A Unique Child: Health - A doctor's diary ... eye infections

Acute infective conjunctivitis in children may be caused by a number of conditions, including both bacteria and viruses. It is defined as infection lasting less than three weeks, although doctors often use two weeks as a cut off between acute and chronic disease. Bacteria that may cause infection include streptococcus species, as well as chlamydia and gonorrhoea.

CONJUNCTIVITIS

Simple conjunctivitis affects one or both eyes and causes the affected eye to be sticky with pus. The child is normally well in himself or herself. General measures such as regular cleaning with water and adhering to strict hygiene practices is often all that is required to treat the condition. Given that simple conjunctivitis normally resolves within one to two weeks without the need for antibiotic drops, and medical research shows antibiotics make little difference, doctors often do not prescribe antibiotics. In addition, around one in ten patients have a reaction to antibiotic drops, and the risks of not treating simple conjunctivitis are low.

TREATMENT

Some schools and nurseries will insist on treatment before the affected child returns. It is not necessary for children with simple infective conjunctivitis to remain at home, unless there is a group outbreak.

Where parents request antibiotics for simple conjunctivitis, doctors often offer a 'delayed' prescription, where the parents are advised to monitor the situation for a number of days before taking their prescription to a chemist in exchange for drops.

It is important to see a doctor, however, if you are concerned, particularly if the child is unwell or distressed, if the eye is very red, swollen or painful, if the vision has been affected or if the skin around the eye is inflamed. In this scenario, doctors will treat with antibiotics and in severe cases, refer the child to a hospital.

CONDITIONS

Ophthalmia neonatorum describes bacterial conjunctivitis occurring within the first four weeks of life. Doctors consider this an ophthalmological emergency. It is very different from simple conjunctivitis.

The causative bacteria are usually contracted from the mother during childbirth. Rather than common-or-garden conjunctivitis, ophthalmia neonatorum causes the eye and skin around it to be very red and swollen, discharging an overwhelming amount of sticky pus. The infection can spread rapidly and cause the child to be seriously unwell with pneumonia, meningitis or septiciaemia.

The herpes virus can also cause severe infections in infants, which may lead to perforation of the eye. It is likely that doctors would organise for the baby to be treated in hospital, where the eye will be swabbed and irrigated. The child will receive antibiotics, which may be delivered intravenously.

A sty, known medically as a hordeolum, is a small abscess within an eyelid. It is usually found at the edge of the lid and causes a red painful lump. Styes rarely lead to serious problems, and may be treated with warm compresses. The evidence regarding the use of antibiotic drops to treat styes is inconclusive.

The nasolacrimal duct carries water from the inner corner of the lower eyelid to the nose which is why we, as adults, get a runny nose when we cry. In some children, this duct fails to form a patent canal, causing excessive tears known as epiphora.

Unusually, they can become infected, causing acute dacryocystitis. This bacterial infection causes fever and a painful lump in the partially patent canal. The surrounding skin sometimes becomes infected as a consequence. Affected children require compresses and antibiotics.

Peri-orbital and orbital cellulitis, respectively, describe bacterial infections of the skin surrounding the eye or the housing of the eye itself, known as the orbit. Periorbital cellulitis causes the eyelid and skin around the eye to be red and swollen, although the eye itself is not affected. Orbital cellulitis requires urgent hospital care. The child is usually unwell, with fever and a red, painful and bulging eye. Intravenous antibiotics are required.

MEDICAL ADVICE

Most eye infections in children are not serious and may be managed by simple measures. However, there are some serious conditions that have potentially devastating consequences. A common-sense approach is often all that is required, but if in doubt, always seek medical advice.

Dr Raj Thakkar BSc(Hons) MBBS MRCGP MRCP(UK) is a full-time GP in Buckinghamshire.