Acute Conjunctivitis in Pediatrics

Interactive clinical guide for emergency management

Types of Conjunctivitis

  • 1.

    Bacterial

    Purulent discharge (greenish/yellowish discharge), intense morning stickiness. It usually starts unilateral and becomes bilateral. Moderate-intense hyperemia.

  • 2.

    Viral

    The most frequent. Watery or serous discharge. Foreign body sensation. Frequent association with upper respiratory tract catarrh and palpable preauricular adenopathy. Very contagious.

  • 3.

    allergic

    Itching is the key symptom! Mucous or watery discharge, eyelid edema (swollen eyes), chemosis. It is usually bilateral and seasonal. Often associated with rhinitis.

  • 4.

    Irritative

    Caused by external agents (chlorine, smoke, foreign body). Lacrimation, hyperemia and foreign body sensation. The cessation of the exhibition usually resolves the condition.

How to differentiate them? Diagnostic Keys

Feature Bacterial Viral allergic
Pruritus Mild Mild +++ Intense
Secretion Purulent Aqueous/Serous Mucous/Aqueous
Preauricular lymphadenopathy Strange Frequent No
Bilaterality Frequent (sequential) Frequent (sequential) Almost always
Associated symptoms Otitis media Pharyngitis, fever Rhinitis, sneezing, asthma

Pharmacological Treatment (Spain)

BACTERIAL CONJUNCTIVITIS

Treatment usually lasts 5-7 days. Maintain 2 days after resolution of symptoms.

  • Tobramycin 3 mg/ml eye drops (Tobrex®, Tobrabact®): 1 drop every 4 hours.
  • Fusidic Acid 10 mg/g gel (Fucithalmic®): 1 application every 12 hours. Good adhesion.
  • Chloramphenicol 0.5% eye drops / 1% ointment (Colircusí Chloramfenicol®): Classic option. Eye drops 1 drop/2-3h, ointment 1 application/8h.
  • Azithromycin 15 mg/g eye drops (Azydrop®): 1 drop every 12 hours for 3 days. Very comfortable.

ALLERGIC CONJUNCTIVITIS

  • Topical antihistamines:
    • Azelastine (Corifina®, Afluon®): 1 drop every 12 hours.
    • Olopatadine (Opatanol®): 1 drop every 12 hours.
  • Oral antihistamines (Cetirizine, Loratadine, etc.): If other systemic allergic symptoms are associated.

VIRAL CONJUNCTIVITIS

Treatment is symptomatic. They do not require antibiotics unless bacterial superinfection is suspected.

  • artificial tears to relieve foreign body sensation.
  • Topical NSAIDs (Diclofenac, Ketorolac) in cases with significant inflammation (assess individually).

NON-Pharmacological Management

  • ✓ Frequent hand washing (key to avoid infections!).
  • ✓ Cleaning secretions with physiological saline and sterile gauze, one for each eye, from the inner to the outer canthus.
  • ✓ Do not occlude the affected eye.
  • ✓ Avoid sharing towels, pillows or any object in contact with your face.
  • ✓ Apply cold compresses to relieve itching and inflammation in viral and allergic conjunctivitis.
  • ✓ School/daycare exclusion: In bacterial cases, up to 24 hours after starting antibiotic treatment. In viruses, while the active aqueous secretion phase lasts.

ALERT! Referral Criteria to Ophthalmology

Refer URGENTLY if any of the following warning signs appear:

  • ! Decreased visual acuity.
  • ! Severe eye pain (not just discomfort or itching).
  • ! Severe photophobia.
  • ! Ciliary or perikeratic hyperemia (intense red eye around the iris).
  • ! Suspected keratitis (positive fluorescein stain).
  • ! Corneal involvement, pupillary abnormalities or increased intraocular pressure.
  • ! Conjunctivitis in neonates (<1 month of age).
  • ! Absence of improvement in 48-72 hours with correct treatment.