Conjunctivitis in children
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.
- In 1750, Neonatal conjunctivitis was first described by S.T. Quellmaz.
- In 1881, Crédé introduced 2% silver nitrate for the first time as a prophylaxis treatment method for conjunctivitis in the newborns.
- In 1883, Koch discovered the bacilli of two different forms of infectious conjunctivitis.
- In 1953, Micheal Hogan first described the association between atopic dermatitis and conjunctivitis.
- Bacterial conjunctivitis
- Viral conjunctivitis
- Allergic conjunctivitis
- Chemical conjunctivitis
- Immune mediated conjunctivitis
- The surface tissues of the eye and the ocular adnexa are colonized by normal flora such as streptococci, staphylococci, and corynebacteria. Alterations in the bacterial titer, or in the species of bacteria can lead to clinical infection.
- Alteration in the flora can also result from external contamination, the use of topical or systemic antibiotics, or spread from adjacent infectious sites.
- Disruption of defense barriers can lead to infection. The primary defense against infection is the epithelial layer covering the conjunctiva.
- Secondary defense include hematologic immune mechanisms carried by the conjunctival vessels, tear film immunoglobulins and lysozyme and the rinsing action of lacrimation and blinking.
- Common causes of neonatal conjunctivitis include:
- Common causes of Conjunctivitis in children inculde:
Differentiating conjunctivitis from other Diseases
- Corneal abrasion
- Subconjunctival haemorrhage
- Periorbital cellulitis
Epidemiology and Demographics
- Bacterial conjunctivitis most commonly affects individuals younger than <6 years of age. Recent studies have shown that haemophilus influenzae and streptococcus pneumoniae are the two organisms most commonly responsible for bacterial conjunctivitis in children.
- Viral conjunctivitis occurs most often in the fall and winter and usually affects children older than 6 years.
- Children age 0-4 years shows a peak of conjunctivitis during the month of March.
- Boys and girls are affected in similar proportions.
- STDs in mother
- HIV infected mothers
- Exposure of the infant to infectious organisms
- Poor hygienic delivery conditions
- Ocular trauma during delivery
Natural History, Complications and Prognosis
- Chlamydial conjunctivitis is cuased by chlamydia trachomatis which is one of the most common causes in neonatal conjunctivitis. Women with untreated chlamydia can pass the bacteria to her baby during childbirth. Symptoms include red eye, swelling of the eyelids, and purulent discharge. Symptoms are likely to appear 5 to 12 days after birth. About half ofnewborns with chlamydial conjunctivitis also have the infection in other parts of their bodies.
- Gonococcal conjunctivitis is caused by neisseria gonorrhoeae. Women with untreated gonorrhea can pass the bacteria to her baby during childbirth. Symptoms usually include red eye, thick pus in the eyes, and swelling of the eyelids. This type of conjunctivitis usually begins about 2 to 4 days after birth. It can be associated with bacteremia and meningitis in newborns.
- Chemical conjunctivitis can occur when eye drops are given to newborns or children to help prevent a bacterial infections. Symptoms of chemical conjunctivitis usually include mildly red eye and some swelling of the eyelids. Symptoms are likely to last for only 24 to 36 hours.
- Conjunctivitis caused by adenovirus is frequently hemorrhagic, and cases of adenovirus keratoconjunctivitis are often accompanied by dramatic degrees of periorbital swelling.
- Pseudomembrane formation
- Corneal edema
- Peripheral pannus formation
- Corneal opacification
- Corneal perforation
- Loss of eye and blindness
- Infantile pneumonia
- Nasopharyngeal, rectaland vaginal colonization
- Some systemic complications particularly in gonococcal conjunctivitis including:
- Early detection and early treatment of extremely pathogenic bacteria, such as Chlamydia trachomatis or Neisseria gonorrhoeae, is associated with a good prognosis. 
- The diagnosis of conjunctivitis in children is based on the clinical physical findings which include:
- Redness, excessive tearing, and irritation are symptoms common to all forms of conjunctivitis.
- Photophobia, itching, mucopurulent or non-purulent discharge, chemosis, burning eyes, blurred vision and eyelid swelling are variable depending on the pathogen.
- Broad generalizations can be made about the clinical characteristics of bacterial conjunctivitis as compared to viral conjunctivitis but distinguishing them clinically in individual children may be difficult.
Herpes simplex keratoconjunctivitis
- 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.
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.
- Chlamydial conjunctivitis
- Gonococcal conjunctivitis
- Positive conjunctival scraping for polymerase chain reaction (PCR)
- Positive viral culture of corneal epithelial cells for HSV
- Positive gram staining or giemsa staining of conjunctival scraping
- Positive polymerase chain reaction (PCR) of conjunctival scraping
- Positive special cultures for neisseria species on chocolate agar or Thayer-Martin
- Positive culture on blood agar
Echocardiography or Ultrasound
Other Imaging Findings
- There are no other imaging findings associated with conjunctivitis.
Other Diagnostic Studies
- There are no other diagnostic findings associated with 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.
- Chlamydial conjunctivitis
- Gonococcal conjunctivitis
- Herpetic conjunctivitis
Conjunctivitis in children
- Azithromycin 1.5% ocular solution
- Polymyxin B with Trimethoprim sulfate 10,000 U, 1 mg/mL ophthalmic solution for 1 week
- Gentamicin 0.3% ophthalmic ointment for 1 week
- Sodium sulfacetamide 10%-30% ophthalmic solution for 1 week
Most cases do not need therapeutic interaction. However, in severe cases below can be used
- Surgical intervention is not recommended for the management of conjunctivitis in children and neonates.
- Ocular prophylaxis with 0.5% erythromycin ointment or 1% tetracycline hydrochloride can be given to all newborns.
- 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:
- Washing hands
- Change towels and wash cloths daily
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