Pediatric emergency medicine trisk 4048 4048

FIGURE 123.9 Herpes zoster ophthalmicus. Note the eyelid swelling and the presence of
vesicular lesions in a dermatomal distribution.

Triage Considerations. Some forms of infectious conjunctivitis are highly
contagious and spread by direct contact with the patient’s secretions or with
contaminated objects and surfaces. Potential cases of conjunctivitis should ideally
be identified in triage and appropriate contact precautions should be initiated.
Proper hand washing is essential to prevent spread.
Diagnostic Testing. In neonates with purulent conjunctivitis, urgent bacterial
Gram stain and cultures should be obtained to look for gram-negative diplococci
consistent with gonorrhea. Chlamydial studies may also be useful in this age
group. Conjunctival specimens must contain conjunctival cells from an everted
eyelid since chlamydia is an obligate intracellular organism. Although various
methods of detection exist (e.g., nucleic acid amplification tests, antigen detection
methods), chlamydial cultures remain the gold standard for diagnosis. Outside the
neonatal period a diagnosis of conjunctivitis can generally be made on the clinical
features alone. Studies to determine a causative organism should be reserved for
cases of severe inflammation or chronic or recurrent infections. Viral culturing is
rarely necessary.