Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT
--Otitis Media:
Classification, Rx and Complications
--Pediatric ENT:
1. When to Refer for Tubes
2. Laryngeal Abnormalities
--The Treatment of Otorrhea

Eye Problems of Children

1. Stye (Hordeolum): Infection at base of eyelash most often due to Staph aureus.
Treatment: frequent warm compresses and topical ophthalmic antibiotic ointment.

2. Chalazion: Inflammation of meibomian gland: firm nodule on either lid - more commonly on upper eyelid.  This is a chronic condition – usually no treatment needed.

3. Blepharitis: A recurrent inflammation of lid margins with burning, itching symptoms. On PE obvious scaling of lids. Daily cleaning of lid margins with a cloth can help.  If infection present, antibiotic ophthalmic ointment at lid margins at bedtime is indicated.

4. Corneal Abrasion: Usually due to trauma - some abrasions are visible to the examiner without testing; most can be seen only after fluorescein application.  The fluorescein strip is opened and moistened, the lower lid of the affected eye pulled down, and the strip applied.  This can be uncomfortable for the patient.  Treatment: topical antibiotic ophthalmic ointment and patching.  Recovery: within 24-48 hours.  Need to see children back until normal (Arch Peds April 2000).

5. Allergic Reactions:

1. chemosis: Whitish swelling of the white of the eye that can be so severe that protrudes from the eye. This is readily treatable with antihistamines and occasionally steroids. Ophthalmologists should usually prescribe steroids.
2. allergic conjuctivitis: Cobblestone papillary lesions with watery discharge, not usually purulent unless secondarily infected.
   Rx: po antihistamines since often associated with nasal symptoms.
   If ineffective, then nasal steroids - use the AQ Vancenase, or Nasalcrom.
   Topical: prophylaxis: cromolyn (opticrom, crolom);
   Treatment: specific H1 antihistamines (Emodine, Livostin); or mast cell stabilizer (Alocril, Alomide).
3. periorbital swelling: Often seen after insect bites, constant rubbing; Rx: antihistamine

6. Tear duct obstruction (dacryostenosis and dacryocystitis)
Tears drain from the inner canthus through the tear duct into the nose.  Blockage occurs commonly and produces drainage from the affected side.  This can be seen quite early and is considered normal during the first year of age unless recurrent cellulitis occurs. Treatment: Massage tear duct two to three times a day. Use topical ophthalmic antibiotic three times a day: some use daily until gone. Tear duct probe after one year of age- some now say up to 2 yrs of age.  If this fails, ophthalmologists consider stents.

7. Bacterial Conjunctivitis: Can be any number of organisms, but Hemophilus aegypti common.  In young children associated with otitis media in large numbers of cases; therefore, many physicians treat with oral antibiotics in infants/toddlers with this condition.  If oral treatment chosen, no need for topical antibiotics.

8. Viral Conjunctivitis: Most common adenovirus 8, 17.  As such, often associated with fever, sore throat. Requires no antibiotic treatment, though often (if not usually) treated with antibiotic drops because of daycare, family issues.

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004