infective conjunctivitis Flashcards
when does neonatal conjunctivitis occur? what is the most common cause?
what happens to these cases management wise?
- first 28 days of life
- GU tract, chlamydia most common, but also gonococcal
- all referred to ophthalmology
if it is gonococcal neonatal conjunctivitis how will it look and how is it treated?
- purulent discharge with swelling within first 48 hours
- IV cefotaxime
when does chlamydial neonatal conjunctivitis occur? how is it treated?
- end of 1st week of life
- 2 week course of oral erythromycin or doxycycline
what 3 categories can conjunctivitis be split into?
- neonatal
- infective
- allergic
what usually happens with bacterial conjunctivitis?
what bacterial organisms are most likely causes?
how is bacterial normally treated?
what is viral conjunctivitis usually caused by? what complications can one of them cause?
- self limiting
- S. aureus
- S. epidermis
- Strep pneumoniae
- chloramphenicol/ fusidic acid
- HSV, HZ
- keratitis and uveitis
what does allergic rhinitis look like?
what type of hypersensitivity reaction is it?
how can it be treated?
- recurrent non-infective conjunctivitis
- eyes are red, feel gritty, itchy, burning and tearful
- Type 1
- topical antihistamines
- topical mast cell stabilisers (sodium cromoglicate)
should the child be in pain?
what is the discharge like?
how is their vision?
- no, pain indicates a serious diagnosis
- thick rather than watery
- normal, although “smearing” on waking is common
what does significant photophobia suggest?
- adenoviral or corneal involvement
what should be looked for in examination?
- pre auricular lymph nodes
- visual acuity (VVBFLAP)
- external eye: assess for orbital cellulitis, blepharitis, herpetic rash and nasolacrimal blockage
- conjunctiva: look at pattern of congestion, discharge and presence of follicles or papillae
- cornea: evidence of corneal involvement (staining)
- fundoscopy
What separates the orbit from the periosteum?
what is orbital cellulitis?
- the orbital septum
- extremely serious ophthalmic emergency, infection behind the orbital septum
What might be the cause of orbital cellulitis?
- extension of infection from periorbital structures, face, lacrimal sac or dental infection
- extension of preseptal cellulitis
- direct inoculation of the orbit from trauma
- haematogenous spread from distant bacteraemia
what are the main causative organisms of periorbital cellulitis?
what might be a complications?
- strep pneumoniae
- staph aureus
- strep pyogenes
- h influenza
- spread to CNS
What is preseptal cellulitis?
- anterior to the orbital septum
- less serious than orbital cellulitis
what is the likely cause of preseptal cellulitis?
- result of local skin trauma
- due to spread from local infection e.g. sinuses
- spread from distant infections e.g. upper respiratory tract
what are the most likely causative organisms for preseptal cellulitis?
- s. aureus/ s.epidermis, streptococci
