infection

Attract Pediatric Pink-Eye Patients

Show parents and other healthcare practitioners that you're the best person to handle their child's conjunctivitis.

DANIEL E. SMITH, O.D., Kansas City, MO

The proper installation of an antibiotic began to quell this child's bacterial conjunctivitis.

Despite the fact that eyecare practitioners are the experts in the identification and treatment of conjunctivitis, parents of children who have "pink-eye" often seek care from the child's pediatrician or family physician. I believe the reason for this is that we fail in seizing the opportunity to market ourselves on a day-to-day basis as the best provider for ocular infection.

To change the mindset of parents and physicians alike that conjunctivitis is a condition that we, as optometrists, are best equipped to handle, follow these four tips.

1. Educate the parent

Always take the time to discuss conjunctivitis, especially the fact that all ocular inflammation is not "pink eye" or requires pharmacological care. This misconception is what leads many parents to seek the care of a non-eyecare practitioner, who may prescribe an inappropriate therapeutic or implement the unnecessary use of an antibiotic for palliative care.

It's not uncommon for our patients, despite being healthy, to hear or receive unsolicited information focused on the latest treatment for age-related macular degeneration or seasonal allergies, so we shouldn't overlook disseminating information on the serious nature of an infectious conjunctivitis and its prevalence during the cold/flu season or in environments, such as day-care centers.

Pre-emptive discussion concerning this matter may or may not decrease the incidence of bacterial infection, but it can begin to establish you as the essential provider in the event of its onset.

2. Medicate only when indicated

One would think that the development of therapeutics having broader spectrums of coverage, shorter onsets of action and simpler instillation instruction than their predecessors would serve only as an ally in our attempt to maintain normal ocular flora. Nevertheless, this is not always the case in pediatric use.

Because early stages of the various types of conjunctivitis may share clinical signs and symptoms, redness being the most common, this may prompt some practitioners to prescribe an antibiotic to a patient who presents without a clear etiology. As a result, some practitioners utilize antibiotics with an "it won't hurt" mentality rather than a clinically indicated one. An astute clinician is able to confidently manage the course of conjunctivitis even when a prescription isn't required.

When an antibiotic is warranted, treat aggressively for total eradication of the organism. In addition, warn of potential adverse events, such as stinging and redness, so the parent doesn't alter the course of the medication out of sympathy for his or her child. Also, know the spectrum of the antibiotic in the event the condition doesn't improve and the ailment requires a different drug. Finally, include in your instructions that the child may return to school only when the symptoms are completely resolved, as you want to contain the contagious nature of the infection.

3. Always follow-up

Follow-up care is vital in maintaining that eyecare professionals are the appropriate pro-viders for conjunctivitis. Too often, practitioners write prescriptions with instructions to return only if the condition doesn't improve. The message conveyed by doing so lessens the serious nature of inflammation, which can lead to self-diagnosing and self-medicating by parents. Though tempting, and often well intended, the risks involved in the lack of follow-up care may include the development of cellulitis or the misdiagnosing of a potential masquerade syndrome, such as anterior segment inflammation or a conjunctival intraepithelial neoplasia.

In addition, I find that most parents are appreciative of your seeing the condition to its conclusion, as it shows you genuinely care about ensuring the child reclaims his health.

4. Write letters

Each year, optometrists spend a lot of money on marketing ideas that may attract some new patients, but will never benefit from the professional relationship between themselves and their local healthcare colleagues. Dictation outlining your care on a mutual patient, filed in the pediatrician's chart, serves as an inexpensive yet constant reminder to him that you assume responsibility for the child's eye health.

In addition to serving as this reminder, letters that explain why you selected a certain therapeutic agent and detail your follow-up care offer a means of communication without requiring either provider to take time from a busy clinic schedule to come to the phone.

I recommend you send dictation to the parent and pediatrician, even if the pediatrician didn't directly refer the child to you. Currently, a variety of office-management software, voice-recognition programs, over-the-phone dictation services and professional medical transcription businesses are available to aid in letter-writing.

Unfortunately, just broadening the scope of our profession doesn't automatically identify optometrists as the essential provider for pediatric infectious conjunctivitis. Only the consistent implementation of promotion, such as the four aforementioned tips, will enable us to demonstrate our ability to effectively treat ocular anomalies. The result: Our competence will further educate parents and other healthcare practitioners that optometry is a medical profession, rather than a retail-based one. OM

Dr. Smith is on the optometric staff at Children's Mercy Hospital, Kansas City, Mo. and is in private practice in Lawrence, Kan. E-mail him at desmith5@msn.com.