The causes of acute conjunctivitis in children are numerous and the basis of the clinical diagnosis is the history and the predominant clinical findings. Typically they present with eye discharge and eye redness.
Children presenting with acute thick purulent membranous conjunctivitis may have acute bacterial conjunctivitis.
Those presenting with non-purulent follicular reaction may have any of the three syndromes of viral conjunctivitis: acute follicular conjunctivitis (AFC), pharyngoconjunctival fever (PCF), or epidemic keratoconjunctivitis (EKC). Of the three, PCF is accompanied by sore throat and fever. EKC is usually accompanied by enlarged pre-auricular lymph nodes.Some children present with less severe conjunctivitis but with pseudomembrane such as seen in Hemophilus influenza and adenovirus conjunctivitis. Herpes simplex keratitis may also be accompanied by pseudomembranous conjunctivitis. Eye allergy is usually associated with eye itchiness and frequent blinking. Affected kids may be seen blinking frequently or squeezing their eyelids, if not scratching them. The allergic causes of conjunctivitis include seasonal conjunctivitis, perenial conjunctivitis and vernal keratoconjunctivitis (VKC) . Instead of follicuar reaction, affected children present with papillary reaction. Vernal keratoconjunctivitis can develop giant papillae that puts pressure on the cornea, producing the shield ulcer, in severe cases.
The treatment depends on the cause. Infectious conjunctivitis should be given the appropriate antibiotic. Allergy-related conjunctivitis, on the other hand, should be managed with topical mast cell stabilizers. When inflammation is severe, some affected children may be given topical steroids. Severe cases of vernal keratoconjunctivitis need supratarsal steroid injection.
When left untreated, conjunctivitis in children can lead to keratitis (corneal ulcer) and severe scarring (corneal leukoma). These are vision threatening conditions and should be avoided at all cost.
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