Pediatric emergency medicine trisk 4043 4043

Conjunctivitis refers to “inflammation of the conjunctiva” and it is the most common acute eye disorder seen by pediatric ED clinicians Acute conjunctivitis is generally classified as either infectious or noninfectious Infectious conjunctivitis may be bacterial or viral Bacterial conjunctivitis in children is commonly caused by Streptococcus pneumoniae, H influenzae, S aureus, and Moraxella catarrhalis N gonorrhea can be a causative agent in sexually active adolescents Viral conjunctivitis is typically caused by adenovirus, although enteroviruses and herpes simplex virus (HSV) are also possible pathogens Noninfectious conjunctivitis includes both allergic conjunctivitis from airborne allergens (which may manifest as acute hypersensitivity reactions or more gradual seasonal reactions) and nonallergic conjunctivitis resulting from a mechanical or chemical insult Goals of Treatment Acute conjunctivitis is typically a benign self-limited disease but can cause significant patient discomfort Goals of treatment include symptomatic relief and shortening of the clinical course when possible Eye lubricants (artificial tears) and/or cool compresses may provide symptomatic relief in all cases Topical antibiotics may be used for bacterial conjunctivitis to hasten healing time and eradicate the pathogen Cases with atypical courses and those that not respond to treatment as expected should be referred to an ophthalmologist for further evaluation Clinical Considerations Clinical Recognition The hallmark of conjunctivitis is dilation of conjunctival blood vessels resulting in erythema and edema Common symptoms include eye redness, irritation, tearing, discharge, and morning crusting The patient’s age is often useful in determining a specific diagnosis Almost all newborn nurseries now use erythromycin ointment or dilute betadine solutions for prophylaxis against gonorrhea However, no prophylaxis is completely effective An infection with gonorrhea typically presents to days after birth with sudden onset, severe, grossly purulent conjunctivitis, with profuse exudate and swelling of the eyelids ( Fig 123.6 ) Left untreated it can rapidly progress to corneal ulceration and perforation Neonatal chlamydia trachomatis conjunctivitis, also known as inclusion conjunctivitis of the newborn (ICN), typically presents to 14 days after delivery and can range from mild swelling with a watery to mucopurulent discharge, to marked swelling of the eyelids with red, thickened, and friable conjunctivae Untreated infection can cause corneal and conjunctival scarring