Conjunctivitis in children: Difference between revisions

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__NOTOC__
__NOTOC__
{{SI}}                                                                  
                                                               
{{CMG}} {{AE}}
{{CMG}} ; {{AE}} {{Arash.M}}


{{SK}} Conjunctivitis in kids
{{SK}} Madras eye, pink-eye, pinkeye, conjunctivitis, ophthalmia, rubor, inflammation, ophthalmitis, redness, neonatal conjunctivitis


==Overview==
==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==
==Historical Perspective==
*In 1750, [[Neonatal conjunctivitis]] was first described by S.T. Quellmaz.<ref name="pmid5543850">{{cite journal| author=| title=Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn. | journal=Am J Dis Child | year= 1971 | volume= 121 | issue= 1 | pages= 3-4 | pmid=5543850 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5543850  }} </ref><ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
*In 1881, Crédé introduced 2% silver [[nitrate]] for the first time as a [[prophylaxis]] treatment method for [[conjunctivitis]] in the [[newborns]].<ref>{{cite journal|title=INTRODUCTION|journal=Acta Paediatrica|volume=75|issue=s330|year=1986|pages=7–27|issn=0803-5253|doi=10.1111/j.1651-2227.1986.tb10403.x}}</ref>
*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]].


*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
==Classification==
==Classification==
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
[[Conjunctivitis]] can be classified into subtypes:<ref name="pmid6970802">{{cite journal| author=Gigliotti F, Williams WT, Hayden FG, Hendley JO, Benjamin J, Dickens M | display-authors=etal| title=Etiology of acute conjunctivitis in children. | journal=J Pediatr | year= 1981 | volume= 98 | issue= 4 | pages= 531-6 | pmid=6970802 | doi=10.1016/s0022-3476(81)80754-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6970802  }} </ref><ref name="pmid28722870">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28722870 | doi= | pmc= | url= }} </ref>
:*[group1]
* [[Bacterial conjunctivitis]]
:*[group2]
* [[Viral conjunctivitis]]
:*[group3]
* [[Allergic conjunctivitis]]
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
* [[Chemical]] [[conjunctivitis]]
* [[Immune]] mediated [[conjunctivitis]]


==Pathophysiology==
==Pathophysiology==
 
*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]].
*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
*Alteration in the [[flora]] can also result from external [[contamination]], the use of topical or systemic [[antibiotics]], or spread from adjacent infectious sites.
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
*Disruption of defense barriers can lead to [[infection]]. The primary defense against [[infection]] is the [[epithelial layer]] covering the [[conjunctiva]].  
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*Secondary defense include [[hematologic]] immune mechanisms carried by the [[conjunctival]] vessels, tear film [[immunoglobulins]] and [[lysozyme]] and the rinsing action of lacrimation and blinking.<ref name="pmid32864068">{{cite journal| author=Azari AA, Arabi A| title=Conjunctivitis: A Systematic Review. | journal=J Ophthalmic Vis Res | year= 2020 | volume= 15 | issue= 3 | pages= 372-395 | pmid=32864068 | doi=10.18502/jovr.v15i3.7456 | pmc=7431717 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32864068  }} </ref>
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
*Common causes of neonatal [[conjunctivitis]] include:<ref name="pmid8174390">{{cite journal| author=Weiss A| title=Acute conjunctivitis in childhood. | journal=Curr Probl Pediatr | year= 1994 | volume= 24 | issue= 1 | pages= 4-11 | pmid=8174390 | doi=10.1016/0045-9380(94)90022-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8174390  }} </ref>
 
**[[Chlamydia trachomatis]]
OR
**[[Neisseria gonorrhoeae]]
 
**[[Herpes zoster virus]], [[HSV]]
Common causes of [disease] include [cause1], [cause2], and [cause3].
 
OR
 
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
 
OR


The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
*Common causes of [[Conjunctivitis]] in children inculde:<ref name="pmid8174390">{{cite journal| author=Weiss A| title=Acute conjunctivitis in childhood. | journal=Curr Probl Pediatr | year= 1994 | volume= 24 | issue= 1 | pages= 4-11 | pmid=8174390 | doi=10.1016/0045-9380(94)90022-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8174390  }} </ref><ref name="pmid3874389">{{cite journal| author=Bodor FF, Marchant CD, Shurin PA, Barenkamp SJ| title=Bacterial etiology of conjunctivitis-otitis media syndrome. | journal=Pediatrics | year= 1985 | volume= 76 | issue= 1 | pages= 26-8 | pmid=3874389 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3874389  }} </ref>
==Differentiating [disease name] from other Diseases==
**[[Haemophilus influenzae]]
**[[Streptococcus pneumoniae]]
**[[Adenovirus]]
**[[Moraxella catarrhalis]] (rarely)


For further information about the differential diagnosis, click [[Disease_Name differential diagnosis|here]].
==Differentiating conjunctivitis from other Diseases==
In children with [[red eye]] and [[conjunctivitis]] symptoms, mentioned diagnosis should be excluded:<ref name="pmid27884914">{{cite journal| author=Rainsbury PG, Cambridge K, Selby S, Lochhead J| title=Red eyes in children: red flags and a case to learn from. | journal=Br J Gen Pract | year= 2016 | volume= 66 | issue= 653 | pages= 633-634 | pmid=27884914 | doi=10.3399/bjgp16X688309 | pmc=5198670 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27884914  }} </ref>
* [[Corneal abrasion]]
* [[Subconjunctival haemorrhage]]
* [[Blepharitis]]
* [[Periorbital cellulitis]]
* [[Uveitis]]
* [[Episcleritis]]


==Epidemiology and Demographics==
==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.<ref name="RamirezPorco2017">{{cite journal|last1=Ramirez|first1=David A.|last2=Porco|first2=Travis C.|last3=Lietman|first3=Thomas M.|last4=Keenan|first4=Jeremy D.|title=Epidemiology of Conjunctivitis in US Emergency Departments|journal=JAMA Ophthalmology|volume=135|issue=10|year=2017|pages=1119|issn=2168-6165|doi=10.1001/jamaophthalmol.2017.3319}}</ref>
*Boys and girls are affected in similar proportions.<ref name="pmid8174390">{{cite journal| author=Weiss A| title=Acute conjunctivitis in childhood. | journal=Curr Probl Pediatr | year= 1994 | volume= 24 | issue= 1 | pages= 4-11 | pmid=8174390 | doi=10.1016/0045-9380(94)90022-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8174390  }} </ref>


*The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
==Risk Factors==
*In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
Risk factors of neonatal [[conjunctivitis]] includes:<ref name="pmid19995198">{{cite journal| author=Gichuhi S, Bosire R, Mbori-Ngacha D, Gichuhi C, Wamalwa D, Maleche-Obimbo E | display-authors=etal| title=Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers. | journal=Ophthalmic Epidemiol | year= 2009 | volume= 16 | issue= 6 | pages= 337-45 | pmid=19995198 | doi=10.3109/09286580903144746 | pmc=3223245 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19995198  }} </ref><ref name="pmid29345007">{{cite journal| author=Honkila M, Renko M, Ikäheimo I, Pokka T, Uhari M, Tapiainen T| title=Aetiology of neonatal conjunctivitis evaluated in a population-based setting. | journal=Acta Paediatr | year= 2018 | volume= 107 | issue= 5 | pages= 774-779 | pmid=29345007 | doi=10.1111/apa.14227 | pmc=7159510 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29345007  }} </ref>
* [[STDs]] in mother
===Age===
* [[HIV]] infected mothers
* Exposure of the infant to infectious organisms
* [[Prematurity]]
* Poor hygienic delivery conditions
* [[Ocular]] trauma during delivery


*Patients of all age groups may develop [disease name].
==Natural History, Complications and Prognosis==
*[Disease name] is more commonly observed among patients aged [age range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
===Gender===
 
*[Disease name] affects men and women equally.
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
*The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
===Race===


*There is no racial predilection for [disease name].
===Natural history===
   
* [[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 of[[ newborns]] with [[chlamydial conjunctivitis]] also have the infection in other parts of their bodies.<ref name="pmid30007329">{{cite journal| author=Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N| title=Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis. | journal=J Pediatric Infect Dis Soc | year= 2018 | volume= 7 | issue= 3 | pages= e107-e115 | pmid=30007329 | doi=10.1093/jpids/piy060 | pmc=6097578 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30007329  }} </ref><ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid8174390">{{cite journal| author=Weiss A| title=Acute conjunctivitis in childhood. | journal=Curr Probl Pediatr | year= 1994 | volume= 24 | issue= 1 | pages= 4-11 | pmid=8174390 | doi=10.1016/0045-9380(94)90022-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8174390 }} </ref>
*[Disease name] usually affects individuals of the [race 1] race.
* [[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]].
*[Race 2] individuals are less likely to develop [disease name].
* [[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.


==Risk Factors==
===Complications===
 
Complications to neonatal [[conjunctivitis]] include:<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC | display-authors=etal| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi=10.1093/infdis/153.5.862 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name="pmid21733975">{{cite journal| author=Drug and Therapeutics Bulletin| title=Management of acute infective conjunctivitis. | journal=Drug Ther Bull | year= 2011 | volume= 49 | issue= 7 | pages= 78-81 | pmid=21733975 | doi=10.1136/dtb.2011.02.0043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21733975  }} </ref>
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
* [[Pseudomembrane]] formation
 
* [[Corneal]] [[edema]]
==Natural History, Complications and Prognosis==
* Peripheral [[pannus]] formation
* [[Corneal]] [[opacification]]
* [[Corneal]] [[perforation]]
* [[Endophthalmitis]]
* Loss of eye and blindness
* Infantile [[pneumonia]]
* [[Nasopharyngeal]], [[rectal]]and [[vaginal]] colonization
* Some systemic complications particularly in [[gonococcal conjunctivitis]] including:
** [[Stomatitis]]
** [[Arthritis]]
** [[Rhinitis]]
** [Septicemia]]  
** [[Meningitis]]
Complications of [[viral conjunctivitis]] in children including:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
* [[Keratitis]]
* [[Corneal]] [[ulceration]] with [[keratoconjunctivitis]]


*The majority of patients with [disease name] remain asymptomatic for [duration/years].
===Prognosis===
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
* Early detection and early treatment of extremely pathogenic [[bacteria]], such as [[Chlamydia trachomatis]] or [[Neisseria gonorrhoeae]], is associated with a good [[prognosis]]. <ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===
*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.<ref name="pmid17696792">{{cite journal| author=Rose P| title=Management strategies for acute infective conjunctivitis in primary care: a systematic review. | journal=Expert Opin Pharmacother | year= 2007 | volume= 8 | issue= 12 | pages= 1903-21 | pmid=17696792 | doi=10.1517/14656566.8.12.1903 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17696792  }} </ref>


*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
===Symptoms===
====Gonococcal Conjunctivitis====
[[Gonococcal conjunctivitis]] is more severe than [[chlamydial conjunctivitis]]. The [[incubation period]] is 2-5 days and it is usually bilateral.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
* [[Purulent]] discharge
* Eyelid [[oedema]]
* [[Chemosis]]
* [[Red eye]]


:*[criterion 1]
====Chlamydial conjunctivitis====
:*[criterion 2]
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.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
:*[criterion 3]
* Eyelid [[swelling]]
:*[criterion 4]
* Watery or mild [[mucoid]] [[discharge]]
* [[Red eye]]
===Symptoms===


*[Disease name] is usually asymptomatic.
====Chemical conjunctivitis====
*Symptoms of [disease name] may include the following:
Chemical [[conjunctivitis]] usually occurs within 24 hours of instillation of [[silver nitrate]] solution and resolves spontaneously within a few days.<ref name="pmid6970802">{{cite journal| author=Gigliotti F, Williams WT, Hayden FG, Hendley JO, Benjamin J, Dickens M | display-authors=etal| title=Etiology of acute conjunctivitis in children. | journal=J Pediatr | year= 1981 | volume= 98 | issue= 4 | pages= 531-6 | pmid=6970802 | doi=10.1016/s0022-3476(81)80754-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6970802  }} </ref>
* Eyelids [[swelling]]
* [[Red eye]]


:*[symptom 1]
====Herpes simplex keratoconjunctivitis====
:*[symptom 2]
[[Herpes simplex keratoconjunctivitis]] in an infant usually presents with generalized [[herpes infection]].<ref name="pmid6970802">{{cite journal| author=Gigliotti F, Williams WT, Hayden FG, Hendley JO, Benjamin J, Dickens M | display-authors=etal| title=Etiology of acute conjunctivitis in children. | journal=J Pediatr | year= 1981 | volume= 98 | issue= 4 | pages= 531-6 | pmid=6970802 | doi=10.1016/s0022-3476(81)80754-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6970802  }} </ref>
:*[symptom 3]
* [[Vesicles]] around the eye
:*[symptom 4]
* [[corneal]] involvement
:*[symptom 5]
* Watery [[discharge]]
:*[symptom 6]
* Itchy eyes
* Eye redness
===Physical Examination===


*Patients with [disease name] usually appear [general appearance].
====Bacterial Conjunctivitis====
*Physical examination may be remarkable for:
[[Bacterial conjunctivitis]] more than [[viral conjunctivitis]] tend to cause bilateral rather than unilateral involvement.<ref name="pmid6970802">{{cite journal| author=Gigliotti F, Williams WT, Hayden FG, Hendley JO, Benjamin J, Dickens M | display-authors=etal| title=Etiology of acute conjunctivitis in children. | journal=J Pediatr | year= 1981 | volume= 98 | issue= 4 | pages= 531-6 | pmid=6970802 | doi=10.1016/s0022-3476(81)80754-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6970802  }} </ref>
* [[Mucopurulent discharge]]
* Eyelids [[swelling]]
* [[Red eye]]


:*[finding 1]
===Physical Examination===
:*[finding 2]
Ophthalmologic examination of children with [[conjunctivitis]] is usually remarkable for:<ref name="pmid6970802">{{cite journal| author=Gigliotti F, Williams WT, Hayden FG, Hendley JO, Benjamin J, Dickens M | display-authors=etal| title=Etiology of acute conjunctivitis in children. | journal=J Pediatr | year= 1981 | volume= 98 | issue= 4 | pages= 531-6 | pmid=6970802 | doi=10.1016/s0022-3476(81)80754-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6970802  }} </ref><ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref>
:*[finding 3]
* [[Chemosis]]
:*[finding 4]
* [[Mucopurulent]] or watery discharge
:*[finding 5]
* Eye lid [[oedema]]
:*[finding 6]
* Mild to moderate [[hyperemia]]


===Laboratory Findings===
===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.<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC | display-authors=etal| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi=10.1093/infdis/153.5.862 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name="pmid3874389">{{cite journal| author=Bodor FF, Marchant CD, Shurin PA, Barenkamp SJ| title=Bacterial etiology of conjunctivitis-otitis media syndrome. | journal=Pediatrics | year= 1985 | volume= 76 | issue= 1 | pages= 26-8 | pmid=3874389 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3874389  }} </ref><ref name="pmid15195156">{{cite journal| author=Høvding G| title=[Acute bacterial conjunctivitis]. | journal=Tidsskr Nor Laegeforen | year= 2004 | volume= 124 | issue= 11 | pages= 1518-20 | pmid=15195156 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195156  }} </ref>


*There are no specific laboratory findings associated with [disease name].
* Chlamydial [[conjunctivitis]]
** Positive [[polymerase chain reaction]] ([[PCR]]) of [[conjunctival]] scraping
** Positive [[gram staining]] or [[giemsa]] staining of [[conjunctival]] scraping
** Positive enzyme immuno-assays for [[chlamydia]] organisms


*A  [positive/negative] [test name] is diagnostic of [disease name].
* [[Gonococcal]] [[conjunctivitis]]
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
** Positive [[gram staining]] of [[conjunctival]] scraping for [[gram-negative]] [[intra-cellular]] [[diplococci]]
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
** Positive special cultures for [[neisseria]] species on [[chocolate agar]] or [[Thayer-Martin agar]]


===Electrocardiogram===
====Viral conjunctivitis====
There are no ECG findings associated with [disease name].
* Positive conjunctival scraping for [[polymerase chain reaction]] ([[PCR]])<ref name="pmid26602522">{{cite journal| author=Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH| title=The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil. | journal=Clinics (Sao Paulo) | year= 2015 | volume= 70 | issue= 11 | pages= 748-50 | pmid=26602522 | doi=10.6061/clinics/2015(11)06 | pmc=4642493 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602522  }} </ref>
* Positive viral culture of corneal epithelial cells for HSV


OR
====Neonatal conjunctivitis====
* Positive [[gram staining]] or [[giemsa]] staining of [[conjunctival]] scraping<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
* 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]]


An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Electrocardiogram===
* There are no [[ECG]] findings associated with [[conjunctivitis]].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
* There are no [[x-ray]] findings associated with [[conjunctivitis]].
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
* There are no [[echocardiography]] or [[ultrasound]] findings associated with [[conjunctivitis]].
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
* There are no [[CT scan]] findings associated with [[conjunctivitis]].
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
* There are no [[MRI]] findings associated with [[conjunctivitis]].


OR
===Other Imaging Findings===
* There are no other imaging findings associated with [[conjunctivitis]].


[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Other Diagnostic Studies===
* There are no other diagnostic findings associated with [[conjunctivitis]].


OR
==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.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid24235191">{{cite journal| author=Matejcek A, Goldman RD| title=Treatment and prevention of ophthalmia neonatorum. | journal=Can Fam Physician | year= 2013 | volume= 59 | issue= 11 | pages= 1187-90 | pmid=24235191 | doi= | pmc=3828094 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24235191  }} </ref><ref name="pmid30007329">{{cite journal| author=Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N| title=Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis. | journal=J Pediatric Infect Dis Soc | year= 2018 | volume= 7 | issue= 3 | pages= e107-e115 | pmid=30007329 | doi=10.1093/jpids/piy060 | pmc=6097578 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30007329  }} </ref>


There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
* [[Chlamydial conjunctivitis]]
** Oral [[erythromycin]] syrup, 50 mg/kg/day, in 4 divided doses for 14 days
** Topical [[erythromycin]] or [[tetracycline]] as an adjunct therapy


===Other Imaging Findings===
* [[Gonococcal conjunctivitis]]
There are no other imaging findings associated with [disease name].
** Intravenous [[Penicillin G]] 100,000 Units /kg/day for 1 week
** [[Ceftriaxone]] 50 mg/kg as a single dose in case of resistance to [[penicillin]]
** [[Spectinomycin]] 25 mg/kg (maximum 75 mg) as a single IM dose as an alternative option
** [[Kanamycin]] 25 mg/kg (maximum 75 mg) as an alternative option


OR
* Herpetic [[conjunctivitis]]
** Low dose systemic [[acyclovir]] (30mg/kg/ day IV divided tid) Or
** [[Vidarabine]] (30 mg /kg/day in divided doses IV) for at least 2 weeks
** [[Trifluridine]] eye drops


[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
====Conjunctivitis in children====
 
=====Bacterial conjunctivitis=====
===Other Diagnostic Studies===
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]].<ref name="pmid31788487">{{cite journal| author=Oikonomakou MZ, Makri OE, Panoutsou E, Kagkelaris K, Plotas P, Garatziotou D | display-authors=etal| title=Bacteriology and Antimicrobial Susceptibility Patterns of Childhood Acute Bacterial Conjunctivitis in Western Greece. | journal=Med Hypothesis Discov Innov Ophthalmol | year= 2019 | volume= 8 | issue= 4 | pages= 266-271 | pmid=31788487 | doi= | pmc=6778672 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31788487  }} </ref>
* [[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


*[Disease name] may also be diagnosed using [diagnostic study name].
=====Viral conjunctivitis=====
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
The purpose of the treatment in children with [[viral conjunctivitis]] is to reduce virus dissemination and the chance of the development of [[keratitis]]<ref name="pmid25945033">{{cite journal| author=Bremond-Gignac D, Messaoud R, Lazreg S, Speeg-Schatz C, Renault D, Chiambaretta F| title=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. | journal=Clin Ophthalmol | year= 2015 | volume= 9 | issue=  | pages= 725-32 | pmid=25945033 | doi=10.2147/OPTH.S78747 | pmc=4408937 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25945033  }} </ref>
* [[Ganciclovir]] 0.15% ophthlamic gel for 1 week
*  [[Trifluridine]] 1% solution q4h for 1 week


==Treatment==
=====Allergic conjunctivitis=====
===Medical Therapy===
Most cases do not need therapeutic interaction. However, in severe cases below can be used<ref name="pmid32864068">{{cite journal| author=Azari AA, Arabi A| title=Conjunctivitis: A Systematic Review. | journal=J Ophthalmic Vis Res | year= 2020 | volume= 15 | issue= 3 | pages= 372-395 | pmid=32864068 | doi=10.18502/jovr.v15i3.7456 | pmc=7431717 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32864068  }} </ref>
* Topical [[antihistamines]]
* Topical [[mast cell stabilizers]] like [[diclofenac]]or [[ketorolac]]


*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
===Surgery===
===Surgery===
* [[Surgical intervention]] is not recommended for the management of [[conjunctivitis]] in children and neonates.


*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
===Prevention===
===Prevention===
====Neonatal conjunctivitis====
* Ocular prophylaxis with 0.5% [[erythromycin]] ointment or 1% [[tetracycline]] hydrochloride can be given to all newborns.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
* 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).


*There are no primary preventive measures available for [disease name].
====Conjunctivitis in children====
Effective measures to prevent conjunctivitis in children include:<ref name="pmid32864068">{{cite journal| author=Azari AA, Arabi A| title=Conjunctivitis: A Systematic Review. | journal=J Ophthalmic Vis Res | year= 2020 | volume= 15 | issue= 3 | pages= 372-395 | pmid=32864068 | doi=10.18502/jovr.v15i3.7456 | pmc=7431717 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32864068  }} </ref>
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
* Washing hands
 
* Change towels and wash cloths daily
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].


==References==
==References==
Line 216: Line 245:
   
   
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Primary care]]

Latest revision as of 21:12, 24 February 2021


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.
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