Paediatrics: Special senses Common presentations

Special senses

Common presentations

The red eye

Careful evaluation is needed when presentation is acute and there is associated pain, swelling, constant lacrimation, or blurred vision.

Causes

•   URTI.

•   Viral conjunctivitis.

•   Irritant conjunctivitis, e.g. chlorinated swimming pool.

•   Bacterial conjunctivitis.

•   Stye (infection of eyelash follicle).

•   Chalazion (meibomian or tarsal cyst).

•   Other: corneal laceration/ulcer/keratitis; FB; peri-orbital cellulitis; uveitis.

Differential diagnosis

•   Redness of entire eyelid or swollen eyelid:

•   peri-orbital cellulitis;

•   acute ethmoiditis.

•   Associated eye pain or constant eye tearing, blinking:

•   corneal ulcer;

•   HSV keratitis;

•   eye FB.

•   Blurred vision: uveitis.

•   Infant under age 1mth: gonorrhoea.

•   Painless red eye with good vision: sub-conjunctival haemorrhage

•   Uncomfortable red eye with good vision:

•   conjunctivitis—viral, bacterial, allergic, or chemical;

•   episcleritis

•   Painful red eye with photophobia:

•   corneal or sub-tarsal FB;

•   corneal abrasion;

•   corneal ulcer/keratitis;

•   anterior uveitis (iritis);

•   scleritis.

•   Eyelid redness and oedema:

•   localized—stye, meibomian cyst, dacryocystitis (lacrimal sac abscess);

•   generalized—pre-septal or orbital cellulitis;

•   acute allergic conjunctivitis;

•   herpes simplex/herpes zoster ophthalmicus.

Ear: pain and discharge

Ear discharge (otorrhoea) may be due to drainage of blood, ear wax, pus, or fluid from the external or middle ear.

·Otitis externa.

• Eczema and other skin irritations.

• Foreign object impaction.

• Otitis media.

• Mastoiditis.

• Perforated eardrum.

• Head injury—CSF leak.

Earache (otalgia) can be a symptom of the conditions noted above. However, it may be the result of pain referred from pathology at another location (referred otalgia):

• Sinusitis

• Parotitis.

• Teeth and jaw (impacted molars, dental caries).

• Acute tonsillitis;.

• Oropharyngeal tumours.