Pediatric emergency medicine trisk 4044 4044

These two forms of conjunctivitis, as well as other forms of bacterial
conjunctivitis (S. aureus, Escherichia coli , Pseudomonas aeruginosa ), can be
difficult to distinguish clinically and may coexist.

FIGURE 123.6 Neonatal gonorrheal conjunctivitis. Note the dramatic lid swelling and severe
purulent discharge.

In children beyond the neonatal period, a wide range of organisms, both viral
and bacterial, as well as chlamydia, can cause conjunctivitis. Clinically, these
entities may be indistinguishable. Table 123.1 is designed to give some additional
help in differentiating causes of conjunctivitis. In general, purulence is more
characteristic of bacterial infections, whereas clear serous discharge is more
characteristic of viral infection. Bacterial and viral conjunctivitis can be
associated with otitis media and pharyngitis, respectively. Although both viral and
bacterial conjunctivitis may be unilateral or bilateral, a history of multiple
infected contacts, or consecutive involvement of one eye and then the other,
argues in favor of a viral etiology. Likewise, dramatic lid swelling associated with
preauricular adenopathy, mucoid or serous discharge, and perhaps an
uncomfortable, sandy, foreign-body sensation is strongly suggestive of epidemic
keratoconjunctivitis secondary to adenovirus. This fulminant viral infection is
usually easy to recognize ( Fig. 123.7 ). Both HSV and varicella zoster virus can
cause infections limited to the skin surrounding the eye ( Fig. 123.8 ) or may also
involve the cornea and/or conjunctiva. Patients with ocular HSV infection usually