Red Eye in Children
Diagnosis and Management
Ronit Friling M.D.
SCHNEIDER MEDICAL
CENTER
‫ילדים‬
Red Eye Disorders:
Non-Vision -Threatening
 Conjunctivitis
 Blepharitis
 Subconjunctival
hemorrhage
 Dry eyes
 Chalasion
 Corneal abrasions
(most)
Red Eye Disorders:
Vision -Threatening
 Corneal infection
 Iritis
 Scleritis
 Acute glaucoma
 Hyphema
 Foreign body
Anamnesis:
• How long has the eye been red?
• Does the vision seem to be okay ?
• Do the eyes move normally ?
• Is the infection in both eyes ?
Anamnesis:
• Does the child wear contact
lenses ?
• Is there a history of trauma ?
• How long has the eye been red ?
• Is the pupil round ?
Dacryocystitis
Naso Lacrimal Duct Obstruction
Signs:
Red painful swelling above lacrimal sac
History of chronic eye watering
Dacryocystitis
Dacryocystitis
Dacryocystitis
Pathogens:
Staphylococcus aureus, Strep pneumonia
Treatment:
conservative until 1 yr
(antibiotics after culture, hygiene, massage?)
Surgery at 1 yr - probing, silicone tubes, rarely DCR
Conjunctivitis
Bacterial
Chlamydia
Viral
Allergic
Conjunctivitis:
symptoms & signs
Symptoms:
Sore, red, sticky eyes.
Signs:
Red conjunctiva, discharge.
Viral & Chlamydial: Follicles, swollen lids,
enlarged preauricular node.
Conjunctivitis
Bacterial
Strep pneumonia
Haemophilus
Staph. aureus
Neisseria gonorrhea
Conjunctivitis
Chlamydia
Ophthalmia Neonatorum
Any conjunctivitis during the first month of life
Ophthalmia Neonatorum
 Etiology thought to have been acquired
in birth canal: chlamydia, gonococcus,
other bacteria
 Regard chlamydia and gonococcus as
systemic disease and treat systemically
Corneal ulcer : symptoms
• Pain
• Watering
• Photophobia
• Blurring of vision
Corneal ulcer : signs
• Red eye
• Epithelial defect fluorescein staining
• Corneal infiltrate
• A/C inflammation, Hypopyon
Corneal ulcer : risk factors
• Contact lens wear
• Dry eye
• Insesitive eye
• Blepharitis
• Herpes virus- zoster, simplex
Corneal ulcer : risk factors
• Ectropion
• Bell’s palsy
• Corneal surgery, injury, foreign body
Corneal ulcer : pathogens
• Bacterial
Pseudomonas
Staphylococcus
Streptococcus
• Viral
Herpes simplex
• Fungal
Corneal ulcer : treatment
Referral to hospital - culture
Admission
Urgent topical antibiotic treatment:
Cefazolin - Gentamicin drops
Fluoroquinolon (ciloxan, oflox) drops
q 1h - q 1/2h
Conjunctivitis
Viral
Adenovirus
Herpes simplex virus
Herpes simplex keratitis
Primary infection during childhood
Herpes simplex keratitis
Usually unilateral
Dendritic pattern
Often recurrent
Corneal sensation reduced.
Conjunctivitis: treatment
Bacterial
Chloramphenicol
Phenymixin (Chloramphenicol + polymixin B)
Gentamicin
Bamyxin
Chlamydia
Topical Tetracycline 3 weeks
Systemic Tetracycline 2 weeks
Viral
As bacterial or topical steroids
Conjunctivitis: treatment
Herpes simplex keratitis :
treatment
Topical Acyclovir 3% ointment
5 times / day
Systemic Acyclovir 400 mg x 5/day
in immunesupressed or severe infection.
Herpes zoster ophthalmicus
Usually above age 50
Immune supressed - HIV
Rx: PO zovirax 800 mg X 5
Orbital & periorbital celullitis
Signs:
periorbital swelling and redness
fever
lethargy
proptosis
decreased eye motility
abnormal pupillary reaction
optic nerve swelling or pallor
Orbital & periorbital celullitis
Orbital & periorbital celullitis
Signs:
Limitation of abduction of involved eye
Orbital & periorbital celullitis
Orbital & periorbital celullitis
Etiology:
Sinusitis
Trauma
URI
Orbital & periorbital celullitis
Treatment:
Periorbital
PO antibiotics
Orbital – Hospitalization
– CT
– IV antibiotics
Blunt Ocular Trauma:
Anterior segment

Iris
- hyphema
- mydriasis
- iridodialysis
- angle recess
VERNAL KERATOCONJUCTIVITIS
(VERNALIS)
Usually bilateral
Seasonal
Atopic history:
Asthma, rhinitis,
atopic dermatitis
Palpebral : cobble stones
VERNAL KERATOCONJUCTIVITIS
(VERNALIS)
Treatment of exacerbations
 Topical steroids
 Systemic steroids
Lubricants
 Mast cell stabilizers:
 Sodium chromoglycate
 Alomide Zaditen Livostin
Red Eye in Children