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

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Presentation on theme: "Red Eye in Children Diagnosis and Management Ronit Friling M.D. SCHNEIDER MEDICAL CENTER ילדים."— Presentation transcript:

1 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 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? Anamnesis:

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

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

7 Dacryocystitis

8

9 Pathogens: Staphylococcus aureus, Strep pneumoniaTreatment: 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 Symptoms: 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 Any conjunctivitis during the first month of life Ophthalmia Neonatorum

15 Etiology thought to have been acquired in birth canal: chlamydia, gonococcus, other bacteria Etiology thought to have been acquired in birth canal: chlamydia, gonococcus, other bacteria Regard chlamydia and gonococcus as systemic disease and treat systemically 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 Signs: Limitation of abduction of involved eye

32 Orbital & periorbital celullitis

33 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 - hyphema - mydriasis - iridodialysis - angle recess

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

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

38 Red Eye in Children


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