Conjunctivitis (peds): Difference between revisions
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==Neonatal | ==[[Neonatal conjunctivitis]]== | ||
===Background=== | ===Background=== | ||
*Vesicles + conjunctivitis = full sepsis eval + acyclovir | *Vesicles + conjunctivitis = full sepsis eval + acyclovir | ||
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**Admit | **Admit | ||
==Childhood | ==[[Childhood conjunctivitis]]== | ||
===DDX=== | ===DDX=== | ||
*Viral | *Viral | ||
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[[Category:Peds]] | [[Category:Peds]] | ||
[[Category:Ophtho]] | |||
Revision as of 18:12, 26 January 2015
Neonatal conjunctivitis
Background
- Vesicles + conjunctivitis = full sepsis eval + acyclovir
Diagnosis
- Chlamydial
- Can range from mild to severe hyperemia w/ thick mucopurulent discharge
- Gonococcal
- May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration
Work-Up
- Gram stain/culture to r/o gonorrhea
DDx
- Chemical
- Due to ocular prophylaxis
- Occurs on 1st day of life
- Gonococcal
- Peaks at 3-5 days after birth
- Has potential to cause loss of vision
- Chlamydia
- Peaks from 1wk to 1 month after birth
- Herpetic
- Peaks at 6-14 days of life
- May lead to keratitis and disseminated infection
Treatment
- Gonococcal
- Cefotaxime 100mg/kg IV or IM OR ceftriaxone 25-50mg/kg IV or IM x1 (not to exceed 125mg)
- Cefotaxime is preferred b/c does not displace bilirubin
- Disseminated disease should be suspected until CSF is negative
- Topical tx is unnecessary
- Cefotaxime 100mg/kg IV or IM OR ceftriaxone 25-50mg/kg IV or IM x1 (not to exceed 125mg)
- Chlamydial
- Erythromycin 50mg/kg PO QD in 4 divided doses x 14 days
- Topical tx is unnecessary
- Herpetic
- Acyclovir 20mg/kg IV q8hr x 14-21d
- Topical antiviral
- Full sepsis evaluation
- Chemical
- Watchful waiting
Disposition
- Gonococcal
- Admit
- Herpetic
- Admit
Childhood conjunctivitis
DDX
- Viral
- Most frequently caused by adenovirus
- Herpes infection requires immediate treatment
- Bacterial
- Consider chlamydial and gonococcal, esp in adolescents
- Allergic
- Kawasaki Disease
- Pediculosis
Treatment
- Viral
- Non-herpetic: supportive care
- Herpetic: Acyclovir, ophto referral
- Bacterial
- If otitis media + conj give PO abx
- If conj only give topical abx
- Erythromycin ointment
- Note: does not adequately cover H. flu and Moraxella
- If tx failure switch to fluoroquinolone drops
- Note: does not adequately cover H. flu and Moraxella
- Erythromycin ointment
- Allergic
- Ketotifen 1 drop q8-12hr OR olopatadine 1-2 drop QD
See Also
Source
Tintinalli