2025 – PAGE 249 – OPHTHALMOLOGY

VIRAL CONJUNCTIVITIS

Viral conjunctivitis is usually secondary to adenovirus. Symptoms include red, watery eyes, itchiness, and clear discharge, usually bilateral. Preauricular lymphadenopathy may be present. Diagnosis is clinical and may include a history of recent upper respiratory infection. Treatment involves supportive care such as artificial tears and cold compresses. Avoid antibiotics. Highly contagious, so promote hand hygiene.

BACTERIAL CONJUNCTIVITIS

Bacterial conjunctivitis may be secondary to Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae. Symptoms include red eyes, purulent discharge, and eyelids stuck together in the morning. Usually unilateral but can become bilateral. Diagnosis is clinical but may include Gram stain and culture if severe or unresponsive. Treatment involves topical antibiotics such as erythromycin ointment or polymyxin-trimethoprim drops.

ALLERGIC CONJUNCTIVITIS

Allergic conjunctivitis due to environmental allergies may include symptoms such as itchy eyes, red eyes, watery discharge (typically bilateral), sneezing, and nasal congestion. Diagnosis is clinical, with a history of allergen exposure. Treatment includes avoiding allergens, oral antihistamines, and using antihistamine eyedrops with mast cell-stabilizing properties (e.g., olopatadine).

PRESEPTAL CELLULITIS

Preseptal cellulitis is the infection of the eyelid and surrounding skin, located anterior to the orbital septum. Symptoms typically include red, swollen eyelids with no pain on eye movements, no proptosis, and no vision changes. Often follows trauma or an insect bite. Diagnosis is clinical, but a CT scan may be needed to differentiate it from orbital cellulitis if uncertain. Treatment involves oral antibiotics such as amoxicillin-clavulanate. IV antibiotics may be necessary for severe cases or in young children.

ORBITAL CELLULITIS

Orbital cellulitis is the infection of orbital tissues, often secondary to sinusitis. Symptoms typically include red, swollen eyelids, painful eye movements, proptosis, decreased vision, and fever. Diagnosis is clinical. Blood and nasal swab cultures may be helpful. CT scan may be done to assess the extent of the infection or if the diagnosis is in question because unlike preseptal cellulitis, orbital cellulitis can lead to serious complications such as loss of vision. Treatment requires IV antibiotics such as vancomycin combined with ceftriaxone or cefotaxime. Surgical drainage if abscess is present or if no improvement with antibiotics.

CATARACTS

Cataracts result in opacification of the lens. For the pediatric boards, a cataract is going to be due to GALACTOSEMIA or RUBELLA. The last choice would be Neurofibromatosis Type 2.

MYOPIA

Myopia means a child is nearsighted.

HYPEROPIA

Hyperopia (hypermetropia) means a child is farsighted. As an FYI, “presbyopia” also means farsighted, but the term is typically reserved for farsightedness related to aging.

PEARL: Term babies are more likely to be hyperopic but MAY be myopic. There’s variability. That means you do NOT have to worry about whether newborns are myopic or hyperopic at birth.