Pediatric Primary Care (42 page)

Burns C, Barber N, Brady M, et al.
Pediatric Primary Care: A Handbook for Nurse Practitioners.
4d ed. St. Louis, MO: Mosby; 2009.

Buttaro T, Trybulski J, Bailey P, et al.
Primary Care: A Collaborative Approach.
St. Louis, MO: Mosby; 1999.

Fitzpatrick T, Johnson R, Wolff K, et al.
Color Atlas and Synopsis of Clinical Dermatology.
4th Ed. New York, NY: McGraw-Hill; 2001.

Goodheart H.
Goodheart's Photoguide of Common Skin Disorders.
Philadelphia, PA: Lippincott Williams & Wilkins; 2003.

Habif T.
Clinical Dermatology.
3rd ed. St. Louis, MO: Mosby; 1996.

Kane KS-M, et al.
Color Atlas and Synopsis of Pediatric Dermatology.
2nd ed. New York, NY: McGraw-Hill; 2009.

Schachner L, Hansen R.
Pediatric Dermatology.
3rd ed. St. Louis, MO: Mosby; 2003.

Schalock, PC, et al.
Lippincott's Primary Care Dermatology.
Philadelphia, PA: Lippincott Williams & Wilkins; 2011.

Weston W, Lane A, Morelli J.
Color Textbook of Pediatric Dermatology.
3rd ed. St. Louis, MO: Mosby: 2002.

Please see the end of the book for color images of dermatological conditions.

CHAPTER 21

Eye Disorders

Frances K. Porcher

I.  ALLERGIC CONJUNCTIVITIS

A.  Definition. Conjunctivitis: inflammation or infection of bulbar and/or palpebral conjunctiva.

B.  Etiology.

1.  Allergens such as pollen, molds, animal dander, smoke, dust.

C.  Occurrence.

1.  Common in all age groups.

2.  Often seasonal.

3.  May have had recent upper respiratory infection.

D.  Clinical manifestations.

1.  Watery, red eyes.

2.  Itching or burning bilaterally.

3.  Excessive tearing.

E.  Physical findings.

1.  Diffuse conjunctival hyperemia.

2.  Boggy conjunctiva.

3.  Stringy, mucoid discharge.

4.  May see concurrent asthma, atopic dermatitis, or allergic rhinitis.

F.  Diagnostic tests.

1.  None.

2.  Culture if conjunctivitis is persistent or does not respond to treatment.

G.  Differential diagnosis.

1.  Bacterial or viral conjunctivitis.

2.  Nasolacrimal duct obstruction.

3.  Corneal abrasion.

H.  Treatment.

1.  Eliminate offending agent.

2.  Systemic oral antihistamine (Claritin, Zyrtec).

3.  Topical ophthalmic mast-cell stabilizer (Cromolyn, Alomide).

4.  Topical ophthalmic antihistamine/mast-cell stabilizer combination (Patanol).

5.  Artificial tears.

6.  Cool, wet compresses.

I.  Follow up.

1.  Routine follow up not necessary.

2.  Return if fails to improve in 2-3 days or worsens.

J.  Complications.

1.  Allergic reaction to medication.

2.  Secondary bacterial infection.

K.  Education.

1.  Avoid rubbing eyes.

2.  Use meticulous handwashing.

3.  Avoid wearing eye makeup until resolved.

4.  Avoid use of contact lenses until resolved.

5.  Will last about 10-14 days.

II. BACTERIAL CONJUNCTIVITIS

A.  Etiology.

1.  Haemophilus influenzae.

2.  Streptococcus pneumoniae.

3.  Moraxella catarrhalis.

B.  Occurrence.

1.  Common in school-age children.

2.  Accounts for 80% of pediatric acute conjunctivitis.

C.  Clinical manifestations.

1.  Red eyes.

2.  Purulent discharge, with matted eyelids on awakening.

3.  May complain of gritty sensation in eye.

4.  Usually starts unilaterally, becoming bilateral.

D.  Physical findings.

1.  Diffuse and marked conjunctival hyperemia.

2.  Purulent or mucopurulent discharge.

3.  May see concurrent otitis media (especially with H. influenzae).

E.  Diagnostic tests.

1.  Culture in infants younger than 1 month of age, multiple cases in a daycare/school; unless conjunctivitis is persistent or does not respond to treatment.

F.  Differential diagnosis.

1.  Viral conjunctivitis.

2.  Chlamydial conjunctivitis (refer to ophthalmologist).

3.  Neisseria gonorrhoeae conjunctivitis (refer to ophthalmologist).

4.  Nasolacrimal duct obstruction.

5.  Blepharitis.

6.  Corneal abrasion or ulcer (refer to ophthalmologist).

7.  Herpes simplex (refer to ophthalmologist).

G.  Treatment.

1.  One year of age, newer generation ophthalmic fluoroquinolones.

a.  Levofloxacin (Quixin).

b.  Moxifloxacin (Vigamox).

c.  Gatifloxacin (Zymar).

2.  Younger than 1 year of age.

a.  Tobramycin (Tobrex) ophthalmic solution or ointment.

b.  Erythromycin ophthalmic ointment.

3.  Cool, wet compresses.

H.  Follow up.

1.  No routine follow up necessary.

2.  Recheck if fails to improve in 2-3 days or worsens.

I.  Complications.

1.  Systemic infection.

2.  Blindness.

J.  Education.

1.  Continue treatment for at least 7 days or for at least 3 days after symptoms have resolved.

2.  Very contagious; meticulous handwashing and no sharing of linens.

3.  No school or daycare until antibiotic treatment for 24 hours.

4.  Instillation of ophthalmic ointment will blur vision.

III. CHLAMYDIAL CONJUNCTIVITIS

A.  Etiology.

1.  Chlamydia trachomatis.

B.  Occurrence.

1.  Neonatal occurrence, acquired from infected cervix during birth.

2.  Adult occurrence, acquired through sexual contact.

C.  Clinical manifestations.

1.  Purulent discharge.

2.  May occur in one or both eyes.