Pediatric emergency medicine trisk 0585 0585
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The absence of itching and pain should raise suspicion for an infectious cause
of conjunctivitis. Infectious conjunctivitis may cause diffuse unilateral or bilateral
inflammation. The differentiation among bacterial, viral, chlamydial, and other
types of conjunctivitis is sometimes difficult (see Chapter 123 Ophthalmic
Emergencies ). Viral conjunctivitis is the leading cause of red eye in children,
with adenovirus as the most common organism. It is characterized by
conjunctival hyperemia, chemosis, and a watery discharge. One eye is usually
affected first, followed by the other eye a few days later. It is commonly
associated with upper respiratory tract infection. A palpable preauricular lymph
node strongly supports the diagnosis of viral conjunctivitis. It usually appears
within a few days of the onset of viral conjunctivitis, although it is not present in
all cases. Productive purulent discharge, matting of the lids on awakening, lack of
itching, and no history of conjunctivitis are particularly characteristic of bacterial
conjunctivitis. Patients with nasolacrimal duct obstruction can also present with
discharge; however, the conjunctiva is rarely inflamed (see Chapter 123
Ophthalmic Emergencies ).
FIGURE 27.6 Blepharitis. Note crusts and flakes at base of eyelashes.
