Red Eye in Children Diagnosis and Management Ronit Friling M.D. SCHNEIDER MEDICAL CENTER ילדים

Red Eye in ChildrenRed Eye in Children

Diagnosis and Diagnosis and ManagementManagement

Ronit Friling M.D.

SCHNEIDER MEDICAL CENTER

ילדים

Red Eye Disorders: Non-Vision -Threatening

Conjunctivitis

Subconjunctival hemorrhage

Chalasion

Blepharitis

Dry eyes

Corneal abrasions (most)

Red Eye Disorders: Vision -Threatening

Corneal infection

Scleritis

Hyphema

Iritis

Acute glaucoma

Foreign body

• How long has the eye been red?

• Does the vision seem to be okay?

• Do the eyes move normally?

• Is the infection in both eyes?

Anamnesis:

• Does the child wear contact lenses?

• Is there a history of trauma?

• How long has the eye been red?

• Is the pupil round ?

Anamnesis:

DacryocystitisNaso Lacrimal Duct Obstruction

Signs:Red painful swelling above lacrimal sacHistory of chronic eye watering

Dacryocystitis

Dacryocystitis

Dacryocystitis

Pathogens:Staphylococcus aureus, Strep pneumonia

Treatment:Treatment:

conservative until 1 yr conservative until 1 yr

(antibiotics after culture, hygiene, massage?)(antibiotics after culture, hygiene, massage?)

Surgery at 1 yr - probing, silicone tubes, Surgery at 1 yr - probing, silicone tubes, rarely DCRrarely DCR

Conjunctivitis

Bacterial

Chlamydia

Viral

Allergic

Conjunctivitis:symptoms & signs

Symptoms:Sore, red, sticky eyes.

Signs:Red conjunctiva, discharge.

Viral & Chlamydial: Follicles, swollen lids,enlarged preauricular node.

Conjunctivitis

Bacterial Strep pneumonia Haemophilus Staph. aureus Neisseria gonorrhea

Conjunctivitis

Chlamydia

Any conjunctivitis during the first month of lifeAny conjunctivitis during the first month of life

Ophthalmia Neonatorum

Ophthalmia Neonatorum

Etiology thought to have been acquired Etiology thought to have been acquired in birth canal: chlamydia, gonococcus, in birth canal: chlamydia, gonococcus, other bacteriaother bacteria

Regard chlamydia and gonococcus as Regard chlamydia and gonococcus as systemic disease and treat systemicallysystemic disease and treat systemically

Corneal ulcer : symptoms

• Pain

• Watering

• Photophobia

• Blurring of vision

Corneal ulcer : signs

• Red eye• Epithelial defect -

fluorescein staining

• Corneal infiltrate

• A/C inflammation, Hypopyon

Corneal ulcer : risk factors

• Contact lens wear

• Dry eye • Insesitive eye

• Blepharitis

• Herpes virus- zoster, simplex

Corneal ulcer : risk factors

• Ectropion

• Bell’s palsy

• Corneal surgery, injury, foreign body

Corneal ulcer : pathogens

• Bacterial

Pseudomonas

Staphylococcus

Streptococcus

• Viral

Herpes simplex

• Fungal

Corneal ulcer : treatment

Referral to hospital - cultureAdmission

Urgent topical antibiotic treatment:Cefazolin - Gentamicin dropsFluoroquinolon (ciloxan, oflox) drops

q 1h - q 1/2h

Conjunctivitis

Viral Adenovirus Herpes simplex virus

Herpes simplex keratitis

Primary infection during childhood

Herpes simplex keratitis

Usually unilateral

Dendritic pattern

Often recurrent

Corneal sensation reduced.

Conjunctivitis: treatment

Bacterial ChloramphenicolPhenymixin (Chloramphenicol + polymixin B)GentamicinBamyxin

Chlamydia Topical Tetracycline 3 weeks Systemic Tetracycline 2 weeks

Viral As bacterial or topical steroids

Conjunctivitis: treatment

Herpes simplex keratitis : treatment

Topical Acyclovir 3% ointment 5 times / day

Systemic Acyclovir 400 mg x 5/day in immunesupressed or severe infection.

Herpes zoster ophthalmicus

Usually above age 50

Immune supressed - HIV

Rx: PO zovirax 800 mg X 5

Orbital & periorbital celullitis

Signs :periorbital swelling and redness fever

lethargy

proptosis

decreased eye motility

abnormal pupillary reaction

optic nerve swelling or pallor

Orbital & periorbital celullitis

Orbital & periorbital celullitis

Signs:

Limitation of abduction of involved eye

Orbital & periorbital celullitis

Orbital & periorbital celullitis

Etiology:

Sinusitis

Trauma

URI

Orbital & periorbital celullitis

Treatment :Periorbital PO antibiotics

Orbital – Hospitalization

– CT – IV antibiotics

Blunt Ocular Trauma: Blunt Ocular Trauma: Anterior segment Anterior segment

IrisIris

-- hyphemahyphema

- - mydriasismydriasis

- - iridodialysisiridodialysis

- - angle recessangle recess

VERNAL KERATOCONJUCTIVITIS(VERNALIS)

Usually bilateral

Seasonal

Atopic history:

Asthma, rhinitis,

atopic dermatitis

Palpebral : cobble stones

VERNAL KERATOCONJUCTIVITIS(VERNALIS)

Treatment of exacerbations

Topical steroids

Systemic steroids

Lubricants

Mast cell stabilizers:

Sodium chromoglycate

Alomide Zaditen Livostin

Red Eye in ChildrenRed Eye in Children