What are the considerations for conjunctivitis in an 8-month-old female?

From the Guidelines

For an 8-month-old female with conjunctivitis, it is crucial to first determine if it's viral, bacterial, or allergic in nature to provide appropriate treatment and minimize the risk of complications, as emphasized in the conjunctivitis preferred practice pattern 1. When managing conjunctivitis in an infant, it's essential to consider the potential causes and the most effective treatment approaches.

• Viral conjunctivitis typically resolves on its own within 7-10 days; manage with gentle cleansing of eye discharge using clean cotton balls and warm water.
• For bacterial conjunctivitis, which presents with yellow-green discharge, erythromycin ophthalmic ointment (0.5%) applied to the lower eyelid 3-4 times daily for 5-7 days is appropriate for infants, as indicated in the treatment guidelines 1.
• Alternatively, polymyxin B-trimethoprim drops can be used, 1 drop in affected eye(s) every 3 hours while awake for 7-10 days.
• Avoid over-the-counter eye drops as many aren't approved for infants.
• Keep the baby's hands clean and nails trimmed to prevent eye rubbing and spreading infection.
• Watch for worsening symptoms like increased redness, swelling, pain, or vision changes, which warrant immediate medical attention.
• Conjunctivitis is highly contagious, so practice good hand hygiene, avoid sharing towels, and consider keeping the infant home from daycare until discharge resolves, as advised in the counseling and referral section 1.
• If symptoms don't improve within 48-72 hours of treatment, or if there's significant eye pain, light sensitivity, or vision changes, seek prompt medical reevaluation.

From the FDA Drug Label

For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin. For prophylaxis of ophthalmia neonatorum due to N. gonorrhoeae or C. trachomatis.

For an 8-month-old female with conjunctivitis, erythromycin (OPHTH) can be considered for treatment if the infection is caused by organisms susceptible to erythromycin.

• The drug label does not provide specific guidance for this age group, but it does indicate that the drug is used for superficial ocular infections involving the conjunctiva and/or cornea.
• Prophylaxis of ophthalmia neonatorum is also mentioned, but this is more relevant to newborns. 2

From the Research

Considerations for Conjunctivitis in an 8-Month-Old Female

• The most common causes of conjunctivitis in children are viral and bacterial infections, with bacterial conjunctivitis being more common in this age group 3, 4, 5.
• Bacterial conjunctivitis typically presents with mucopurulent discharge and the eyelids matted shut, whereas viral conjunctivitis presents with watery discharge 3, 6.
• Allergic conjunctivitis is less common in infants and typically presents with itching and watery discharge 3, 6.
• For bacterial conjunctivitis, topical antibiotics may be prescribed, but delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing 3, 4.
• Supportive care options, such as artificial tears and cold compresses, can be used to relieve symptoms in viral conjunctivitis 3, 7.
• It is essential to practice strict personal hygiene, including frequent handwashing, to decrease the risk of transmission 3.
• Ophthalmology referral is indicated for conjunctivitis in a neonate or patients with severe pain, decreased vision, recent ocular surgery, vesicular rash on the eyelids or nose, history of rheumatologic disease, or immunocompromised state 3.