Conjunctivitis (peds)

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
• 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
• Allergic
  • Ketotifen 1 drop q8-12hr OR olopatadine 1-2 drop QD

See Also

• Conjunctivitis

Source

Tintinalli