Treatment for Pediatric Conjunctivitis (Pink Eye)
For pediatric conjunctivitis, treatment should be based on the suspected etiology, with bacterial cases typically requiring topical antibiotics for 5-7 days, viral cases needing supportive care, and allergic cases responding to antihistamines and mast cell stabilizers. 1, 2
Diagnosis and Etiology
- Bacterial conjunctivitis is characterized by mucopurulent discharge, mattering of eyelids, and absence of itching 2, 3
- Viral conjunctivitis typically presents with watery discharge and is the most common overall cause 4
- Allergic conjunctivitis presents with itching as the most consistent symptom 5
- In children, bacterial conjunctivitis is more common than in adults, with Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis being the most frequent pathogens 3, 6
- A history of gluey or sticky eyelids combined with mucoid or purulent discharge has a 96% probability of bacterial infection 3
Treatment Algorithm
Bacterial Conjunctivitis
- Apply broad-spectrum topical antibiotic 4 times daily for 5-7 days 2
- Topical antibiotics decrease duration of symptoms and allow earlier return to school 2, 5
- Moxifloxacin ophthalmic solution 0.5% has demonstrated clinical cure rates of 66-69% in adults and 80% in pediatric patients 7
- For severe cases, obtain conjunctival cultures before starting treatment 2
- For gonococcal or chlamydial conjunctivitis, systemic antibiotics are necessary in addition to topical treatment 2
Viral Conjunctivitis
- Primarily supportive care with artificial tears and cold compresses 4
- Strict personal hygiene with frequent handwashing to prevent transmission 4
- Most cases are self-limiting and resolve without specific treatment 5
Allergic Conjunctivitis
- Topical antihistamines with mast cell-stabilizing activity are the treatment of choice 4, 5
- Allergen-specific immunotherapy is beneficial in reducing allergic conjunctivitis, particularly in children 1
Special Considerations
- Neonatal conjunctivitis requires prompt referral to an ophthalmologist and may require systemic antibiotics 1, 2
- Single-use tubes of ophthalmic ointment containing 0.5% erythromycin are used as standard prophylaxis to prevent ophthalmia neonatorum 1
- Contact lens wearers with conjunctivitis should be referred to an ophthalmologist due to higher risk of complications 2
- Sexual abuse should be considered in children with gonococcal or chlamydial infections 1
When to Refer to an Ophthalmologist
Refer immediately if the patient has any of the following:
- Visual loss 1
- Moderate or severe pain 1
- Severe purulent discharge 1
- Corneal involvement 1
- Lack of response to therapy after 3-4 days 1, 2
- History of HSV eye disease 1
- Immunocompromised state 1, 4
Patient Education and Prevention
- Hand washing is crucial to reduce transmission risk 1, 4
- Avoid sharing towels, pillows, and close contact during the contagious period 2
- Children can generally return to school once treatment has been initiated for 24 hours and symptoms begin to improve 2
- For contact lens wearers, appropriate lens care and frequent replacement can reduce risk of giant papillary conjunctivitis 1
Common Pitfalls
- Bacterial resistance is increasing, particularly with MRSA 2
- Delayed diagnosis of gonococcal conjunctivitis can lead to corneal perforation 1
- Overuse of antibiotics for viral conjunctivitis contributes to antibiotic resistance 4, 5
- Failure to consider sexually transmitted infections in cases of pediatric conjunctivitis 1, 2