Pediatric Red Eye

Pink Eye Yes, when it is 3am in the Peds ED and there are 20 patients waiting to be seen, the chief complaint of “red eye” on the chart can be seen as a “easy” disposition: “Conjunctivitis. Polytrim. Discharge.” Ok, being superiorly trained, you have also considered corneal abrasions… Which also lead you to the dispensing of Polytrim and a quick disposition.

While this tactic will certainly be appropriate for the majority of the cases of pediatric red eye, let us not forget what one of the common themes of the Ped EM Morsels is: staying vigilant.

Pediatric Red Eye – The Common

  • Conjunctivitis
    • Neonatal conjunctivitis – a special consideration (see Morsel)
    • Bacterial
      • More common than you think
      • Non-typeable H. flu, Srep pneumo, and Staph
      • Consider Otitis-Conjunctivitis Syndrome (see Morsel) – gets oral antibiotics… So look in the ears too!
    • Viral
      • Difficult to reliably distinguish from bacterial source, so often treated with topical antibiotics.
      • Adenovirus is a common culprit
      • Pharyngoconjunctival fever = fever, sore throat, and conjunctivitis due to adenovirus; lasts 2 weeks
    • Allergic
      • Topic antihistamines can be helpful
    • Chemical
      • True emergency!
      • Non-verbal kids can splash chemicals in their eyes and not be able to tell anyone what it was.
      • Have a low threshold for checking a pH!
  • Corneal abrasions
    • Often associated with redness, tearing, and photophobia.
    • Topical antibiotics are used to help prevent superinfection.
    • Ointments, while blurring the vision, can help soothe the pain better than drops.

Pediatric Red Eye – The Under Appreciated

  • Glaucoma
    • Can be seen at birth or develop during childhood.
      • 40% present at birth
      • 85% diagnosed during first year of life
    • Increased intraocular pressures can damage the optic nev and lead to blindness.
    • Most common presentations:
      • Excessive tearing (is it really a clogged tear duct)
      • Photophobia
      • Blepharospasm
      • Corneal enlargement
      • Corneal clouding
      • Conjunctival injection (Red Eye)
    • Pediatric Glaucoma therapy is primarily surgical!
  • Iritis
    • Have consensual photophobia and often pain with near-gaze.
    • Can be seen 1-2 days following trauma.
    • Cells seen in anterior chamber.
  • Uveitis
    • Photophobia and Red Eye
    • Can be associated with systemic illnesses
      • Juvenile Inflammatory Arthritis
      • Inflammatory bowel disease
      • TORCHeS infections, Lyme disease
    • Anterior Chamber cells present
    • Keratic percipitates on inner surface of the cornea are present
    • Managed by opthalmology, but consideration for the potential systemic illness should be made in addition.

So the next time, before you write the diagnosis of conjunctivitis on the chart consider whether you should check a pH, get a better look into the anterior and posterior chambers, and whether there is some other significant systemic illness playing a role.

Prentiss KA, Dorfman DH. Pediatric Opthalmology in the Emergency Depaetment. Emerg. Med. Clin. N. Am. 2008; 26: 181-198.

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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2 Responses

  1. June 26, 2015

    […] Red eye and excessive tearing? Congenital conjunctivitis? Glaucoma? […]

  2. October 6, 2017

    […] “Pediatric Red Eye” is a commonly encountered presentation that we are all accustomed to evaluating.  The vast […]

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