo of how her eyes looked in the morning today, but I do not see how I can attach the photo to my question.

Thank you!
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Customer:

Hello Dr. Rick

Dr. Rick :

You can attach your photo using the paperclip on your screen. I would be happy to take a look at it.

Customer:

great. just a second

Customer:

here she is

Dr. Rick :

Ok. Got 'em. Let me take a look

Dr. Rick :

Did this start in both eyes at the same time?

Customer:

I would say, when she started to have these small crusts on lashes a month ago, always more was on one eye

Customer:

but another one had too, but less

Dr. Rick :

Also, how do her eyeballs look once you get her lids cleaned up? And is her vision affected much?

Customer:

yesterday was the same, one eye was bad and another one had just a little bit of discharge

Customer:

the pictures were of today

Customer:

vision is not affected, she is saying

Customer:

wait a sec, i will send a picture of now, when cleaned

Dr. Rick :

ok. Also of her actual eyeball if possible........

Customer:

Full Size Image

Customer:

Full Size Image

Customer:

here she is

Dr. Rick :

got em

Customer:

please let me know if you want me to take a closer picture from the eyes or from the side

Dr. Rick :

Those are great. Nice smile :)

Customer:

:) yes and not very nice eyes :(

Dr. Rick :

I have 5 kids....three girls, two boys.

Dr. Rick :

Ok. Well. Good news. This is not a bacterial or even a viral infection/conjunctivitis.

Customer:

oh wow, many happy moments then

Customer:

ohhh

Customer:

what it is then

Dr. Rick :

The most likely cause of the earlier, yucky, pictures followed by the completely normal eyeballs is an allergy.....

Dr. Rick :

even though it does not itch etc...

Dr. Rick :

The good news? No need to leave the DR for therapy. You can treat this at home. Let me tell you how:

Dr. Rick :

(ignore the part of the discussion about dry eyes below...she does not have that)

Dr. Rick :

It sounds like you are suffering from an anterior segment/tear film issue. Many times, for all sorts of reasons, the anterior surface of the eye starts to have difficulties. What can cause this? Well, there are a number of conditions but the most common are dry eyes, allergies and blepharitis....many times all three conditions act together to make you miserable. In order to solve your problem you need to address all of these issues at the same time.


 


When it comes to allergies it is almost impossible to pin down the offending agent(s) and, therefore, treatment needs to focus on controlling the symptoms. Dry eyes are very common and can be improved by a stepwise series of therapies. First, the use of natural tears 4-6+ times/day to augment your natural tear production, if this doesn’t work then you can try temporary punctal occlusion of the lower puncta, then, if needed, temporary occlusion of all 4 puncta then, if indicated, surgical ( non-reversible) closure of the puncta. The openings to your tear drainage system are called puncta and you have one opening on each lid, near your nose.


 


Blepharitis is a condition where glands in the eyelids are not functioning normally. They become plugged and instead of putting out their normal clear, oily secretions, they put out thick, toothpaste like gunk. You may not be able to see this “gunk” yourself, unless it is really bad, but it shows up clearly on slit lamp examination.


 


The best treatment for this condition daily lid scrubs combined with warm compresses. I like to use baby shampoo for lid scrubs. In the shower, place the shampoo on your index fingers, close your eyes, raise your eyebrows (to stretch the skin on your eyelids) and scrub back and forth along your eyelashes for 3 to 5 minutes. The hot water in the shower helps to soften the plugged oils in the glands while the mechanical scrubbing with your soapy fingers removes the oils.


 


Baby shampoo lid scrubs will also help to wash away allergens and stimulate tear production, thereby addressing all three of your issues. Remember, this is not an instant fix. While you are waiting for the lid scrubs to have affect you can use over the counter allergy pills such as Travist, dimetapp or Zyrtec.


 


Should your symptoms get worse, your vision become significantly affected or things just not get better in 3 weeks or so you should have a complete eye examination by your local ophthalmologist to look for other, less common, causes of your symptoms.


 


I understand that this treatment seems a bit "too low tech" to be of value, but after 2 decades of clinical practice, I can assure you (even from personal experience :) that it, does indeed, work.


 

Customer:

hmmm... she is not very allergic, actually.. but she really has dry skin

Customer:

and she has dry crusts on her head, we always fighting with

Customer:

could this be just dry eyes, without allergy?

Dr. Rick :

Ok. That gunk in the morning is most likely from an immune reaction to something. The reason it looks so bad in the morning is that the gunk builds up at night whereas during the day blinking washes it away at it forms.

Customer:

because we live in Dominica for 3 year, environment is same, fruits same, food same, flowers same... I think the allergy would show up before, no?

Dr. Rick :

Dry eyes are very, very uncommon in 5 year olds.....

Dr. Rick :

Allergies can show up at anytime......

Customer:

but if it is allergy, if we do not know the cause, how will we get rid of it?

Customer:

I mean would not it cause it again.

Customer:

shampoo is very ok with us, we try to avoid medicines as much as possible, of course if there is no risk to health

Dr. Rick :

You could consider having her seen by a doctor with her eyes all goopy and they could culture the discharge and look at it under the microscope but I bet it will turn out to be inflammatory discharge.

Dr. Rick :

They only way to do that is with formal allergy testing with an allergist.

Dr. Rick :

Baby shampoo is about as safe as it gets :)

Customer:

but the crust she started to have a month ago ?

Customer:

was it the first sign ?

Dr. Rick :

That could be the same thing, but at a lesser degree....

Dr. Rick :

I believe it might have been the first sign, yes.

Customer:

should we think of that period as a start, or of yesterday?

Customer:

I am just trying to figure out what could it be

Dr. Rick :

The good news is that this is not something that is going to damage her vision or her eyes and it does not require an emergency visit to an ophthalmologist.

Dr. Rick :

When the crust began was most likely the beginnig.

Dr. Rick :

I am 100% sure from the pictures and the information you have provided that this is not pink eye and it is not a bacterial infection of her eyeball

Customer:

ahha.. ok.. so just natural tears and baby shampoo scarabs, right?

Customer:

but why did it cause the fever to rise yesterday evening?

Dr. Rick :

and hot compresses.

Dr. Rick :

Good question. And I don't know :(

Customer:

:(

Customer:

what about tears, scrubs, and compresses - do we need to do it every day? for how many days

Dr. Rick :

The tears only to sooth her eyes if needed. I would do the scrubs every day along with the warm compresses. Also try children's allergy meds if you want. Give it 3 to 4 weeks and see how it goes.

Dr. Rick :

If things get worse then a visit to her pediatrician should be fine. If you want to take her to an ophthalmologist that would be OK also, but since I believe this is a systemic problem and not really an eye centered issue, her regular peds MD should be able to take care of this.

Dr. Rick :

Home therapy doesn't work as fast as a shot or a pill.....but it has less side effects.

Customer:

great, we have the appointment with paediatrician tomorrow. Thank you, doctor

Dr. Rick :

My pleasure. Have a good day.

Dr. Rick :

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Customer:

thank you, XXXXX XXXXX

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7909
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year ago.
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