PEDS HEENT Flashcards
etiology of bacterial conjunctivitis
- streptococcus pneumoniae
- Haemophilus influenzae
- moraxella catarrhalis
clinical presentation
- usually unilateral eye affected; can be bilateral
- injection (pronounced BV)
- discharge
- think, purulent (white, yellow, green)
bacterial conjunctivitis
how is bacterial conjunctivitis diagnosed
clinically
treatment of bacterial conjunctivitis
-
Erythromycin ophthalmic ointment
- 0.5 inch applied inside lower lid
-
Trimethoprim-polymyxin B drops
- 1-2 drops instilled QID x 5-7 days
**ointment preferred over drops in young children
etiology of neonatal conjunctivitis
chlamydia trachomatis
clinical presentation
- presents between 5-14 days of life
- orbital swelling
- watery discharge become mucopurulent
- chemosis
- pseudomembrane (exudate adheres to conjunctivae)
- bloody discharge
neonatal conjunctivitis
how do you diagnose neonatal conjunctivitis
culture (need to get epithelial cells, not just exudate)
treatment of neonatal conjunctivitis
-
Oral Erythromycin
- 50 mg/kg per day in 4 divided doses x 14 days
etiology of hyperacute bacterial conjunctivitis
Neisseria gonorrhoeae
clinical presentation
- rapidly progressive
- profuse, purulent discharge
- marked chemosis
- typically accompanied by urethritis
- severe and sight-threatening
hyperacute bacterial conjunctivitis
treatment of hyperacute bacterial conjunctivitis
immediate opthalmologic referral
contact lens wearers who use extended-use lens have a high risk of what
pseudomonal keratitis
- can cause ulcerative keratitis ->perforation
clinical presentation
- FB sensation
- unable to spontaneously open eye
- typically see corneal opacity with penlight
keratitis
treatment of keratitis
- stop contact lens use
- appropriate Abx coverage (anti-pseudomonal)
- follow-up eye care provider within 12-24 hours
etiology of viral conjunctivitis
adenovirus
clinical presentation
- injection
- burning, gritty sensation in the eye
- discharge
- watery, scant stringy mucus
- +/- tender preauricular node
viral conjunctivitis
how do you diagnose viral conjunctivitis
- clinical
- rapid (10 min) test available (adenovirus)
treatment of viral conjunctivitis
- self-limited process
- warm, or cool compresses
- topical antihistamine or decongestant
- OTC: Naphcon-A, Ocuhist
- lubricant eye drops/ointment (OTC)
when can an individual with infectious conjunctivitis return to school/sports
- stay home until there is no longer any discharge
- most daycare/schools require at least 24 hrs of topical therapy before returning
clinical presentation
- bilateral injection
- discharge
- watery
- ocular pruritus
- eyelid edema
- mild photophobia
- +/- associated sneezing, allergic rhinitis
allergic conjunctivitis
how do you diagnose allergic conjunctivitis
clinically
treatment of allergic conjunctivitis
antihistamine with mast cell stabilizing properties
- olopatadine (patanol, pataday)
- azelastine HCL (optivar)
Kawasaki disease presents with what symptoms?
- fever: does not respond well to antipyretics
CRASH
- Conjunctivitis (bilat, nonexudative)
- Rash (morbilliform)
- Adenopathy (cervical)
- Strawberry tongue (cracked, red lips)
- Hands (red, swollen with desquamation)
what diagnosis should be considered in all children with prolonged unexplained fever > or = 5 days
Kawasaki disease
Kawasaki disease has a high risk of what type of complication
cardiovascular complication
treatment of Kawasaki disease
- intravenous immunoglobulins and high dose aspirin
- infectious disease and cardiology consults
what is amblyopia
- vision in one of the eyes is reduced because the eye and the brain are not working together properly
- brain is favoring the other eye
- sometimes called lazy eye
what is stabismus
misalignment of eyes
*potential to cause amblyopia
how is strabismus diagnosed
- abnormal corneal light reflection test
- cover/uncover test demonstrates deviation
management of strabismus
refer to ophthalmology
what is dacryostenosis
nasolacrimal duct obstrcution
*most commo cause of persistent tearing and ocular discharge in infants and young children
clinical presentation
- chronic, intermittent tearing
- mucoid discharge
- debris on lashes
- mild redness of lower lid from chronic rubbing
dacryostenosis