From the Guidelines
For a 2-year-old with yellow drainage and crusting in the left eye, I recommend applying erythromycin ophthalmic ointment (0.5%) to the inside of the lower eyelid 3-4 times daily for 7-10 days, as this condition is likely bacterial conjunctivitis, commonly known as pink eye, and erythromycin is a suitable treatment option for children under 18 years, as per the conjunctivitis preferred practice pattern guidelines 1. The treatment approach should prioritize removing discharge and applying antibiotic ointment to manage symptoms and prevent complications.
- Cleaning the eye with warm water and a clean washcloth several times daily to remove discharge is essential.
- Applying erythromycin ophthalmic ointment (0.5%) to the inside of the lower eyelid 3-4 times daily for 7-10 days is the recommended treatment.
- When applying the ointment, gently pull down the lower eyelid to create a small pocket, place a thin ribbon of ointment (about 1/4 inch) inside, and have the child close their eyes briefly to distribute the medication.
- It is crucial to wash hands thoroughly before and after treatment to prevent spreading the infection.
- Keeping the child from rubbing their eyes and using separate towels and washcloths can help avoid infecting others.
- If symptoms don't improve within 48-72 hours, or if the child develops fever, severe eye pain, vision changes, or if the eyelid becomes significantly swollen, seeking medical attention promptly is necessary. The guidelines from the conjunctivitis preferred practice pattern 1 support the use of erythromycin for children under 18 years, making it a suitable choice for this 2-year-old patient.
From the FDA Drug Label
In the treatment of superficial ocular infections, erythromycin ophthalmic ointment approximately 1 cm in length should be applied directly to the infected eye(s) up to six times daily, depending on the severity of the infection. The ointment should be applied directly into the conjunctival sac 1 to 3 times daily.
The treatment for a 2-year-old with left (L) eye yellow discharge/crusting, likely indicating conjunctivitis, is to apply erythromycin ophthalmic ointment or bacitracin ophthalmic ointment directly to the infected eye.
- For erythromycin, apply approximately 1 cm in length up to six times daily 2.
- For bacitracin, apply 1 to 3 times daily 3.
From the Research
Treatment for Conjunctivitis in a 2-year-old
The treatment for a 2-year-old with left eye yellow discharge/crusting, likely indicating conjunctivitis, can be approached in the following ways:
- Supportive treatment is often recommended, as conjunctivitis is typically self-limiting 4, 5
- Topical antibiotic therapy may be considered to shorten the duration of the disease and enhance eradication of the causative organism 6, 7
- A watchful observation approach can be taken, as most cases of bacterial conjunctivitis are self-limited 6, 5
- Antibiotic eye drops can be used if eye washing is ineffective or if symptoms persist 5
Considerations for Treatment
Some key considerations for treatment include:
- The use of topical antibiotics can reduce discomfort, prevent person-to-person transmission, and reduce the rate of reinfection 6
- Systematic use of local antibiotic therapy may not be needed, and a wait-and-see approach can be taken before prescribing antibiotics 5
- The natural history of bacterial conjunctivitis and the potential benefits of topical antibiotic therapy should be taken into account when making treatment decisions 7
Types of Conjunctivitis
It's also important to consider the different types of conjunctivitis, including:
- Bacterial conjunctivitis, which is often caused by Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis 6
- Viral conjunctivitis, which is primarily caused by adenovirus and presents with a burning, gritty feeling and watery discharge 4
- Allergic conjunctivitis, which is largely seasonal and presents with bilateral itching and watery discharge 4