Have you recently heard anyone say the following statement: “Around 80% of conjunctivitis is due to viruses. We often treat them with antibiotics, but it is more so the kid can go back to daycare.”  I certainly was taught that… and it really irritates me when I was taught incorrectly!

As with everything in Pediatrics, it depends on age.

• Neonatal period (see Ophthalmia neonatorum (Jan. 28, 2011 Morsel):
  • Chemical irritant often presents in 1st day and is mild (and not that common now)
  • Big concern is for GC and Chlamydia, but other bacteria and viruses also possible.
• Beyond neonate up to school age:
  • Acute Conjunctivitis is TWICE as likely to be due to BACTERIA than to viruses.
    • Non-typeable H. influenzae is the most common culprit
    • S. pneumoniae and B. catarrhalis are also encountered frequently
    • Should still consider GC and Chlamydia in the patient with abrupt onset of copious, purulent discharge, eyelid edema, and fever.
• School-aged and older:
  • Most often is viral or allergic
  • ~20% of all conjunctivitis is due to adenovirus.
  • More prevalent in Fall and Winter
  • Epidemic keratoconjunctivitis more commonly afflicts adolescents and adults.
  • Don’t forget about HSV!

Treatment

• For Ophthalmia neonatorum, see Jan. 28, 2011 Morsel
• For everyone else, recall that there is NO Reliable way to discern between bacterial vs viral etiologies.
• Certainly, you can play the odds and diagnose viral conjunctivitis in the adolescent, but I definitely wouldn’t do that for the younger pre-school group.
• Additionally, acute bacterial conjunctivitis is a SELF-LIMITED disease… so why bother at all?
  • We know that topical or systemic antibiotics lead to quicker clinical improvement and eradicate the bacteria from the conjunctiva when compared to placebo.

• Bacitracin-polymyxin (Polysporin) or trimethoprim-polymyxin (Polytrim) are good first-line therapies as they cover the most common bacterial.

Conjunctivitis-Otitis Syndrome – special consideration

• ~25% of patients with conjunctivitis have a concurrent otitis media, even in the ABSENCE of ear pain.
• Every patient with conjunctivitis needs to have an examination of his/her TMs, as your management may change.
• Non-typeable H. influenzae is the most common recovered bacterial. Identical pathogens are seen in the middle ear effusion and the purulent conjunctival discharge.
• Younger children and those with multiple AOM that year had higher risk for developing Otitis media associated with the conjunctivitis.
• For these patients, systemic (oral) antibiotics are recommended and the topical ophthalmic antibiotics are NOT necessary.
• Antibiotics should cover beta-lactamase producing organisms.

Teoh DL, Reynolds S. Diagnosis and management of pediatric conjunctivitis. Pediatric Emergency Care: 2003; 19(1), pp. 48-55.

Ward ER. Conjunctivitis in infants and children. Pediatric Infectious Disease Journal: 1997; 16(2), pp.S17-S20.

Harrison CJ, Hendrick JA, Block SL, Gilchrist MJR. Relation of the outcome of conjunctivitis and the conjunctivitis-otitis syndrome to identifiable risk factors and oral antimicrobial therapy. Pediatric Infectious Disease Journal: 1987; 6(6), pp. 536-540.

Bodor FF, Marchant CD, Shurin PA, Barenkamp SJ. Bacterial etiology of conjunctivitis-otitis media syndrome. Pediatrics: 1985; 76(1), pp.26-28.

Bodor FF. Conjunctivitis-Otitis Syndrome. Pediatrics: 1982; 69(6), 695-698.