Red eye resident survival guide (pediatrics)

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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: Approach to red eye in children, Red-eye work-up in kids, Red-eye management in children

Red eye resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Red eye is one of the most common ophthalmologic conditions in the primary care setting in children. Inflammation of almost any part of the eye, including the lacrimal glands and eyelids, or faulty tear film can lead to red eye. Primary care physicians often effectively manage red eye, although knowing when to refer patients to an ophthalmologist is crucial, baseline ophthalmological tests, and accompanying manifestations can narrow down the differential diagnosis. The duration and laterality of symptoms (unilateral- vs. bilateral) and the intensity of pain are the main criteria allowing the differentiation of non-critical changes that can be cared for a general practitioner from diseases calling for an elective referral to an ophthalmologist and eye emergencies requiring urgent ophthalmic surgery.[1]


Causes

Life Threatening Causes

Life-threatening causes include conditions that could lead to death or permanent disability within 24 hours if left untreated.[2]

Common Causes[3][4][5][6][7]

Infectious[8]

Non-infectious

FIRE: Focused Initial Rapid Evaluation

Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis can be readily identified in many patients. Identifying conditions that threaten vision and understanding the urgency of referral to an ophthalmologist is paramount. Some systemic diseases such as leukemia, sarcoidosis, and juvenile idiopathic arthritis can present with the chief symptom of a red eye. Finally, trauma, ranging from mild to severe, often precipitates an office visit with a red eye, and thus understanding the signs that raise concern for a ruptured globe is essential . In the primary care setting, with a focused history, a few simple examination techniques, and an appreciation of the differential diagnosis, one can feel confident in managing patients with acute red eyes.[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23], or eye emergencies requiring urgent ophthalmic surgery.[24][25]

 
 
 
 
 
 
 
 
History & Physical examination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Emergency
 
 
 
 
Trauma
 
 
 
 
Systemic disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute
 
 
 
 
Mild-severe
 
 
 
 
Main symptom of red eye
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urgent ophthalmologic evaluation
 
 
 
 
Rupture of globe
 
 
 
 
Acute
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Office visit
 
 
 
 
Office visit


Complete Diagnostic Approach

Localized, diffused and perikeratic injection. [26]

Shown below is an algorithm summarizing the diagnosis of red eye according to the Nelson Essentials of Pediatrics guidelines. [27]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Age group
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Neonates
 
 
 
 
Infants and toddlers
 
 
 
School age children
 
 
School age children and adolescent
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
24 hours
 
<1 week
 
1-2 weeks
 
 
 
 
 
 
 
1-5 years
 
 
Viral conjunctivitis
Allergic conjunctivitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chemical conjunctivitis
 
Neisseria Ghonorrhea
 
Chlamydia Trachomatis
 
 
 
 
 
 
 
Herpes Simplex
Varicella Zoster
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Without otitis
 
 
 
With otitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Haemophilus Influenzae
Streptoccoccus Penumoniae
 
 
 
H. Influenzae
 
 
 
 
 
 
 
 
 


Treatment

Shown below is an algorithm summarizing the treatment of Red eye according to the American journal of medicine. [6]


 
 
 
 
 
 
 
 
 
Patient with red eye
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Emergency
 
 
 
 
 
Acute conjunctivitis
 
 
 
 
 
 
Chronic blepharitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urgent ophthalmic surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Eyelid hygiene
Topical antibiotics
•Oral tetracycline or doxycycline
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Severe
 
 
 
 
Mild
 
 
 
 
Moderate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Viral
 
Bacterial
 
 
Over the counter
Antihistamine
Vasocontricter agent or with more effective second generation topical histamine H1 receptor antagonist
 
 
 
 
Antiinflammatory agents (eg. topical cyclosporine)
Topical corticosteroids
Systemic omega 3 fatty acids
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hand washing and meticulous hygiene or normal saline spray
 
Ophthalmic antibiotic such as gentamycin
 
 
 


  • Good hygiene, such as meticulous hand washing, is important in decreasing the spread of acute viral conjunctivitis.[28][29]
  • Any ophthalmic antibiotic may be considered for the treatment of acute bacterial conjunctivitis because they have similar cure rates.[30] [31]
  • Mild allergic conjunctivitis may be treated with an over-the-counter antihistamine/vasoconstrictor agent, or with a more effective second-generation topical histamine H1 receptor antagonist.[32][33]
  • Anti-inflammatory agents (e.g., topical cyclosporine [Restasis]), topical corticosteroids, and systemic omega-3 fatty acids are appropriate therapies for moderate dry eye.
  • Patients with chronic blepharitis who do not respond adequately to eyelid hygiene and topical antibiotics may benefit from an oral tetracycline or doxycycline.

Do's

Don'ts

  • Do not miss the pupillary exam in the pediatric population is a vital part of any clinician's workup. In the right clinical setting, pupillary abnormalities such as anisocoria, light-near dissociation, an afferent pupillary defect, and paradoxic pupillary constriction in the dark can be red flags that trigger further examination and workup.
  • Through both careful physical examination and detailed history taking and observation, potentially vision- and life-threatening conditions can be detected So eye emergencies requiring urgent ophthalmic surgery.[1]

.

References

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  2. Wirbelauer C. "Management of the red eye for the primary care physician". Am J Med. 119 (4): 302–6. doi:10.1016/j.amjmed.2005.07.065. PMID 16564769 PMID: 16564769 Check |pmid= value (help).
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  7. Ismail, M.; Adel, A. (2020). "Prediction of α -decay chains and cluster radioactivity of 121300–304 and 122302–306 isotopes using the double-folding potential". Physical Review C. 101 (2). doi:10.1103/PhysRevC.101.024607. ISSN 2469-9985. line feed character in |title= at position 15 (help)
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  13. Cheung, Chui Ming Gemmy; Chee, Soon-Phaik (2012). "Posterior Scleritis in Children: Clinical Features and Treatment". Ophthalmology. 119 (1): 59–65. doi:10.1016/j.ophtha.2011.09.030. ISSN 0161-6420.
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