Red eye in children

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]

Synonyms and Keywords: Red eye in kids, Conjunctivitis, outbreak-epidemic-symptoms.

Overview

Red eye in children is a common consultation purpose. Mostly benign, this sign may also cause visual impairment. We differentiate three kinds of red eye: localised, diffused and perikeratic injection. The last one must be recognized because of its association with severe ocular diseases. Diagnosis must be sure and treatment has to be efficient to not pertubate childrens visual development. Unfortunately, physical examination on children is not always easy. Consultation with an ophthalmologist is justified if a doubt remains, in case of chronic pathology or resistance to first intention treatment. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications rare.

Historical Perspective

  • Can’t find any historical perspective in Red eye in children.

Classification

  • Red eye may be classified according to classification method into three subtypes/groups:[1]

Pathophysiology

Causes

Common causes of Red Eye in Children[3]

Common causes of Red Eye in Children

Life Threatening Causes

Life-threatening causes include conditions that could lead to death or permanent disability within 24 hours if left untreated.

Differentiating Red eye from other Diseases

Red eye is diffrentiated from many disease, the most common is conjunctivitis . Others include: Bacterial conjunctivitis, Viral conjunctivitis, Allergic conjunctivitis,Chemical conjunctivitis, Foreign body, Blepharitis, Hordeola , Keratitis, Endophthalmitis , Dacrocystitis, Anterior uveitis (iridocyclitis) :associated with juvenile RA, Behcet diease and IBS; sudden onset pain, photophobia, blurred vision, irregular pupil, poor vision, Posterior uveitis (choroiditis) and Scleritis/Episcleritis[4] [5]

[6]



Differential diagnosis of red eye with no injury

CONJUNCTIVITIS CORNEAL ULCER ACUTE IRITIS ACUTE GLAUCOMA
Eye Usually both eyes Usually one eye Usually one eye Usually one eye
Vision Normal Usually decreased Often decreased Marked decrease
Eye pain Normal or gritty Usually painful Moderate pain, light sensitive Severe pain (headache and nausea)
Discharge Sticky or watery May be sticky Watering Watering
Conjunctiva Generalised (variable) redness Redness most marked around the cornea Redness most marked around the cornea Generalised marked redness
Cornea Normal Grey, white spot (fluorescein staining) Usually clear, (keratitic precipitates may be visible with magnification) Hazy (due to fluid in the cornea)
Anterior chamber (AC) Normal Usually normal (occasionally hypopyon) Cells will be visible with magnification Shallow or flat
Pupil size Normal and round Normal and round Small and irregular Dilated
Pupil response to light Active Active Minimal reaction as already small Minimal or no reaction
Intraocular pressure (IOP) Normal (but do not attempt to measure IOP) Normal (but do not attempt to measure IOP) Normal Raised
Useful diagnostic sign/test Pussy discharge in both eyes Fluorescein staining of the cornea Irregular pupil as it dilates with drops Raised IOP

Epidemiology and Demographics

Age

  • Patients of all age groups may develop red eye.

Gender

Race

  • There is no racial predilection for red eye in children.

Risk Factors

Common risk factors in the development of red eye in children are [9][10]

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

There are no ECG findings associated with red eye in children.


X-ray

There are no x-ray findings associated with red eye in children. However, an x-ray may be helpful in the diagnosis of complications of traumatic red eye, which include a plain skull X-ray is performed to exclude cranial and facial fractures and will visualize radio-opaque foreign bodies FBs[16].

Echocardiography or Ultrasound

There are no echocardiography findings associated with red eye in children accept in some diseases like conjunctivitis in Kawasaki syndrome. However, an ultrasound may be helpful in the diagnosis of complications of emergency red eye.

CT scan

There are no CT scan findings associated with red eye in children. However, a CT scans are the test of choice for orbital and IOFB localization in traumatic red eye. A CT scan will often diagnose other unsuspected cranial and facial injuries [16][17].

. Computed tomography imaging of the orbits should be performed if a high-velocity penetrating injury is suspected. If acute glaucoma is suspected, intraocular pressure should be measured in the emergency department.[18]

MRI

There are no MRI findings associated with red eye in children. However, a MRI may be helpful in the diagnosis of complications of traumatic red eye. The on-call ophthalmologist must be proficient at ocular ultrasound, as it is an indispensible tool for the diagnosis and triage of ophthalmic emergencies[19].

Other Imaging Findings

New diagnostic instruments for imaging the anterior segment of the eye have been developed using the corneal topographer as optical coherence tomography (OCT) may be helpful in the diagnosis of red eye. Findings on an OCT suggestive of/diagnostic of keratoconus or pellucid marginal corneal degeneration include epithelial edema in the epithelial layer and stromal layer associated with intraocular pressure elevation[20].

Other Diagnostic Studies


Treatment

treatment is based on the underlying etiology, and Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections[22]. clinical signs that require an urgent ophthalmic consultation are chemical burns, intraocular infections, globe ruptures or perforations, and acute glaucoma.[23]

Medical Therapy

Surgery

Prevention

Practice good hygiene to control the spread of red eye. For instance:[30]

  • Don't touch your eyes with your hands.
  • Wash your hands often.
  • Use a clean towel and washcloth daily.
  • Don't share towels or washcloths.
  • Change your pillowcases often.
  • Throw away your eye cosmetics, such as mascara.
  • Don't share eye cosmetics or personal eye care items.

Keep in mind that red eye is no more contagious than the common cold. It's okay to return to work, school or child care if you're not able to take time off — just stay consistent in practicing good hygiene.

Preventing red eye in newborns

Newborns' eyes are susceptible to bacteria normally present in the mother's birth canal. These bacteria cause no symptoms in the mother. In rare cases, these bacteria can cause infants to develop a serious form of conjunctivitis known as ophthalmia neonatorum, which needs treatment without delay to preserve sight. That's why shortly after birth all babies should have their eyes cleaned immediately, then an antibiotic ointment like tetracycline is applied to every newborn's eyes. The ointment helps prevent eye infection. During antenatal care, all mothers with vaginal infections should be treated. Educate traditional birth attendants, community health workers, and both parents as this is often a sexually transmitted disease.[6]

References

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  19. "Ocular Ultrasound: A Quick Reference Guide for the On-Call Physician".
  20. Maeda N (2011) [New diagnostic methods for imaging the anterior segment of the eye to enable treatment modalities selection.] Nippon Ganka Gakkai Zasshi 115 (3):297-322; discussion 323. PMID: 21476312 PMID: 21476312
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