• Bacterial conjunctivitis
• Preseptal cellulitis
• Orbital cellulitis

	URL: http://www.opt.indiana.edu/ce/peddz/inflam.htm Revised: November 30, 2006
	IU Optometry home page: http://www.opt.indiana.edu/ Comments (content): Dr. Don Lyon at dwlyon@indiana.edu Comments: Web Administrator Page design and coding: Terri Greene Copyright © 2006, The Trustees of Indiana University

Bacterial Conjunctivitis Bacterial conjunctivitis is more commonly associated with children than adults. It can be an isolated event or can occur in combination with a nasal lacrimal duct obstruction. The two most common causes of bacterial conjunctivitis are H. influenza and S.pneumoniae. Clinical signs of bacterial conjunctivitis include: Mucopurulent discharge Mattering of eyelids Inflamed, edematous conjunctiva Can be confused with viral conjunctivitis; however, with a viral condition you may also see: Concurrent URI Mixed conjunctival reaction Watery discharge Polytrim ophthalmic solution is currently the only ophthalmic antibiotic FDA approved for use in children under the age of one year. Usual treatment plan is 1gt QID OU for 7-10 days with a follow-up visit during that time. If Polytrim is not effective at treating the infection in a child less than one year old, a third or fourth generation fluoroquinolone may be used with close monitoring of the patient. If the patient is 1 year or older, then the third and fourth generation fluoroquinolones are approved for topical ophthalmic use and you will follow their recommended dosage. It is important to educate parents to watch for signs of increase in symptoms including pain, swelling, and redness. If any of these signs increase or the child does not appear to be getting better in a couple of days, they should return to your office for follow-up and possible further evaluation--including culturing of organism. [Return to top]

Preseptal Cellulitis Preseptal cellulitis is more common than orbital cellulitis, especially in young children. This condition can arise from trauma to the eyelids, a sinus infection, or from an external cutaneous infection of the eyelids. Clinical examination is important to rule out orbital cellulitis. Clinical signs of preseptal cellulitis are usually unilateral and can include: Lid edema (both superior and inferior lids may be affected) which can extend past the eyelids Chemosis of the conjunctiva Pain upon palpation Mucopurulent discharge The child with a concurrent sinus infection or URI may also have a fever and have general malaise. Treatment Treatment is dependent upon the age and overall wellness of the child as well as the extent of the infection. In severe cases of preseptal cellulitis (especially when the child is generally unwell), it is recommended that the pediatrician, a pediatric ENT, or pediatric ophthalmologist be contacted to help co-manage the case. In rare instances, the child may be hospitalized for treatment. If the age and/or the cooperativeness of the child preclude a thorough optometric examination (including dilation and optic nerve evaluation), then the child should be referred for imaging to rule out orbital cellulitis. Oral antibiotics can be utilized in children with mild to moderate cases of preseptal cellulitis. The two medications recommended are: Keflex (Cephalexin) First generation cephalsporin Write for generic Pediatric dosage: 40mg/kg/day (divided q6hr) Augmentin Beta-lactam and beta-lactamase combination Pediatric dosage: < 40kg 20-40mg/kg/day (divided dose every 8 hours) Available in suspension or chewable tablet Please remember that some patients with penicillin allergies may have a cross reaction with Keflex, so use with caution in children with mild allergic reaction to penicillin. Augmentin is contraindicated in children with allergies to penicillin. If the child has a severe allergy to penicillin, then communication with the pediatrician or pediatric ENT for co-management is important. [Return to top]

Orbital Cellulitis Orbital cellulitis usually occurs in children over the age of five and can be a result of a severe sinus infection, but it needs to be ruled out in all cases of preseptal cellulitis, especially in infants. The clinical presentation of the eyelid inflammation can be less severe then preseptal cellulitis. Children with orbital cellulitis can be markedly ill. Clinical signs include: Headache and/or fever Concurrent severe sinusitis Lid edema Proptosis Restriction of extraocular eye movements (can have pain) Treatment: Children with orbital cellulitis will be admitted to the hospital for IV antibiotics. They will be seen daily by a pediatrician or pediatric ENT during their hospitalization and undergo CT scans during this treatment period. [Return to top]

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