What is the treatment for a 1-year-old with a conjunctival (eye) infection?

Treatment of Eye Infection in a 1-Year-Old

For a 1-year-old with bacterial conjunctivitis, initiate a 5-7 day course of broad-spectrum topical antibiotic (such as erythromycin ophthalmic ointment) applied 4 times daily. 1

Initial Assessment and Red Flags

Before starting treatment, evaluate for severe infections that require different management:

• Check for severe purulent discharge, eyelid swelling >50%, or corneal involvement - these require immediate ophthalmology referral and possible hospitalization 1, 2
• Consider gonococcal or chlamydial infection if there is severe purulent discharge, as these require systemic antibiotics in addition to topical therapy 1, 3
• Assess for orbital involvement (proptosis, impaired eye movement, or visual changes) - this is a medical emergency requiring hospitalization 4

Standard Treatment for Uncomplicated Bacterial Conjunctivitis

Topical Antibiotic Therapy

• Apply erythromycin ophthalmic ointment approximately 1 cm in length directly to the infected eye(s) up to 6 times daily depending on severity 5
• Treatment duration is typically 5-7 days 1, 2
• Topical antibiotics reduce symptom duration from 7 days to 5 days, promote earlier microbiological clearance, and reduce transmission 1, 2

Supportive Care

• Implement strict hand hygiene - wash hands frequently with soap and water after touching the eye 1, 2
• Use separate towels and avoid sharing pillows during the contagious period 3, 2
• Consider preservative-free artificial tears for comfort, especially with frequent use 1

When Systemic Antibiotics Are Required

Gonococcal Conjunctivitis

If gonococcal infection is suspected (severe purulent discharge, rapid onset):

• Obtain conjunctival cultures and Gram stain before treatment 1
• Administer ceftriaxone 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg 4
• Hospitalize the patient and evaluate for disseminated infection (sepsis, arthritis, meningitis) 4
• Daily follow-up is mandatory until complete resolution 1, 3
• Topical antibiotics are unnecessary when systemic treatment is given 4

Chlamydial Conjunctivitis

If chlamydial infection is suspected (manifests 5-19 days after birth in neonates, can occur later in infants):

• Administer erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses for 14 days 1
• Treatment efficacy is approximately 80%; a second course may be required 1
• More than 50% of infants may have infection at other sites (nasopharynx, genital tract, lungs) 1

Follow-Up and Monitoring

• Return for evaluation if no improvement after 3-4 days of treatment 1, 2
• If symptoms worsen or fail to improve, consider:
  • Resistant organisms (including MRSA) 3, 2
  • Alternative diagnoses (viral, allergic, or foreign body) 6
  • Gonococcal or chlamydial infection requiring systemic therapy 1, 2

Critical Pitfalls to Avoid

• Do not rely on topical antibiotics alone for gonococcal or chlamydial conjunctivitis - systemic treatment is mandatory 4, 1
• Do not use topical corticosteroids indiscriminately 2
• Do not delay ophthalmology referral if there is visual loss, moderate-to-severe pain, corneal involvement, or lack of response after 3-4 days 1, 2
• Consider child abuse in cases of gonococcal or chlamydial infection in this age group 1, 3, 2

When to Refer to Ophthalmology

Immediate referral is indicated for: 1, 2

• Visual loss or impaired visual acuity
• Moderate or severe eye pain
• Severe purulent discharge suggesting gonococcal infection
• Corneal involvement (infiltrate, ulcer, or opacity)
• Conjunctival scarring
• History of immunocompromise
• Lack of response to therapy after 3-4 days