Bacterial conjunctivitis and keratitis in children

ICD-10 code

• H10 Conjunctivitis.
• H10.0 Mucopurulent conjunctivitis.
• H16 Keratitis.
• H16.0 Corneal ulcer.
• H16.2 Keratoconjunctivitis (epidemic B30.0 + H19.2).
• H16.3 Interstitial (stromal) and deep keratitis.
• H16.9 Keratitis, unspecified.

Acute catarrhal conjunctivitis

Pathogens: staphylococci or streptococci. The disease begins acutely with damage to both eyes, sticking of the eyelids in the morning, abundant mucopurulent or purulent discharge, drying in the form of crusts on the eyelashes. Hyperemia of the conjunctiva of the eyelids, transitional folds and sclera is characteristic. Marginal keratitis often occurs.

Corneal ulcer caused by staphylococcus develops in chronic blepharitis and conjunctivitis or when a foreign body enters. The focus of corneal infiltration is limited, ulcerates gradually, eye irritation is moderate, iritis phenomena are usually weakly expressed.

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Pneumococcal conjunctivitis

The causative agent is Streptococcus pneumoniae. Children aged 1-3 years are most often affected, and newborns are less often. Infection occurs through contact and household contact. The incubation period is 1-2 days. The disease begins acutely with alternating lesions of both eyes. The eyelids are swollen and soft. Characteristic features include pronounced conjunctival injection, edema of the transitional fold, and abundant purulent discharge. Hemorrhages and delicate, whitish-gray films appear on the conjunctiva, which are easily removed with a damp swab; the conjunctiva does not bleed under them. If the inflammatory process spreads to the cornea, superficial marginal keratitis occurs.

Acute epidemic conjunctivitis

The causative agent is Haemophilus influenzae (Koch-Weeks bacillus). The disease is highly contagious. The route of transmission is contact or household. The incubation period is from several hours to 1-3 days.

Acute onset, clinical picture development during the first day. Complaints of lacrimation, photophobia, eye pain. Characteristic are pronounced edema and hyperemia of the conjunctiva of the eyeball and the lower transitional fold, polymorphic hemorrhages. In the first days, the discharge is scanty mucous, gluing the eyelashes, then it becomes abundant and purulent. Delicate, easily removable films may appear on the conjunctiva of the eyelids. When the process spreads to the cornea, superficial punctate keratitis occurs, deep keratitis is rarely observed. Symptoms of general intoxication are possible (increased body temperature, headache, insomnia, respiratory phenomena).

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Diphtheritic conjunctivitis

Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae (Klebs-Leffler bacillus), the source of infection is a sick person or a carrier of bacteria. The transmission route is airborne. Children under 4 years of age are most often affected. Diphtheritic conjunctivitis occurs against the background of a child's severe general condition and, as a rule, is combined with diphtheria of the upper respiratory tract. Increased body temperature, weakness, headache, swelling and soreness of the anterior auricular and submandibular lymph nodes are noted. Currently, due to the use of anti-diphtheria vaccinations, only isolated cases of the disease are noted.

At the onset of the disease, the eyelids are sharply edematous, cyanotic, dense. Gradually they become softer, abundant mucopurulent discharge occurs. Characteristically, dirty-gray films appear on the conjunctiva of the eyelids, transitional folds, eyeball, intercostal space and on the skin of the eyelids, tightly fused with the underlying tissue. When removing the films, the mucous membrane bleeds easily. After 7-10 days from the onset of the disease, the necrotic superficial layers of the conjunctiva are rejected, loose granulations remain in their place, and subsequently stellate scars form. In some cases, symblepharon, eversion of the eyelids, trichiasis occur. Very often, already in the first days of the disease, the cornea is involved in the process. Multiple infiltrates, ulcerations, areas of necrotic tissue occur. As a result, corneal opacities and decreased visual acuity are formed. Rare but most severe complications are perforation of the corneal ulcer, panophthalmitis with subsequent atrophy of the eyeball.

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Conjunctivitis and keratitis caused by Pseudomonas aeruginosa

The causative agent is Pseudomonas aeruginosa. Characterized by rapid acute development with damage to one eye. There is severe cutting pain, lacrimation and photophobia, pronounced swelling of the eyelids, abundant purulent discharge. The conjunctiva is sharply hyperemic, edematous, loose, often - chemosis. Keratitis quickly develops - a corneal infiltrate appears, which, with progression, turns into an ulcer.

Corneal ulcer caused by Pseudomonas aeruginosa develops rapidly, characterized by severe cutting pain, lacrimation, photophobia. Purulent discharge is pronounced, as if fixed to the ulcer surface. Iritis develops quickly. Hypopyon appears. In 2-3 days, the ulcer with a purulent crater-like bottom can lead to corneal perforation.

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Gonococcal conjunctivitis and keratitis

ICD-10 code

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

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

Acute purulent conjunctivitis is characterized by rapid progression and damage to both eyes. The eyelids are swollen, the discharge is abundant and purulent. The conjunctiva is sharply hyperemic, swollen, infiltrated, and gathers into folds. Severe chemosis of the conjunctiva is often noted. Keratitis develops in 15-40% of cases, initially superficial. The ulcer progresses rapidly, accompanied by rapid destruction of the corneal stroma, which can lead to perforation in the first day. Penetration of the infection into the inner membranes with the development of endo- and panophthalmitis is possible.

Gonoblenorrhea of newborns usually develops on the 2nd-5th day after birth with damage to both eyes. The eyelids are swollen, dense, bluish-purple in color, they cannot be opened to examine the eye. Thick purulent discharge mixed with blood is characteristic. The conjunctiva is sharply hyperemic, loose, bleeds easily. A dangerous complication of gonoblenorrhea is damage to the cornea, which first appears as an infiltrate, and then quickly turns into a purulent ulcer. The ulcer spreads over the surface of the cornea and into the depths, often leading to perforation. As a result, a simple or fused leukoma is formed, a sharp decrease in vision or blindness occurs. If the infection penetrates 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 begins immediately, without waiting for laboratory confirmation of the diagnosis, since a delay of 1-2 days can lead to the development of a corneal ulcer up to its perforation. The eye of a child with conjunctivitis is not covered with a bandage to prevent the occurrence of conditions favorable for the proliferation of bacteria.

Treatment of bacterial conjunctivitis and keratitis

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