Conjunctivitis in children
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Synonyms and keywords: Conjunctivitis in kids
Overview
Conjunctivitis is characterized by inflammation and swelling of the conjunctival tissue which can be associated with engorgement of the blood vessels, ocular discharge, and pain. Neonatal conjunctivitis is a red eye in a newborn caused by infection, irritation, or a blocked tear duct. When caused by an infection, neonatal conjunctivitis can be very serious.
Historical Perspective
- Neonatal conjunctivitis was first described by S.T. Quellmaz in 1750.[1][2]
- Crédé introduced 2% silver nitrate for the first time as a prophylaxis treatment method for conjunctivitis in the newborns in 1881. In 1883, Koch discovered the bacilli of two different forms of infectious conjunctivitis.
- In 1953, Micheal Hogan first described the association between atopic dermatitis and conjunctivitis.
Classification
Conjunctivitis can be classified into subtypes:[3]
- Bacterial conjunctivitis
- Viral conjunctivitis
- Allergic conjunctivitis
- Chemical conjunctivitis
- Immune mediated conjunctivitis
Pathophysiology
- The surface tissues of the eye and the ocular adnexa are colonized by normal flora such as streptococci, staphylococci and corynebacteria. Alterations in the bacterial titer, or in the species of bacteria can lead to clinical infection. Alteration in the flora can also result from external contamination, the use of topical or systemic antibiotics, or spread from adjacent infectious sites.
- Disruption of defense barriers can lead to infection. The primary defense against infection is the epithelial layer covering the conjunctiva. Secondary defense include hematologic immune mechanisms carried by the conjunctival vessels, tear film immunoglobulins and lysozyme and the rinsing action of lacrimation and blinking.[4]
Causes
- Conjunctivitis in children[5][6]
Differentiating conjunctivitis from other Diseases
In children with red eye and conjunctivitis symptoms, mentioned diagnosis should be excluded:[7]
- Corneal abrasion
- Subconjunctival haemorrhage
- Blepharitis
- Periorbital cellulitis
- Uveitis
- Episcleritis
Epidemiology and Demographics
- Bacterial conjunctivitis predominantly occurs in children <6 years of age. Recent studies have confirmed that haemophilus influenzae and streptococcus pneumoniae are the two organisms most commonly responsible for bacterial conjunctivitis in children.
- Viral conjunctivitis occurs most often in the fall and winter and usually affects children older than 6 years.
- Boys and girls are affected in similar proportions.[5]
Risk Factors
Risk factors of neonatal conjunctivitis includes:[8][9]
- STDs in mother
- HIV infected mothers
- Exposure of the infant to infectious organisms
- Prematurity
- Poor hygienic delivery conditions
- Ocular trauma during delivery
Natural History, Complications and Prognosis
Natural history
- Chlamydial conjunctivitis is cuased by chlamydia trachomatis which is one of the most common causes in neonatal conjunctivitis. Women with untreated chlamydia can pass the bacteria to her baby during childbirth. Symptoms include red eye, swelling of the eyelids, and purulent discharge. Symptoms are likely to appear 5 to 12 days after birth. About half ofnewborns with chlamydial conjunctivitis also have the infection in other parts of their bodies.[10][2][5]
- Gonococcal conjunctivitis is caused by neisseria gonorrhoeae. Women with untreated gonorrhea can pass the bacteria to her baby during childbirth. Symptoms usually include red eye, thick pus in the eyes, and swelling of the eyelids. This type of conjunctivitis usually begins about 2 to 4 days after birth. It can be associated with bacteremia and meningitis in newborns.
- Chemical conjunctivitis can occurs when eye drops are given to newborns or children to help prevent a bacterial infections. Symptoms of chemical conjunctivitis usually include mildly red eye and some swelling of the eyelids. Symptoms are likely to last for only 24 to 36 hours.
- Conjunctivitis caused by adenovirus is frequently hemorrhagic, and cases of adenovirus keratoconjunctivitis are often accompanied by dramatic degrees of periorbital swelling.
Complications
Complications to neonatal conjunctivitis include:[11][12]
- Pseudomembrane formation
- Corneal edema
- Peripheral pannus formation
- Corneal opacification
- Corneal perforation
- Endophthalmitis
- Loss of eye and blindness
- Infantile pneumonia
- Nasopharyngeal, rectaland vaginal colonization
- Some systemic complications particularly in gonococcal conjunctivitis including:
- Stomatitis
- Arthritis
- Rhinitis
- [Septicemia]]
- Meningitis
Complications of viral conjunctivitis in children including:[2]
- Keratitis
- Corneal ulceration with keratoconjunctivitis
Prognosis
- Early detection and early treatment of extremely pathogenic bacteria, such as Chlamydia trachomatis or Neisseria gonorrhoeae, is associated with a good prognosis. [2]
Diagnosis
Diagnostic Criteria
- Redness, excessive tearing, and irritation are symptoms common to all forms of conjunctivitis. Photophobia, itching, mucopurulent or non-purulent discharge, chemosis, burning eyes, blurred vision and eyelid swelling are variable depending on the pathogen. Broad generalizations can be made about the clinical characteristics of bacterial conjunctivitis as compared to viral conjunctivitis but distinguishing them clinically in individual children may be difficult.[13]
Symptoms
Gonococcal Conjunctivitis
Gonococcal conjunctivitis is more severe than chlamydial conjunctivitis. The incubation period is 2-5 days and it is usually bilateral.[2]
Chlamydial conjunctivitis
Chlamydial conjunctivitis has a later onset than gonococcal conjunctivitis. The incubation period is 5-14 days. Most of the cases are mild and self-limited, but occasionally may be severe.[2]
Chemical conjunctivitis
Chemical conjunctivitis usually occurs within 24 hours of instillation of silver nitrate solution and resolves spontaneously within a few days.[3]
Herpes simplex keratoconjunctivitis
Herpes simplex keratoconjunctivitis in an infant usually presents with generalized herpes infection.[3]
Bacterial Conjunctivitis
Bacterial conjunctivitis more than viral conjunctivitis tend to cause bilateral rather than unilateral involvement.[3]
- Mucopurulent discharge
- Eyelids swelling
- Red eye
Physical Examination
Ophthalmologic examination of children with conjunctivitis is usually remarkable for:[3][14]
- Chemosis
- Mucopurulent or watery discharge
- Eye lid oedema
- Mild to moderate hyperemia
Laboratory Findings
- There are no specific laboratory findings associated with [disease name].
- A [positive/negative] [test name] is diagnostic of [disease name].
- An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
- Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Electrocardiogram
There are no ECG findings associated with [disease name].
OR
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
X-ray
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with [disease name].
OR
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
CT scan
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Other Imaging Findings
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
- [Disease name] may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for [disease name]; the mainstay of therapy is supportive care.
- The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action 1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for [disease name].
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
- [Surgical procedure] can only be performed for patients with [disease stage] [disease name].
Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
References
- ↑ "Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn". Am J Dis Child. 121 (1): 3–4. 1971. PMID 5543850.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
- ↑ 3.0 3.1 3.2 3.3 3.4 Gigliotti F, Williams WT, Hayden FG, Hendley JO, Benjamin J, Dickens M; et al. (1981). "Etiology of acute conjunctivitis in children". J Pediatr. 98 (4): 531–6. doi:10.1016/s0022-3476(81)80754-8. PMID 6970802.
- ↑ Azari AA, Arabi A (2020). "Conjunctivitis: A Systematic Review". J Ophthalmic Vis Res. 15 (3): 372–395. doi:10.18502/jovr.v15i3.7456. PMC 7431717 Check
|pmc=value (help). PMID 32864068 Check|pmid=value (help). - ↑ 5.0 5.1 5.2 5.3 Weiss A (1994). "Acute conjunctivitis in childhood". Curr Probl Pediatr. 24 (1): 4–11. doi:10.1016/0045-9380(94)90022-1. PMID 8174390.
- ↑ Bodor FF, Marchant CD, Shurin PA, Barenkamp SJ (1985). "Bacterial etiology of conjunctivitis-otitis media syndrome". Pediatrics. 76 (1): 26–8. PMID 3874389.
- ↑ Rainsbury PG, Cambridge K, Selby S, Lochhead J (2016). "Red eyes in children: red flags and a case to learn from". Br J Gen Pract. 66 (653): 633–634. doi:10.3399/bjgp16X688309. PMC 5198670. PMID 27884914.
- ↑ Gichuhi S, Bosire R, Mbori-Ngacha D, Gichuhi C, Wamalwa D, Maleche-Obimbo E; et al. (2009). "Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers". Ophthalmic Epidemiol. 16 (6): 337–45. doi:10.3109/09286580903144746. PMC 3223245. PMID 19995198.
- ↑ Honkila M, Renko M, Ikäheimo I, Pokka T, Uhari M, Tapiainen T (2018). "Aetiology of neonatal conjunctivitis evaluated in a population-based setting". Acta Paediatr. 107 (5): 774–779. doi:10.1111/apa.14227. PMC 7159510 Check
|pmc=value (help). PMID 29345007. - ↑ Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N (2018). "Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis". J Pediatric Infect Dis Soc. 7 (3): e107–e115. doi:10.1093/jpids/piy060. PMC 6097578. PMID 30007329.
- ↑ Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis". J Infect Dis. 153 (5): 862–9. doi:10.1093/infdis/153.5.862. PMID 3084664.
- ↑ Drug and Therapeutics Bulletin (2011). "Management of acute infective conjunctivitis". Drug Ther Bull. 49 (7): 78–81. doi:10.1136/dtb.2011.02.0043. PMID 21733975.
- ↑ Rose P (2007). "Management strategies for acute infective conjunctivitis in primary care: a systematic review". Expert Opin Pharmacother. 8 (12): 1903–21. doi:10.1517/14656566.8.12.1903. PMID 17696792.
- ↑ Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.