X hits on this document

109 views

0 shares

0 downloads

0 comments

32 / 33

TABLE A-I DIFFERENTIAL DIAGNOSIS IN INFECTIONS OF THE CONJUNCTIVA IN NEONATES

Cause

Time of pre- sentation

Clinical features

Comments and treatment

Chemical

1 – 2 days

Slight hyperaemia, serous discharge

Treatment not necessary

Neisseria gonorrhoeae

2 – 4 days

Hyper-acute conjunctivitis, severe purulent, yellow- green discharge, lid oedema, chemosis, rapidly progressive, corneal ulcer, risk of corneal perforation in hours. Can cause blindness.

Check for sepsis, meningitis, arthritis. Urgent case, treat- ment with systemic (basic therapy) ceftraxione 25 – 50 mg/kg (not to exceed 125 mg) IM or IV single dose if no evidence of dissemina- ted disease. Topical fluoro- quinolones or erythromycin. Treat mother and her sexual partner.

Viral (HSV2)

5 – 12 days

Lid vesicles, copious serous discharge, lid oedema, possibility of corneal changes

Check for cataract, uveitis and disseminated infection. Topical acyclovir. Systemic acyclovir treatment may be necessary in intraocular or disseminated infections.

Chlamydia

5 – 7 days

Mucopurulent discharge, marked hyperaemia, some- times micropannus, pseudo- membranes and rarely cor- neal opacity. No follicular reaction.

Check for pneumonia nasopharyngitis and otitis. Treatment with oral (basic therapy) erythromycin 50 mg/kg per day in four divided doses for 2 weeks and topical erythromycin or tetracycline ointment for two weeks. Treat mother and her sexual partner.

Other bacterial

1 – 30 days

Purulent discharge, no corneal changes.

Start treatment with topical aminoglycosides or fluoroquinolones. If not effective switch to newer topical fluoroquinolones. Exclude obstruction of nasolacrimal duct.

s. pneumoniae staph. aureus proteus, klebsiel- la, pseudomonas, serratia marces- cens.

Nasolacrimal duct obstruction

ca. 21 days

Bacterial conjunctivitis

Lacrimal sac massage, if not effective perform probing. Topical aminoglycosides for prophylaxis of keratitis.

62

INFECTIOUS CONJUNCTIVITIS

TABLE A-II BLEPHAROCONJUNCTIVITIS

Cause

  • 1.

    Staphylococcal infection

  • 2.

    Meibomian gland

dysfunction

  • 3.

    Contact dermatitis

  • 4.

    Eczema

  • 5.

    Seborrhoeic dermatitis

  • 6.

    Acne rosacea

  • 7.

    Angular blepharitis –

moraxella lacunata

8. Unusual causes – molluscum, pediculosis

2. Lid crusting (scales)

2. Morning removal of crustings

3. Hyperaemia of lid mar- gins and conjunctiva

3. Antibiotic ointment (tetracyclines, fluoroqui- nolones) to lid margin

4. Small ulcerations of eyelid margin

5. Collarettes and crustings around eyelashes

4. Oral tetracycline for chro- nic or severe disease [4]

6. Loss of eyelashes

5. Steroid ointment (selec- ted cases)

  • 7.

    Recurrent hordeola

  • 8.

    Corneal marginal ulcera- tion may develop (usually immune response)

Treatment and comments

1. Lid hygiene

Clinical features and comments

1. Lid margin oedema

Most common cause is underlined.

INFECTIOUS CONJUNCTIVITIS

63

Document info
Document views109
Page views109
Page last viewedThu Jan 19 14:09:48 UTC 2017
Pages33
Paragraphs1444
Words22306

Comments