Chapter 22 Red Eye
1 What are the dangerous associated features of a “red eye”?
2 What is included in the differential diagnosis for a red eye in a pediatric patient?
Abnormalities of the lids or lashes
Conjunctivitis (allergic, bacterial, viral, or chemical)
Periorbital or orbital cellulitis
Ocular inflammation from systemic disease (uveitis, episcleritis)
Levin AV: Eye—red. In Fleisher GR, Ludwig S, Henretig FM (eds): Textbook of Pediatric Emergency Medicine, 5th ed. Philadelphia, Lippincott Williams & Wilkins, 2006, pp 267–271.
3 What systemic conditions are associated with red eyes?
Collagen vascular disorders, juvenile rheumatoid arthritis, infectious diseases (varicella, measles, mumps, otitis media), Kawasaki disease, inflammatory bowel disease, cystic fibrosis, Stevens-Johnson syndrome.
Levin AV: Eye—Red. In Fleisher GR, Ludwig S, Henretig FM (eds): Textbook of Pediatric Emergency Medicine, 5th ed. Philadelphia, Lippincott Williams & Wilkins, 2006, pp 267–271.
4 Describe the characteristics of bacterial conjunctivitis
Mucopurulent discharge that involves one eye and usually spreads to the second eye associated with injection of the bulbar conjunctiva. Haemophilus influenzae, Streptococcus pneumoniae, and staphylococci are the most common pathogens. Treat with topical antibiotic drops every 4–6 hours or ointment three times daily for younger children. Trimethoprim sulfate and polymyxin B sulfate (Polytrim) is a good choice because it provides broad-spectrum coverage and is well tolerated (minimal stinging with application).
Wright KW: Pediatric “pink eye.” In Pediatric Ophthalmology for Pediatricians. Baltimore, Williams & Wilkins, 1999, pp 165–193.
5 What is epidemic keratoconjunctivitis (EKC)?
EKC is a specific type of viral conjunctivitis caused by adenovirus types 8, 19, and 37. It usually affects older children and adolescents. Physical examination findings include severe bilateral conjunctivitis with conjunctival hyperemia, watery discharge, eyelid swelling, petechial conjunctival hemorrhages, pseudomembrane along the conjunctiva, and preauricular adenopathy. One third of patients develop corneal inflammation (keratitis) associated with severe photophobia. EKC is extremely contagious, and patients may need to be isolated for as long as 2 weeks. Because of the risk for keratitis, refer all patients with EKC to an ophthalmologist.
Wright KW: Pediatric “pink eye.” In Pediatric Ophthalmology for Pediatricians. Baltimore, Williams & Wilkins, 1999, pp 165–193.
6 How do a stye and a chalazion differ?
A stye or external hordeolum is an inflammation of the ciliary follicles or accessory glands of the anterior lid margin. A chalazion or internal hordeolum is an inflammation of the meibomian glands and involves deeper eyelid tissues than does a stye. Both conditions cause painful focal tenderness of an eyelid and are treated with warm compresses. If they fail to resolve after several months, refer the patient to an ophthalmologist.
Levin AV: Ophthalmic emergencies. In Fleisher GR, Ludwig S, Henretig FM (eds): Textbook of Pediatric Emergency Medicine, 5th ed. Philadelphia, Lippincott Williams & Wilkins, 2006, pp 1653–1661.
7 What is blepharitis? How is it treated?
Blepharitis is an inflammation of the eyelids. Anterior blepharitis affects the skin, cilia follicles, or accessory glands of the eyelids. Posterior blepharitis is an infection of the meibomian sebaceous glands. Clinical findings include swollen, erythematous lid margins with crusting, a gritty or burning sensation of the eyes, and mild conjunctival injection. Scrubbing the eyelid margins with diluted baby shampoo and applying bacitracin or erythromycin ointment are done to treat anterior disease. Posterior disease is treated with eyelid hygiene and oral antibiotics.
Wright KW: Pediatric “pink eye.” In Pediatric Ophthalmology for Pediatricians. Baltimore, Williams & Wilkins, 1999, pp 165–193.
8 What is the most common cause of conjunctivitis in the newborn period?
Red, watery eyes in an infant who is only a few hours old is almost always a chemical conjunctivitis secondary to the use of topical prophylaxis (1% silver nitrate, 1% tetracycline ointment, or 0.5% erythromycin ointment) for ophthalmia neonatorum. True neonatal conjunctivitis rarely presents prior to 48 hours of age. The infectious organisms associated with neonatal conjunctivitis include Neisseria gonorrhoeae (onset, 2–4 days of age), staphylococci or streptococci (onset, 4–7 days of age), chlamydia (onset, 4–10 days of age), haemophilus (onset, 5–10 days of age), and herpes simplex virus type II (onset, 6 days–2 weeks).
Wright KW: Pediatric “pink eye.” In Pediatric Ophthalmology for Pediatricians. Baltimore, Williams & Wilkins, 1999, pp 165–193.
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