Conjunctivitis

Published on 10/06/2015 by admin

Filed under Pediatrics

Last modified 10/06/2015

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Conjunctivitis

Lynn C. Garfunkel, MD

Basic Information

Definition

Conjunctivitis is any inflammatory condition of the columnar epithelial membranes that line the eyelids (i.e., tarsal or palpebral conjunctiva) or exposed surface of the sclera (i.e., bulbar conjunctiva). The corneal surface is composed of squamous epithelium, and inflammation of the cornea is called keratitis.

Synonyms

Pink eye
Red eye

ICD-9-CM Codes

077.98 Chlamydial conjunctivitis
077.99 Viral conjunctivitis
098.40 Neonatal conjunctivitis
372.0 Acute or allergic conjunctivitis
372.01 Chronic conjunctivitis

Epidemiology & Demographics

• Most common acute condition of the eye seen by pediatricians
• Neonate

image Occurs in 1.6% to 12% of all newborns
image Acute causes of ophthalmia neonatorum: chemical (e.g., silver nitrate), chlamydial, bacterial (including gonococcal), or rarely, viral (without other nonocular manifestations)

• Infants

image Chlamydial, bacterial causes
image Obstructed lacrimal duct

• Children

image Bacterial pathogen twice as likely as viral
image Haemophilus influenzae: 40% to 50% of cases
image Streptococcus pneumoniae: 10% to 15% of cases
image Moraxella Catarrhalis: 8% of cases
image Adenovirus: 20% to 30% of cases

• Allergic

image Hay fever conjunctivitis
image Vernal conjunctivitis

Clinical Presentation

History

• Viral: acute onset; may be associated with upper respiratory symptoms (i.e., fever and sore throat); unilateral but usually becomes bilateral within 24 to 48 hours; associated with gritty or sandy or burning feeling; associated with watery or mucoid discharge; some morning crusting common
• Bacterial: acute or hyperacute onset; significant crusting common; unilateral or bilateral; green, yellow, or white profuse discharge
• Allergic: usually bilateral; itching is hallmark

image Hay fever conjunctivitis: acute onset, short duration, and many recurrences
image Vernal conjunctivitis: onset at age 3 to 12 years, onset usually in spring, more common in warm climates, more common in boys than girls, often associated with history of atopy, rhinitis, or sinusitis
image Atopic keratitis
image Giant papillary conjunctivitis

• Chemical or toxic cause: medication history, work-related exposures, cosmetics
• Dry eyes: antidepressant use, collagen vascular diseases
• Foreign body: unilateral (may be bilateral in contact lens wearers)
• Time of onset: especially important in neonatal conjunctivitis

image In first 24 hours of life: chemical most likely
image Between 2 and 5 days of life: gonococcal (later onset if prophylaxis given)
image Between 5 and 23 days of life: chlamydial

Physical Examination

• Pattern of the conjunctivitis

image Papillary: allergic or contact irritant

image Large papules
image Tarsal conjunctiva, especially upper lids
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