docPediatric Red Eye - Loma Linda University Medical Center
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Pediatric Red Eye - Loma Linda University Medical Center
Pediatric Red Eye Jennifer Dunbar, MD Loma Linda University Annual Optometric Symposium November 2, 2008 Red Eye - Conjunctivitis Allergic Bacterial Viral Allergic Conjunctivitis z Itching and tearing z History of atopy Eczema Asthma Allergic conjunctivitis z Treatment Allergic Conjunctivitis Vernal Keratoconjunctivitis z Young males z Seasonal “Vernal” z Giant Papillae z Horner-Trantas Dots Vernal Keratoconjunctivitis z Palpebral Vernal - GPC Vernal Keratoconjunctivitis z Limbal Vernal - Horner Trantas Dots Vernal Keratoconjunctivitis z Shield Ulcer Vernal Keratoconjunctivitis z Treatment Systemic Allergy Evaluation Topical histamine blockers Artificial Tears Steroids Bacterial Conjunctivitis z Purulent discharge z History of Exposure z Organisms Bacterial Conjunctivitis z Treatment Viral Conjunctivitis z Watery or purulent discharge z Eyelid edema z Highly contagious z Pharyngeal conjunctival fever z Adenovirus Viral Conjunctivitis - EKC Viral Conjunctivitis - EKC Blepharoconjunctivitis z Meibomian gland dysfunction z Chalazion z Blepharitis z Phlyctenulosis Blepharoconjuctivitis z Eyelid margin disease Blepharoconjunctivitis z Scurf Blepharoconjunctivitis z Chalazion Phlyctenule Molluscum Contagiosum z Eyelid lesion with umbilicated center Molluscum contagiosum Treatment - surgical! HSV Conjunctivitis Conjunctivitis HSV Keratitis z Dendrite HSV Keratitis-Sequelae z Treatment - systemic acyclovir z Never use steroids! Pediatric Eye Trauma z Ruptured Globe z Corneal Abrasion Corneal abrasion z Stain with flurescein z Treat with antibiotics z +/- patch Neonatal conjunctivitis z Conjunctivitis in first month of life z Potentially sight and life-threatening z Ophthalmologic Emergency Neonatal Conjunctivitis z HSV z Chlamydia z Gonorrhea z D/Dx naslacrimal obstruction Neonatal Conjunctivitis z Culture eye z Maternal history z Refer mother to GYN for workup z HSV may be type I or type II Nasolacrimal Obstruction z 15% of population z Obstruction in nose “valve of Hasner” z 90% resolve by a year Nasolacrimal Obstruction z Treatment Massage Antibiotic (erythromycin ointment) Neonatal probing Watchful waiting until 12 months then P&I Silicone stent Baloon dilatation Non-accidental trauma z Retinal hemorrhages z Schisis Cavity z Retinal Folds Stevens Johnson Syndrome z Systemic, life threatening immunologic reaction z Red eye & oral lesions Viral illness, esp HSV Drugs z Sulfa z Seizure Steroids z Should be used with extreme caution in the pediatric red eye. z Risks Promoting Infection Missing HSV Corneal Scarring Blindness Antibiotics z Floroquinolones Very good Gram + and Gram - but do not cover MRSA Polytrim z Covers MRSA z Erythromycin Does not cover H flu z Sulfa z Azosite Practical Tips z You must be able to see! z Stain Every Red Eye z Look for papillae or follicles z Steroids should be used with caution! z Refer if lasts longer than 7 days