If the child is going to be urgently referred, you should treat the eye infection. Clean the eye gently. Pull down the lower lid. Squirt the first dose of tetracycline eye ointment onto the lower eyelid and then refer him. Don't try to counsel the mother at this point, because there is not enough time.

If the child is not being referred, then you should teach the mother how to apply the tetracycline eye ointment.

Tell the mother that she should treat both eyes and that she will need to:

Wash her hands before and after treating the eyes
Clean the child's eyes immediately before applying the tetracycline eye ointment. Use a clean cloth to wipe each eye
Repeat the process (cleaning the eyes and applying ointment) three times per day, in the morning, at mid-day and in the evening.

Then show the mother how to treat the eye. Be sure to wash your hands.

Have someone hold the child still
Wipe one of the child's eyes with the cloth
Hold down the lower lid of child's eye. Tell her to be careful that the tube does not touch the eye or lid
Squirt the ointment onto the lower lid. Make sure the mother sees where to apply the ointment and the amount she should use (see Figure 14.2).

Figure 14.2 Actual size of tetracycline ointment to be applied to the child's eye. (Source: FMOH IMNCI Training Module)

Ask the mother to practise cleaning and applying the eye ointment in the child's other eye. Observe and give feedback as she practises. When she is finished, give her the following additional information.

Treat both eyes until the redness is gone from the infected eye. The infected eye is improving if there is less pus in the eye or the eyes are not stuck shut in the morning
Do not put any other eye ointments, drops or alternative treatments in the child's eyes. They may be harmful and damage the child's eyes
After two days, if there is still pus in the eye, she should bring the child back to the health post.

Then give the mother the tube of ointment to take home. Give her the same tube you used to treat the child.

Before the mother leaves, ask checking questions to ensure that she understands how to give the treatment to her child at home.