Conjunctivitis, Peri-orbital Cellulitis and Otitis Media

Question 1

How does conjunctivitis in children present?

Answer 1

Red or pink eye
Discharge from the eye (purulent of bacterial serous if viral) 
Itching and tears 
Photophobia 
Eye stick together in morning 
Recurrent URTI

Question 2

How should conjunctivitis be managed in children?

Answer 2

Antibiotics usually don’t help, will take 2 weeks to recover either way. Family should wash hand regularly to prevent spread.
Symptomatic support with wet cotton buds
If antibiotics are appropriate – topical chloramphenicol

Question 3

When should conjunctivitis in children be managed by a specialist in hospital?

Answer 3

Under 28 days old 
Severe photophobia
Severe pain 
Changes in vision 
Severe headache and vomiting 
Blistering around the eye 
Fever > 38 if under 3 months or lasting for 5 days

Question 4

What is peri-orbital cellulitis?

Answer 4

Infection of the soft tissue around the eye. Sometimes also known as pre-septal cellulitis. Most commonly this is seen in young male children under the age of 10 and most commonly at 21 months.

Question 5

What are the risk factors for peri-oribital cellulitis?

Answer 5

Trauma
Skin infection
Sinusitis

Question 6

How does peri-orbital cellulitis present?

Answer 6

Red swollen painful eye with acute onset.
Fever and other associated symptoms
Puffy erythematous skin surrounding the eye
Partial or complete ptosis
Visual disturbance and pain on moving the eye

Question 7

How is peri-orbital cellulitis investigated?

Answer 7

WBC and CRP
Swab discharge
Contrast CT of the orbit if you suspect orbital cellulitis

Question 8

How is peri-orbital cellulitis managed in children?

Answer 8

All should be referred to secondary care
Oral antibiotics such as Co-amoxiclav are sufficient
Drainage of any abscess

Question 9

What are the risk factors for otitis media in children?

Answer 9

Very common in children and risk factors include day care attendance, older siblings, young age and family history.

Question 10

What are the clinical features of otitis media?

Answer 10

Acute pain on moving pina
Conductive hearing loss
Otorrhoea
Child often rubs ear
Generally unwell and irritable, vomiting and fever
Often preceded by a respiratory tract infection

Question 11

How should otitis media in children be investigated?

Answer 11

Otoscopy – showing bulging tympanic membrane
Temperature
If CNS involvement, then Head MRI

Question 12

How is otitis media managed in children?

Answer 12

Give antibiotics immediately if:
• Symptoms lasting more than 4 days or not improving
• Systemically unwell but not requiring admissions
• Immunocompromised
• Younger than 2 and bilateral
• Perforation and/or discharge

5-day course of amoxicillin (erythromycin or clarithromycin if penicillin allergic)
Analgesia as required