Pediatric Conjunctivitis

Pediatric Conjunctivitis

Conjunctivitis is inflammation of the conjunctiva, being one of the most common ocular conditions in children. Early recognition and appropriate management are crucial for preventing complications.

Key Points

Most common eye infection in children
Multiple etiologies require different treatments
Some forms are highly contagious
May indicate systemic conditions
Proper hygiene crucial for prevention

Classification of Conjunctivitis

1. Infectious Conjunctivitis

Bacterial:
- Acute bacterial
  - Streptococcus pneumoniae
  - Haemophilus influenzae
  - Moraxella catarrhalis
  - Staphylococcus aureus
- Hyperacute bacterial
  - Neisseria gonorrhoeae
  - Emergency condition
- Chronic bacterial
  - Chlamydia trachomatis
  - Mycobacterium tuberculosis
Viral:
- Adenovirus
- Enterovirus
- Herpes simplex virus
- Epidemic keratoconjunctivitis

2. Allergic Conjunctivitis

Acute Forms:
- Seasonal allergic conjunctivitis
- Perennial allergic conjunctivitis
Chronic Forms:
- Vernal keratoconjunctivitis
- Atopic keratoconjunctivitis
- Giant papillary conjunctivitis

3. Chemical/Toxic Conjunctivitis

Irritant exposure
Medication toxicity
Chemical burns

Clinical Presentation

Bacterial Conjunctivitis

Signs:
- Mucopurulent discharge
- Bilateral or unilateral
- Crusting of eyelids
- Conjunctival injection
- Papillary response
Symptoms:
- Eye irritation
- Foreign body sensation
- Sticky eyelids in morning

Viral Conjunctivitis

Signs:
- Watery discharge
- Follicular response
- Preauricular lymphadenopathy
- Subconjunctival hemorrhage
Symptoms:
- Foreign body sensation
- Photophobia
- Often starts in one eye

Allergic Conjunctivitis

Signs:
- Bilateral involvement
- Cobblestone papillae
- Limbal nodules in VKC
- Chemosis
Symptoms:
- Intense itching
- Ropy discharge
- Seasonality
- Associated atopy

Diagnostic Approach

History Taking

Key Questions:
- Onset and duration
- Unilateral vs bilateral
- Type of discharge
- Associated symptoms
- Contact history
- Previous episodes

Physical Examination

External Examination:
- Eyelid swelling
- Type of discharge
- Periorbital changes
Slit Lamp Examination:
- Conjunctival reaction pattern
- Corneal involvement
- Membrane formation

Laboratory Testing

When to Culture:
- Severe cases
- Newborn conjunctivitis
- Treatment failure
- Recurrent cases
Specific Tests:
- Gram stain
- Viral PCR
- Chlamydial testing
- Conjunctival scrapings

Treatment Approaches

Bacterial Conjunctivitis

First-line Treatment:
- Broad-spectrum antibiotics
  - Trimethoprim/Polymyxin B
  - Erythromycin
  - Azithromycin
- Duration: 5-7 days
Special Situations:
- Gonococcal: Systemic therapy
- Chlamydial: Oral antibiotics

Viral Conjunctivitis

Supportive Care:
- Cold compresses
- Artificial tears
- Topical decongestants
Specific Situations:
- HSV: Antiviral therapy
- Severe cases: Topical steroids

Allergic Conjunctivitis

Acute Management:
- Antihistamine drops
- Mast cell stabilizers
- Dual-acting agents
- Cool compresses
Chronic Management:
- Topical steroids
- Immunomodulators
- Systemic antihistamines
- Environmental modifications

Prevention and Complications

Preventive Measures

Hygiene Practices:
- Hand washing
- Avoid touching eyes
- Separate towels/washcloths
- Regular cleaning of contact lenses
Environmental Control:
- Allergen avoidance
- Air filtration
- Protective eyewear

Potential Complications

Acute Complications:
- Corneal scarring
- Membrane formation
- Preseptal cellulitis
- Vision loss (rare)
Chronic Complications:
- Chronic conjunctival scarring
- Symblepharon formation
- Corneal complications in VKC
- Quality of life impact

Follow-up Care

Monitoring:
- Treatment response
- Complication development
- Recurrence prevention
Education:
- Prevention strategies
- Warning signs
- When to seek care

Further Reading