Paediatrics: Disorders of the eye: infection and inflammatory

Disorders of the eye: infection and inflammatory

Eye infections are common in childhood and largely due to bacterial or viral infections affecting the conjunctiva.

Neonatal conjunctivitis

‘Sticky eyes’

Common in the neonatal period starting from the 3rd or 4th day. Swabs are usually negative for significant pathogens. Simple cleaning measures are usually sufficient. Bacterial infection with either Staphylococcus aureus, Pseudomonas aeruginosa, or streptococcal pathogens can occur.

Treatment 

Topical antibiotic ointment is indicated, e.g. neomycin. 

Gonococcal conjunctivitis

Should be suspected if purulent discharge with swelling of the eyelids oc-curs within the first 48hr of life.

Treatment 

IV antibiotics required, e.g. cephalosporin.

Chlamydial conjunctivitis

Usually presents at the end of the first week of life. Diagnosis established by specific monoclonal antibody test performed on conjunctival secre-tions.

Treatment 

Two-week course of oral erythromycin or topical tetracycline eye ointment is required.

Childhood conjunctivitis

May be due to bacteria (e.g. Gram +ve cocci or Haemophilus influenzae), virus (e.g. adenovirus), or to allergic reaction.

Treatment 

Specific antibiotic eye drops or ointment (e.g. fusidic acid or gentamicin) for 5 days is required.

Allergic conjunctivitis

Acute allergic conjunctivitis can cause rapid onset lid swelling and chemo-sis (conjunctival oedema). Seasonal/perennial forms present with other features of atopy. Vernal kerato-conjunctivits is a chronic allergic con-junctivitis which is painful and can cause photosensitivity due to corneal involvement. Topical mast cell stabilizers and antihistamines can improve symptoms. Topical steroids are occasionally necessary, but should only be prescribed by a specialist.

Peri-orbital cellulitis , Keratitis

Keratitis is an inflammation or infection of the cornea, which can lead to corneal scarring and requires urgent specialist management. Symptoms in-clude FB sensation, pain, and photophobia with a red eye. It can occur due to viral infection, e.g. HSV or adenovirus in conjunction with skin lesions or conjunctivitis. Bacterial keratitis can occur secondary to corneal exposure in the hospital setting or secondary to contact lens use. Staphylococcal hypersensitivity is a common cause of keratitis in children with blepharitis. Keratitis can also occur as a toxic effect of chemotherapy.

Iritis

Also known as anterior uveitis. Refers to inflammation of the uveal tract structures (i.e. iris, ciliary body, and choroids). It is characterized by symp-toms of:

• Ocular pain.

• Photophobia.

• Excessive lacrimation.

• Blurred vision.

Signs include:

• Redness.

• Miosis.

• Keratic precipitates on ophthalmoscopic examination.

Long-term disease may be complicated with the development of cataract, glaucoma, and macular eye degeneration.

Causes of iritis

• Local infection: e.g. herpes simplex/zoster.

• Trauma or surgery.

• Systemic disease:

·  Seronegative arthritides—HLA-B27 positive, ankylosing spondylitis, Reiter’s syndrome, psoriatic arthritis.

•   IBD.

•   JIA.

•   Sarcoidosis.

•   Behçet’s disease.

Management 

Referral to the ophthalmologists and treatment with topical steroid drops/ointment and mydriatic agents are required.