Conjunctivitis in children

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Seyed Arash Javadmoosavi, MD[2]

Synonyms and keywords: Madras eye, pink-eye, pinkeye, conjunctivitis, ophthalmia, rubor, inflammation, ophthalmitis, redness, neonatal conjunctivitis


Conjunctivitis is characterized by inflammation and swelling of the conjunctival tissue which can be associated with engorgement of the blood vessels, ocular discharge, and pain. Neonatal conjunctivitis is a red eye in a newborn caused by infection, irritation, or a blocked tear duct. When caused by an infection, neonatal conjunctivitis can be very serious.

Historical Perspective


Conjunctivitis can be classified into subtypes:[4][5]



Differentiating conjunctivitis from other Diseases

In children with red eye and conjunctivitis symptoms, mentioned diagnosis should be excluded:[9]

Epidemiology and Demographics

Risk Factors

Risk factors of neonatal conjunctivitis includes:[11][12]

  • STDs in mother
  • HIV infected mothers
  • Exposure of the infant to infectious organisms
  • Prematurity
  • Poor hygienic delivery conditions
  • Ocular trauma during delivery

Natural History, Complications and Prognosis

Natural history


Complications to neonatal conjunctivitis include:[14][15]

Complications of viral conjunctivitis in children including:[2]



Diagnostic Criteria


Gonococcal Conjunctivitis

Gonococcal conjunctivitis is more severe than chlamydial conjunctivitis. The incubation period is 2-5 days and it is usually bilateral.[2]

Chlamydial conjunctivitis

Chlamydial conjunctivitis has a later onset than gonococcal conjunctivitis. The incubation period is 5-14 days. Most of the cases are mild and self-limited, but occasionally may be severe.[2]

Chemical conjunctivitis

Chemical conjunctivitis usually occurs within 24 hours of instillation of silver nitrate solution and resolves spontaneously within a few days.[4]

Herpes simplex keratoconjunctivitis

Herpes simplex keratoconjunctivitis in an infant usually presents with generalized herpes infection.[4]

Bacterial Conjunctivitis

Bacterial conjunctivitis more than viral conjunctivitis tend to cause bilateral rather than unilateral involvement.[4]

Physical Examination

Ophthalmologic examination of children with conjunctivitis is usually remarkable for:[4][17]

Laboratory Findings

  • Conjunctivitis is essentially a clinical diagnosis made by observation of signs and symptoms. However, lab diagnosis is of paramount importance in establishing the correct diagnosis and initiating the best treatment.

Bacterial Conjunctivitis

Laboratory tests usually are not required in patients with mild bacterial conjunctivitis. However, specimens for bacterial cultures should be obtained in patients who have severe inflammation with mucopurulent discharge or in patients who do not respond to treatment.[14][8][18]

Viral conjunctivitis

Neonatal conjunctivitis



Echocardiography or Ultrasound

CT scan


Other Imaging Findings

Other Diagnostic Studies

  • There are no other diagnostic findings associated with conjunctivitis.


Medical Therapy

Neonatal conjunctivitis

Ophthalmia neonatorum is an ocular emergency so all infants with this condition should be admitted immediately. Clinical treatment should be based on clinical features and laboratory results. However, it is essential to treat ophthalmia neonartum with systemic drugs rather than topical to prevent systemic dissemination.[2][20][13]

Conjunctivitis in children

Bacterial conjunctivitis

Although bacterial conjunctivitis generally resolves spontaneously in a few days, there is broad agreement that topical antibiotics are worthwhile, particularly in moderate to severe infection.[21]

Viral conjunctivitis

The purpose of the treatment in children with viral conjunctivitis is to reduce virus dissemination and the chance of the development of keratitis[22]

Allergic conjunctivitis

Most cases do not need therapeutic interaction. However, in severe cases below can be used[6]



Neonatal conjunctivitis

  • Ocular prophylaxis with 0.5% erythromycin ointment or 1% tetracycline hydrochloride can be given to all newborns.[2]
  • To prevent neonatal conjunctivitis, women with STDs should consult with their physician about ways to minimize the chances of spread to their newborn baby.
  • Avoid vaginal delivery in mothers with STDs (HSV transmission rates are high for women who acquire genital herpes in the last few weeks of pregnancy).

Conjunctivitis in children

Effective measures to prevent conjunctivitis in children include:[6]

  • Washing hands
  • Change towels and wash cloths daily


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