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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