PEM Playbook – Conjunctivitis
- Mar 12th, 2021
- Tim Horeczko
Originally published at Pediatric Emergency Playbook on December 1, 2020 – Visit to listen to accompanying podcast. Reposted with permission.
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Straightforward, until it’s not — know when to treat, when to test, and when to pull out all the stops…
Within 24 hours of birth, chemical.
1-2 days of birth, gonorrheal.
1-2 weeks of birth, chlamydial.
These of course are general timelines, and there is much overlap; assume gonorrhea and rule-out sepsis in the neonate with conjunctivitis until proven otherwise. [Explanation, nuance, and strategy in Audio]
In infants, toddlers, and young children, assume bacterial and treat. Signs and symptoms are unreliable to distinguish viral from bacterial.
In children: more likely bacterial.
In adults: more likely viral.
Chronic allergic conjunctivitis may need ophthalmology referral: vernal conjunctivitis and giant papillae.
Mostly conjunctivitis is a clinical diagnosis and no testing is required.
Exception: Beware of Hyperacute Conjunctivitis in any age — think gonococcus and aggressive empiric treatment and testing.
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