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

Overview

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

Classification

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

Pathophysiology

Causes

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

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

Complications of viral conjunctivitis in children including:[2]

Prognosis

Diagnosis

Diagnostic Criteria

Symptoms

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

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

  • There are no other diagnostic findings associated with conjunctivitis.

Treatment

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]

Surgery

Prevention

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

References

  1. "Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn". Am J Dis Child. 121 (1): 3–4. 1971. PMID 5543850.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
  3. "INTRODUCTION". Acta Paediatrica. 75 (s330): 7–27. 1986. doi:10.1111/j.1651-2227.1986.tb10403.x. ISSN 0803-5253.
  4. 4.0 4.1 4.2 4.3 4.4 Gigliotti F, Williams WT, Hayden FG, Hendley JO, Benjamin J, Dickens M; et al. (1981). "Etiology of acute conjunctivitis in children". J Pediatr. 98 (4): 531–6. doi:10.1016/s0022-3476(81)80754-8. PMID 6970802.
  5. "StatPearls". 2020. PMID 28722870.
  6. 6.0 6.1 6.2 Azari AA, Arabi A (2020). "Conjunctivitis: A Systematic Review". J Ophthalmic Vis Res. 15 (3): 372–395. doi:10.18502/jovr.v15i3.7456. PMC 7431717 Check |pmc= value (help). PMID 32864068 Check |pmid= value (help).
  7. 7.0 7.1 7.2 7.3 Weiss A (1994). "Acute conjunctivitis in childhood". Curr Probl Pediatr. 24 (1): 4–11. doi:10.1016/0045-9380(94)90022-1. PMID 8174390.
  8. 8.0 8.1 Bodor FF, Marchant CD, Shurin PA, Barenkamp SJ (1985). "Bacterial etiology of conjunctivitis-otitis media syndrome". Pediatrics. 76 (1): 26–8. PMID 3874389.
  9. Rainsbury PG, Cambridge K, Selby S, Lochhead J (2016). "Red eyes in children: red flags and a case to learn from". Br J Gen Pract. 66 (653): 633–634. doi:10.3399/bjgp16X688309. PMC 5198670. PMID 27884914.
  10. Ramirez, David A.; Porco, Travis C.; Lietman, Thomas M.; Keenan, Jeremy D. (2017). "Epidemiology of Conjunctivitis in US Emergency Departments". JAMA Ophthalmology. 135 (10): 1119. doi:10.1001/jamaophthalmol.2017.3319. ISSN 2168-6165.
  11. Gichuhi S, Bosire R, Mbori-Ngacha D, Gichuhi C, Wamalwa D, Maleche-Obimbo E; et al. (2009). "Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers". Ophthalmic Epidemiol. 16 (6): 337–45. doi:10.3109/09286580903144746. PMC 3223245. PMID 19995198.
  12. Honkila M, Renko M, Ikäheimo I, Pokka T, Uhari M, Tapiainen T (2018). "Aetiology of neonatal conjunctivitis evaluated in a population-based setting". Acta Paediatr. 107 (5): 774–779. doi:10.1111/apa.14227. PMC 7159510 Check |pmc= value (help). PMID 29345007.
  13. 13.0 13.1 Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N (2018). "Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis". J Pediatric Infect Dis Soc. 7 (3): e107–e115. doi:10.1093/jpids/piy060. PMC 6097578. PMID 30007329.
  14. 14.0 14.1 Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis". J Infect Dis. 153 (5): 862–9. doi:10.1093/infdis/153.5.862. PMID 3084664.
  15. Drug and Therapeutics Bulletin (2011). "Management of acute infective conjunctivitis". Drug Ther Bull. 49 (7): 78–81. doi:10.1136/dtb.2011.02.0043. PMID 21733975.
  16. Rose P (2007). "Management strategies for acute infective conjunctivitis in primary care: a systematic review". Expert Opin Pharmacother. 8 (12): 1903–21. doi:10.1517/14656566.8.12.1903. PMID 17696792.
  17. Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
  18. Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
  19. Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH (2015). "The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil". Clinics (Sao Paulo). 70 (11): 748–50. doi:10.6061/clinics/2015(11)06. PMC 4642493. PMID 26602522.
  20. Matejcek A, Goldman RD (2013). "Treatment and prevention of ophthalmia neonatorum". Can Fam Physician. 59 (11): 1187–90. PMC 3828094. PMID 24235191.
  21. Oikonomakou MZ, Makri OE, Panoutsou E, Kagkelaris K, Plotas P, Garatziotou D; et al. (2019). "Bacteriology and Antimicrobial Susceptibility Patterns of Childhood Acute Bacterial Conjunctivitis in Western Greece". Med Hypothesis Discov Innov Ophthalmol. 8 (4): 266–271. PMC 6778672 Check |pmc= value (help). PMID 31788487.
  22. Bremond-Gignac D, Messaoud R, Lazreg S, Speeg-Schatz C, Renault D, Chiambaretta F (2015). "A 3-day regimen with azithromycin 1.5% eyedrops for the treatment of purulent bacterial conjunctivitis in children: efficacy on clinical signs and impact on the burden of illness". Clin Ophthalmol. 9: 725–32. doi:10.2147/OPTH.S78747. PMC 4408937. PMID 25945033.