Amy Essex is 6 weeks old, her mother Kate is concerned about her left eye which is often watery and 'mucky'. One of the mothers at her mother's group said that it could be conjunctivitis and she is worried because she knows that this is very contagious.
Amy is otherwise well and has been developing normally.
History:
Examination:
Vision develops from a very low level after birth to near adult levels by 12-18 months of age. At birth an infant has visual acuity of approximately 6/120 and by 12 months this has improved to about 6/12.
According to the World Health Organisation a person is considered blind if their vision is worse than 6/120. This means they would not be able to see the top E on the chart when standing 6 meters away.
Conjunctivitis may result from infective, allergic or chemical agents interacting with the conjunctiva. Symptoms are itch, pain and irritation or a gritty sensation. Signs are epiphora (watering), discharge and erythema of conjunctiva and lids. The relative prominence of different symptoms and signs varies with the cause of the conjunctivitis.
Red Flags for child presenting with red eyes:
**Any of these = Refer to ophthalmologist
Most mild conjunctivitis is allergic or irritative, from which viral or bacterial infections are difficult to distinguish; empirical antibiotic therapy may therefore be appropriate. More severe symptoms, including significant pain, loss of vision or photophobia, indicate acute keratitis or another serious disorder, and require prompt referral to an ophthalmologist.
Causes of Conjunctivitis:
In young children, a follicular conjunctivitis may indicate an infection with herpes simplex virus. Many children under 12 months with sticky eyes have blocked tear ducts and the material accumulating represents skin debris rather than pus.
This occurs commonly in infancy as the result of congenital nasolacrimal duct obstruction. About 10% of newborn infants have obstructed nasolacrimal ducts. This will present as a watery and sticky eye in the first few weeks of life. Despite the persistent discharge the eye is generally not red or inflamed. An inflamed eye suggests an alternative diagnosis such as infective conjunctivitis. If the obstruction persists, the lower lid will often become red and sometimes slightly scaly as a result of the skin being constantly moist.
Why it occurs: Failure of membrane at end of tear duct to open at time of birth (other causes include narrow duct system or infection). Symptoms are exacerbated if child has URTI because more tears are produced.
Natural History:
Most congenital nasolacrimal duct obstructions resolve spontaneously. Approximately 95% of cases have resolved by the time of the first birthday, with most doing so in the first 6 months. In persistent cases, probing under a general anaesthetic is recommended after 1 year of age.
As Amy is only 6 weeks old, conservative management such as gentle cleaning of the discharge with cotton wool soaked in a sterile saline solution is appropriate.
Supportive Care:
Follow-up if:
Definition: Buildup of aqueous humour in vitreous cavity (high pressure)
Presentation:
Glaucoma in infancy presents with a cloudy and enlarged cornea with associated epiphora (watery eye) and photophobia. It may be unilateral or bilateral and is usually an isolated ocular abnormality. If unrecognized it will result in severe and untreatable visual loss over weeks to months. Prompt diagnosis allows surgical treatment, which controls the glaucoma in the majority of cases.
Common causes in Kids:
Complications:
Treatment: