Transcript Conjunctivitis
Red Eye in Children
Diagnosis and Management
Ronit Friling M.D.
SCHNEIDER MEDICAL CENTER םידלי
Red Eye Disorders: Non-Vision -Threatening
Conjunctivitis
Subconjunctival hemorrhage
Chalasion
Blepharitis
Dry eyes
Corneal abrasions (most)
Red Eye Disorders: Vision -Threatening
Corneal infection
Scleritis
Hyphema
Iritis
Acute glaucoma
Foreign body
Anamnesis:
•
How long has the eye been red?
•
Does the vision seem to be okay ?
•
Do the eyes move normally ?
•
Is the infection in both eyes ?
Anamnesis:
•
Does the child wear contact lenses ?
•
Is there a history of trauma ?
•
How long has the eye been red ?
•
Is the pupil round ?
Dacryocystitis N aso L acrimal D uct O bstruction Signs: Red painful swelling above lacrimal sac History of chronic eye watering
Dacryocystitis
Dacryocystitis
Dacryocystitis Pathogens
: Staphylococcus aureus, Strep pneumonia
Treatment:
conservative until 1 yr (antibiotics after culture, hygiene, massage?) Surgery at 1 yr - probing, silicone tubes, rarely DCR
Bacterial Chlamydia Viral Allergic
Conjunctivitis
Conjunctivitis: symptoms & signs
Symptoms: Sore, red, sticky eyes.
Signs: Red conjunctiva, discharge.
Viral & Chlamydial: Follicles, swollen lids, enlarged preauricular node.
Bacterial
Conjunctivitis
Strep pneumonia Haemophilus Staph. aureus Neisseria gonorrhea
Chlamydia
Conjunctivitis
Ophthalmia Neonatorum Any conjunctivitis during the first month of life
Ophthalmia Neonatorum
Etiology thought to have been acquired in birth canal: chlamydia, gonococcus, other bacteria
Regard chlamydia and gonococcus as systemic disease and treat systemically
Corneal ulcer : symptoms
• Pain • Watering • Photophobia • Blurring of vision
Corneal ulcer : signs
• Red eye • Epithelial defect fluorescein staining • Corneal infiltrate • A/C inflammation, Hypopyon
Corneal ulcer : risk factors
• Contact lens wear • Dry eye • Insesitive eye • Blepharitis • Herpes virus- zoster, simplex
Corneal ulcer : risk factors
• Ectropion • Bell ’s palsy • Corneal surgery, injury, foreign body
Corneal ulcer : pathogens
•
Bacterial
Pseudomonas Staphylococcus • Streptococcus
Viral
Herpes simplex •
Fungal
Corneal ulcer : treatment
Referral to hospital - culture Admission Urgent topical antibiotic treatment: Cefazolin - Gentamicin drops Fluoroquinolon (ciloxan, oflox) drops q 1h - q 1/2h
Conjunctivitis
Viral Adenovirus Herpes simplex virus
Herpes simplex keratitis
Primary infection during childhood
Herpes simplex keratitis
Usually unilateral Dendritic pattern Often recurrent Corneal sensation reduced .
Conjunctivitis: treatment
Bacterial Chloramphenicol Phenymixin (Chloramphenicol + polymixin B) Gentamicin Bamyxin Chlamydia Topical Tetracycline 3 weeks Systemic Tetracycline 2 weeks Viral As bacterial or topical steroids
Conjunctivitis: treatment
Herpes simplex keratitis : treatment
Topical Acyclovir 3% ointment 5 times / day Systemic Acyclovir 400 mg x 5/day in immunesupressed or severe infection.
Herpes zoster ophthalmicus
Usually above age 50 Immune supressed - HIV Rx: PO zovirax 800 mg X 5
Orbital & periorbital celullitis
Signs: periorbital swelling and redness fever lethargy proptosis decreased eye motility abnormal pupillary reaction optic nerve swelling or pallor
Orbital & periorbital celullitis
Orbital & periorbital celullitis
Signs: Limitation of abduction of involved eye
Orbital & periorbital celullitis
Orbital & periorbital celullitis Etiology:
Sinusitis Trauma URI
Orbital & periorbital celullitis Treatment
: Periorbital PO antibiotics Orbital – Hospitalization – CT – IV antibiotics
Blunt Ocular Trauma: Anterior segment
Iris - hyphema mydriasis iridodialysis angle recess
VERNAL KERATOCONJUCTIVITIS (VERNALIS)
Usually bilateral Seasonal Atopic history: Asthma, rhinitis, atopic dermatitis Palpebral : cobble stones
VERNAL KERATOCONJUCTIVITIS (VERNALIS)
Treatment of exacerbations
Topical steroids
Systemic steroids
Lubricants
Mast cell stabilizers:
Sodium chromoglycate
Alomide Zaditen Livostin