What is the treatment for conjunctivitis (pink eye) in a 12-month-old child?

Treatment of Conjunctivitis in a 12-Month-Old Child

For bacterial conjunctivitis in a 12-month-old child, apply topical antibiotic eye drops or ointment such as erythromycin or bacitracin 1-3 times daily for 5-7 days until symptoms resolve. 1, 2, 3

Diagnosis and Classification

Before initiating treatment, it's important to identify the type of conjunctivitis:

• Bacterial conjunctivitis: Characterized by purulent or mucopurulent discharge, matting of eyelids (especially in the morning), and mild discomfort. Most common bacterial causes in children include Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus 1, 4

• Viral conjunctivitis: Typically presents with watery discharge, mild redness, and often accompanies upper respiratory symptoms 1, 5

• Allergic conjunctivitis: Distinguished by intense itching, watery discharge, and often occurs seasonally or with known allergen exposure 1, 6

Treatment Approach

For Bacterial Conjunctivitis:

1. Topical antibiotics:

   • Erythromycin ophthalmic ointment: Apply approximately 1 cm directly to the infected eye(s) up to six times daily, depending on severity 2
   • Bacitracin ophthalmic ointment: Apply directly into the conjunctival sac 1 to 3 times daily 3
   • Other options include polymyxin B-bacitracin, trimethoprim-polymyxin B, gentamicin, or moxifloxacin 0.5% 1

2. Duration: Continue treatment for 5-7 days until resolution of discharge, no more matting of eyelids in the morning, and reduction in conjunctival redness 1

For Viral Conjunctivitis:

1. Supportive care only:
   • Artificial tears for comfort
   • Cold compresses to reduce inflammation
   • Avoid antibiotics as they are ineffective against viruses 1, 5

For Allergic Conjunctivitis:

1. Topical antihistamines with mast cell-stabilizing activity 1, 5
2. Avoidance of identified allergens

Prevention of Spread

• Frequent handwashing for caregivers and other family members
• Avoid sharing towels, washcloths, and pillowcases
• Proper disinfection of surfaces
• For bacterial conjunctivitis, children can typically return to daycare after 24 hours of antibiotic treatment 1

Special Considerations for Infants

• Neonatal conjunctivitis (within first month of life) requires urgent evaluation as it may indicate serious infections like gonococcal or chlamydial infections 1
• For infants and young children, ointment formulations may be easier to administer than eye drops
• Take care to avoid contamination of medication containers during application 2, 3

When to Refer to an Ophthalmologist

Seek immediate ophthalmology consultation if:

• Symptoms don't improve after 3-4 days of treatment
• Moderate to severe eye pain develops
• Vision changes occur
• Corneal involvement is suspected
• There's a history of herpes simplex virus eye disease 1, 5

Common Pitfalls to Avoid

• Indiscriminate antibiotic use: Not all conjunctivitis requires antibiotics; viral cases won't respond to antibacterial agents 1
• Missing serious underlying conditions: Be alert for signs of more serious eye conditions requiring specialist care
• Inadequate infection control: Proper hygiene is essential to prevent spread within households
• Using corticosteroids without ophthalmology consultation: These can potentiate viral infections 1

Remember that most cases of bacterial conjunctivitis in children are self-limiting, but treatment with appropriate antibiotics can reduce symptom duration and allow earlier return to daycare or school 7, 4.