oPositive family historyoStrabismusoUnilateral or bilateral leukocoria (reflection of white pupil instead of red)oDecreased visual acuityoAbnormal red reflex (important to check for red reflex)-ManagementoRefer to ophthalmologyoEnucleation of eye for advanced tumorsoHigh cure rateConjunctivitis (most frequent ocular disorder in pediatrics)-Bacterial, viral, allergicBacterial conjunctivitis (30-50%)-Most common: Staph, Strep, H influenzae-Pseudomonas, E Coli, Corynebacterium, Moraxella catarrhalis, Klebsiella pneumoniae,Pseudomonas aeruginosa-Pink eye-Erythema,yellow-green purulent d/c, encrusted/matted eyelids on awakening,burning, stinging, itching, photophobia, symptoms of URI, normal vision screenManagement-Treatment depends on organism (ophthalmic drops or ointment)oPolymyxin-bacitracin (Polytrim)oSulfacetamide (Sodium Sulamyd)oErythromycin ointment 0.3%oTobramycin (Tobrex)oGentamycin and/or fluoroquinolones (Cipro)1-2 gtts BID for 7-10 days-Most children under 10 have secondary bacterial conjunctivitis not primaryoSecondary due to ear infection or sinusitisViral Conjunctivitis-Usually adenovirus-More common in children > 6-Tearing,clear watery d/c (not purulent), fever, headache, anorexia, malaise, URI,pharyngitis, itchyredswollen conjunctivae, hyperemia, swollen eyelids, photophobiawith measles/varicella, herpetic vesicles on eyelid margins-ManagementoGood hygieneoWarm or cold compresses; artificial tearsoProphylaxis with antibiotics not recommendedoAntihistamine or vasoconstrictive solutionsoHSV (refer immediately)oMolluscum (refer for excision)
Allergic Conjunctivitis-Hay fever associated – mild injection, swelling-Vernal – more severe-Atopic keratoconjunctivitis – with atopic dermatitis or asthma-Giant papillary – in contact lens wearers-Clinical findingsoSevere itching/tearingoFamily historyoRhinitis, eczema, asthmaoPrecipitated by allergensoRedness, swelling of conjunctiva or eyelidoFollicular reactionoStringy, mucoid dischargeoBilateraloCobblestone papillary hypertrophyoNormal vision screen-DiagnosticoSmears reveal eosinophilsConjunctivitis in the Newborn-Ophthalmia neonatorum-Occurs in first few months-Chlamydia most common cause-Newborns are treated with Erythromycin at birth to prevent any gonorrhea infectionoIf they aren’t born in a hospital, they aren’t treating them for thisoDo a good history because if not treated properly they can go blind-FindingsoC trachomatis – 5-14 days: moderate eyelid swelling, purulent dischargeoN gonorrheae – 3-5 days: acute conjunctival inflammation, excessing purulentdischargeoHSV – at birth: mild conjunctivitis, erythema, serosanguineous discharge-ManagementoChemical: no specific treatmentoMothers/partners should be treated-PreventionoProphylactic antibiotic eye medication within 1 hour after birthHordeolum (stye): Acute infection of eyelid margin or sebaceous glands of the eyelashes-Staph: one or more pustules may form-Signa and symptoms:oAbscess localized to base of eyelashes, with edema of lid, pustule exudate
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