Bacterial conjunctivitis and keratitis in children

ICD-10 code

• H10 Conjunctivitis.
• H10.0 Muco-purulent conjunctivitis.
• H16 Keratitis.
• H16.0 Corneal ulcer.
• H16.2 Keratoconjunctivitis (epidemic B30.0 + H19.2).
• H16.3 Interstitial (stromal) and deep keratitis.
• H16.9 Unspecified keratitis.

Acute catarrhal conjunctivitis

Pathogens: Staphylococci or streptococci. The disease begins acutely with the defeat of both eyes, gluing the eyelids in the mornings, plentiful mucopurulent or purulent discharge, drying up in the form of crusts on eyelashes. Characterized by hyperemia of the conjunctiva of the eyelids. Transitional folds and sclera. Often, there is marginal keratitis.

Corneal ulcer caused by staphylococcus develops with chronic blepharitis and conjunctivitis or when foreign body enters. The foci of infiltration of the cornea is limited, ulcerated gradually, the irritation of the eye is moderate, the phenomena of irita are usually poorly expressed.

[1], [2], [3], [4], [5]

Pneumococcal conjunctivitis

The causative agent is Streptococcus pneumoniae. Most often ill children 1-3 years, less often newborn. Infection occurs by contact-household way. The incubation period is 1-2 days. The disease begins sharply with alternating defeat of both eyes. Eyelids are edematous, soft. Characterized by a pronounced injection of the conjunctiva, edema of the transitional fold, abundant purulent discharge. On the conjunctiva there are hemorrhages and tender, whitish-gray films, which are easily removed with a moist tampon, the conjunctiva underneath does not bleed. If the inflammatory process passes to the cornea, surface keratitis occurs.

Acute epidemic conjunctivitis

The causative agent is Haemophilus influenzae (Koch-Wicks stick). The disease is highly contagious. The transmission path is contact or household. The incubation period is from several hours to 1-3 days.

An acute onset, the development of the clinical picture during the first day. Complaints of lacrimation, photophobia, pain in the eyes. Characterized by pronounced edema and hyperemia of the conjunctiva of the eyeball and lower transitional fold, polymorphic hemorrhages. In the early days, the separated lean mucous, gluing eyelashes, then it becomes plentiful and purulent. On the eyelid conjunctiva, gentle, easily removable films may appear. When the process spreads to the cornea, there is a superficial point keratitis, deep keratitis is observed rarely. There may be symptoms of general intoxication (fever, headache, insomnia, respiratory symptoms).

[6], [7], [8]

Diphtheria conjunctivitis

Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae (Klebs-Leffler's wand), the source of infection is a sick person or a carrier. The transmission path is airborne. Children are more often ill than 4 years old. Diphtheria conjunctivitis occurs against the background of a severe general condition of the child and, as a rule, is combined with the diphtheria of the upper respiratory tract. They note an increase in body temperature, weakness, headache, swelling and tenderness of the anterior ear and submandibular lymph nodes. Currently, due to the use of antidiphtheria vaccinations, only single cases of the disease are noted.

At the beginning of the disease the eyelids are sharply edematous, cyanotic, dense. Gradually they become softer, there is a profuse mucopurulent discharge. Characteristic is the appearance of dirty-gray films on the conjunctiva of the eyelids, transitional folds, the eyeball, intercostal space and on the skin of the eyelids, tightly welded to the underlying tissue. When removing the film, the mucous membrane easily bleeds. After 7-10 days from the onset of the disease, the necrotic superficial layers of the conjunctiva are discarded, loose granulations remain in their place, and later the formation of starry scars. In a number of cases, there is a symphobaron, a twig of the eyelids. Trichiasis. Very often already in the first days of the disease, the cornea is involved in the process. There are multiple infiltrates, ulceration, areas of necrotic tissue. In the outcome, corneal opacities and decreased visual acuity are formed. Rare, but most severe complications - perforation of the corneal ulcer, panophthalmitis followed by atrophy of the eyeball.

[9], [10], [11], [12],

Conjunctivitis and keratitis caused by Pseudomonas aeruginosa

Pathogen - Pseudomonas aeruginosa (Pseudomonas aeruginosa). A violent acute development characterized by the defeat of one eye is characteristic. There is a strong cutting pain, lacrimation and photophobia, pronounced edema of the eyelids, abundant purulent discharge. Conjunctiva sharply hyperemic, edematous, loose, often - chemosis. Quickly there is a keratitis - there is an infiltration of a cornea which at progrossing passes in an ulcer.

Corneal ulcer caused by Pseudomonas aeruginosa develops violently, characterized by severe cutting pain, lacrimation, photophobia. The purulent discharge is expressed, as it were fixed to the surface of the ulcer. Irit rapidly develops. A hypopion appears. After 2-3 days an ulcer with a purulent craterial bottom can lead to perforation of the cornea.

[13], [14], [15], [16], [17], [18]

Gonococcal conjunctivitis and keratitis

ICD-10 code

• A54.3 Gonococcal infection of the eyes.
• P39.1 Conjunctivitis and dacryocystitis in the newborn.

The causative agent is Gram-negative diplococcus Neisseria gonorrhoeae, which is brought into the eye from the genital organs by hands or infected objects. The source of infection is a person with gonorrhea. The transmission path is mainly contact. Gonorrheal conjunctivitis can develop in adolescents with the onset of sexual activity. Newborns are infected mainly at the time of passage through the birth canal of a mother suffering from gonorrhea.

For acute purulent conjunctivitis is characterized by rapid progression and defeat of both eyes. Eyelids are edematous, separated abundant, purulent. Conjunctiva sharply hyperemic, edematous, infiltrated, collected in folds. Often noted sharp chemosis of the conjunctiva. Keratitis develops in 15-40% of cases, first superficial. The ulcer proceeds violently, is accompanied by rapid destruction of the stroma of the cornea, which can lead to perforation as early as the first day. It is possible to penetrate the infection into the inner shell with the development of endo- and panophthalmitis.

Gonoblennorrhea of newborns usually develops on the 2nd-5th day after birth with damage to both eyes. Eyelids are edematous, dense, cyanotic-purple, they can not be opened for examination of the eye. Characteristic is a thick purulent discharge with an admixture of blood. The conjunctiva is sharply hyperemic. Loose, easily bleeds. A dangerous complication of gonoblenaire is the defeat of the cornea, which first appears as an infiltrate, and then quickly turns into a purulent ulcer. The ulcer extends over the surface of the cornea and into the depth, often leading to perforation. In the outcome, a simple or coalesced throat is formed, there is a sharp decrease in vision or blindness. With the penetration of infection into the eye, endophthalmitis or panophthalmitis may develop.

Treatment of bacterial conjunctivitis and keratitis

In acute conjunctivitis, presumably caused by dangerous pathogens (gonococcus, Pseudomonas aeruginosa), treatment is started immediately, without waiting for a laboratory confirmation of the diagnosis, since a delay of 1-2 days can lead to the development of the corneal ulcer up to its perforation. The eye of the child with conjunctivitis is not covered with a bandage to prevent the emergence of conditions favorable for the reproduction of bacteria.

Treatment of bacterial conjunctivitis and keratitis

With acute staphylococcal conjunctivitis, local antibacterial drugs are prescribed: picloxidine, fusidic acid, tobramycin, chloramphenicol 0.25% (with inefficiency 0.3% drop), ofloxacin, ciprofloxacin or lomefloxacin 3-4 times a day, eye ointment (tetracycline, erythromycin or ofloxacin) 2-3 times a day.