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Presentation on theme: "SCHNEIDER MEDICAL CENTER"— Presentation transcript:

Red Eye in Children Diagnosis and Management Ronit Friling M.D. SCHNEIDER MEDICAL CENTER ילדים

2 Red Eye Disorders: Non-Vision -Threatening
Conjunctivitis Subconjunctival hemorrhage Chalasion Blepharitis Dry eyes Corneal abrasions (most)

3 Red Eye Disorders: Vision -Threatening
Corneal infection Scleritis Hyphema Iritis Acute glaucoma Foreign body

4 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?

5 Anamnesis: Does the child wear contact lenses? Is there a history of trauma? How long has the eye been red? Is the pupil round ?

6 Dacryocystitis Naso Lacrimal Duct Obstruction
Signs: Red painful swelling above lacrimal sac History of chronic eye watering

7 Dacryocystitis

8 Dacryocystitis

9 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

10 Conjunctivitis Bacterial Chlamydia Viral Allergic

11 Conjunctivitis: symptoms & signs
Sore, red, sticky eyes. Signs: Red conjunctiva, discharge. Viral & Chlamydial: Follicles, swollen lids, enlarged preauricular node.

12 Conjunctivitis Bacterial Strep pneumonia Haemophilus Staph. aureus
Neisseria gonorrhea

13 Conjunctivitis Chlamydia

14 Ophthalmia Neonatorum
Any conjunctivitis during the first month of life

15 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

16 Corneal ulcer : symptoms
Pain Watering Photophobia Blurring of vision

17 Corneal ulcer : signs Red eye Epithelial defect - fluorescein staining
Corneal infiltrate A/C inflammation, Hypopyon

18 Corneal ulcer : risk factors
Contact lens wear Dry eye Insesitive eye Blepharitis Herpes virus- zoster, simplex

19 Corneal ulcer : risk factors
Ectropion Bell’s palsy Corneal surgery, injury, foreign body

20 Corneal ulcer : pathogens
Bacterial Pseudomonas Staphylococcus Streptococcus Viral Herpes simplex Fungal

21 Corneal ulcer : treatment
Referral to hospital - culture Admission Urgent topical antibiotic treatment: Cefazolin - Gentamicin drops Fluoroquinolon (ciloxan, oflox) drops q 1h - q 1/2h

22 Conjunctivitis Viral Adenovirus Herpes simplex virus

23 Herpes simplex keratitis
Primary infection during childhood

24 Herpes simplex keratitis
Usually unilateral Dendritic pattern Often recurrent Corneal sensation reduced.

25 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

26 Conjunctivitis: treatment

27 Herpes simplex keratitis : treatment
Topical Acyclovir 3% ointment 5 times / day Systemic Acyclovir 400 mg x 5/day in immunesupressed or severe infection.

28 Herpes zoster ophthalmicus
Usually above age 50 Immune supressed - HIV Rx: PO zovirax 800 mg X 5

29 Orbital & periorbital celullitis
Signs: periorbital swelling and redness fever lethargy proptosis decreased eye motility abnormal pupillary reaction optic nerve swelling or pallor

30 Orbital & periorbital celullitis

31 Orbital & periorbital celullitis
Signs: Limitation of abduction of involved eye

32 Orbital & periorbital celullitis

33 Orbital & periorbital celullitis
Etiology: Sinusitis Trauma URI

34 Orbital & periorbital celullitis
Treatment: Periorbital PO antibiotics Orbital – Hospitalization – CT – IV antibiotics

35 Blunt Ocular Trauma: Anterior segment
Iris - hyphema - mydriasis - iridodialysis - angle recess

(VERNALIS) Usually bilateral Seasonal Atopic history: Asthma, rhinitis, atopic dermatitis Palpebral : cobble stones

(VERNALIS) Treatment of exacerbations Topical steroids Systemic steroids Lubricants Mast cell stabilizers: Sodium chromoglycate Alomide Zaditen Livostin

38 Red Eye in Children Thank you


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