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 do 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 2 to 5 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 5 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.