Mario Gaspar de Alba, MD

TTUHSC
 Objectives
Distinguish between allergic and infectious
conjunctivitis
Microbiology
Prevention
Clinical manifestations
Treatment
Prep Objectives
 Allergic Conjunctivitis
Most often seen in late childhood and early adulthood
frequently associated with Hx of rhinitis, asthma, and
eczema (2).
Bilateral involvement; redness
Itching
Tearing
Clear mucoid discharge
Conjunctival edema and chemosis
mild eyelid edema
Recurrent; seasonal
Papillary changes
Allergic
 Allergic Treatment
Allergen avoidance
Cold compresses
Oral antihistamines; esp if systemic signs
See table

From Diagnosis and management of pediatric conjunctivitis; Teoh & Reynolds, Ped Emerg Car; vol19, 1,
 Viral Conjunctivitis
Clear mucoid discharge
Preauricular adenopathy
Associated pharyngitis, URI
Approximately 20% of all cases of
conjunctivitis are caused by adenovirus,
with a seasonal predilection for fall and
winter months (5, 13)
NO ITCHING………………usually
Slide 55
Follicular conjunctivitis of
viral origin.
Slide 58
Viral conjunctivitis with
hyperemia and a watery
discharge.
 Viral
Treatment
Artificial tears are as good as anything else
Isolation for about 10 days from start of any viral
symptoms
 HSV Conjunctivitis
Mostly HSV 1
In neonates; HSV 2
Looks like adeno but
may also have:
lid vesicles
URI
gingivostomatitis
Keratitis (dendritic)
80% of cases unilateral
Tx
Call ophtho
Antiviral gtts - viroptic
 Bacterial Conjunctivitis
Neonates
Infants and toddlers (preschool aged)
Mucopurulent discharge
Unilateral or Bilateral
Papillary response
Associated otitis
Slide 57
Acute bacterial
conjunctivitis. Copious
amounts of mucopurulent
discharge have made the
upper and lower eyelids
adherent to each other.
Chemosis of the upper
and lower lids may also
make opening of the
eyelids difficult.
Slide 56
Papillary conjunctivitis of
bacterial or allergic origin.
 Bacterial Treatment
Despite what many of you have heard me
say……

4th gen fluoroquinolone – vigamox

Why?
 Ophthalmia Neonatorum
Etiologies in order of occurrence (6) :
Chemical
Chlamydial
Bacterial
Viral
 Ophthalmia Neonatorum
Etiologies in order of occurrence (12) :
Chemical
Chlamydial
Bacterial
Viral

Ophthalmia neonatorum, a
hyperacute bacterial
conjunctivitis, with thick purulent
discharge and red swollen lids.
 Neonatal Micro
< 24hrs
Chemical (esp with silver nitrate)
Resolves within 48hrs; otherwise Cx
3-5 days
Neisseria gonorrhea
sudden, severe, grossly purulent
Cx shows Gm – diploccoci
Tx – ceftriaxone; 25-50 mg/kg IV/IM in a single dose, max 125 mg
(11, 12)

Topical antibiotic therapy alone is insufficient and unnecessary (11, 12)

The eyes should be irrigated with saline several times a day until the
purulence subsides (10-12).
The mother and her sexual contacts should be treated (10)
The patient also should be evaluated for disseminated infection,
such as arthritis, meningitis, or sepsis (11)
 Neonatal Micro
1-2 wks (up to 30 days)
Chlamydia trachomatis
Prophylaxis does not prevent infection (erythromycin?)
Presentation can vary
– mild to moderate conjunctival erythema
– scant, mucoid discharge to copious, purulent discharge
– ocular edema, chemosis, or pseudomembrane formation may
also be present
Cx w/ dacron-tipped swab, and epithelial cells must be
collected, not just exudates
Tx - oral erythromycin, 50 mg/kg/day divided q6hr doses for
10 to 14 days
– Tx mother and partner
– Topical abx are ineffective
 Infants and Toddlers
Most common organisms
H. influenzae is the most common
S. pneumoniae
Branhamella catarrhalis (formerly Moraxella
catarrhalis) (3, 4, 7, 8).

With Otits
H. influenzae
From Diagnosis and management of pediatric conjunctivitis; Teoh & Reynolds, Ped Emerg Car; vol19, 1,
2003
 Please Match

1. Allergic Conj

2. Viral Conj

3. Bacterial Conj
…given the significant overlap in the signs
and symptoms of bacterial and viral
conjunctivitis, clinicians cannot reliably
predict etiology based on clinical
examination (14).
More than just conjunctivitis (1,2) ….
Ocular pain and/or Photophobia
– exception of adenoviral keratoconjunctivitis
– uveitits, iritis or keratitis, acute glaucoma, or corneal
abrasion
Limbus involvement
– inflammation of the cornea (keratitis) or
anteriorsegment (iritis or uveitis) should be
considered
Decreased visual acuity also suggests a more
serious disease
 References
1. Steinkuller PG, Edmond JC, Chen RM. Ocular infections. In: Feigin RD, Cherry JD, eds.
Textbook of pediatric infectious diseases, ed 4. Philadelphia: WB Saunders, 1998;786–806.
2. Hara JH. The red eye: diagnosis and treatment. Am Fam Physician1996;54:2423–2430.
3. Weiss A. Acute conjunctivitis in childhood. Curr Probl Pediatr 1994;24:4–11.
4. Gigliotti F, Williams WT, Hayden FG, et al. Etiology of acute conjunctivitis in children. J
Pediatr 1981;98:531–536.
5. Fransen L, Van der Berghe P, Mertens A, et al. Incidence and bacterial aetiology of neonatal
conjunctivitis. Eur J Pediatr 1987;146:152–155.
6. Hammerschlag MR. Neonatal conjunctivitis. Pediatr Ann 1993;22:346–351.
7. Weiss A, Brinser JH, Nazor-Stewart V. Acute conjunctivitis in childhood.J Pediatr
1993;122:10–14.
8. Gigliotti F. Acute conjunctivitis of childhood. Pediatr Ann 1993;22:353–356.
9. Wald ER. Conjunctivitis in infants and children. Pediatr Infect Dis J1997;16:817–820.
10. O’Hara MA. Ophthalmia neonatorum. Pediatr Clin North Am 1993;40:715–725.
11. 1998 guidelines for treatment of sexually transmitted diseases. Centers for Disease Control
and Prevention. MMWR Recomm Rep 1998; 47(RR-1):1–111.
12. American Academy of Pediatrics. Gonococcal infections. In: Pickering LK, ed. 2000 Red
Book: Report of the Committee on Infectious Diseases, ed 25. Elk Grove Village, IL: American
Academy of Pediatrics, 2000;254–260.
13. Gigliotti F. Acute conjunctivitis. Pediatr Rev 1995;16:203–207.
14. Lohr JA. Treatment of conjunctivitis in infants and children. Pediatr Ann 1993;22:359–364.
Thank You!