Red eye (peds) - Revision history

Danbot: Add verified PubMed reference (PMID 39172671)

2026-03-22T10:49:28Z

Add verified PubMed reference (PMID 39172671)

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	==Background==		==Background==
	[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]		[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]
	*This page describes a general approach to the complaint of eye redness for pediatric patients		*This page describes a general approach to the complaint of eye redness for pediatric patients<ref>Winters S, Frazier W, Winters J. Conjunctivitis: Diagnosis and Management. Am Fam Physician. 2024 Aug;110(2):134-144. PMID 39172671</ref>
	*Red eye is extremely common in pediatrics — the vast majority is caused by viral [[conjunctivitis]]		*Red eye is extremely common in pediatrics — the vast majority is caused by viral [[conjunctivitis]]
	*Key EM considerations: distinguish benign causes from sight-threatening or systemic diseases		*Key EM considerations: distinguish benign causes from sight-threatening or systemic diseases

Danbot: Strip excess bold

2026-03-22T09:32:25Z

Strip excess bold

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	===Neonatal Conjunctivitis by Timing===		===Neonatal Conjunctivitis by Timing===
	*~~'''~~Day 1~~'''~~: chemical conjunctivitis (from erythromycin prophylaxis) — self-limited		*Day 1: chemical conjunctivitis (from erythromycin prophylaxis) — self-limited
	*~~'''~~Day 2-5~~'''~~: [[Gonococcal conjunctivitis\|Neisseria gonorrhoeae]] — emergent, can rapidly perforate		*Day 2-5: [[Gonococcal conjunctivitis\|Neisseria gonorrhoeae]] — emergent, can rapidly perforate
	*~~'''~~Day 5-14~~'''~~: [[Chlamydia trachomatis]] — most common infectious cause of neonatal conjunctivitis		*Day 5-14: [[Chlamydia trachomatis]] — most common infectious cause of neonatal conjunctivitis
	*~~'''~~Day 6-14~~'''~~: Herpes simplex virus — vesicles, keratoconjunctivitis		*Day 6-14: Herpes simplex virus — vesicles, keratoconjunctivitis

	==Differential Diagnosis==		==Differential Diagnosis==
	===Infectious===		===Infectious===
	*~~'''~~Viral conjunctivitis~~'''~~ (adenovirus most common — bilateral watery discharge, preauricular LAD)		*Viral conjunctivitis (adenovirus most common — bilateral watery discharge, preauricular LAD)
	*~~'''~~Bacterial conjunctivitis~~'''~~ (purulent discharge, H. flu, S. pneumo, Moraxella)		*Bacterial conjunctivitis (purulent discharge, H. flu, S. pneumo, Moraxella)
	*~~'''~~Gonococcal ophthalmia neonatorum~~'''~~ (hyperacute, profuse purulent discharge in neonate)		*Gonococcal ophthalmia neonatorum (hyperacute, profuse purulent discharge in neonate)
	*~~'''~~Chlamydial conjunctivitis~~'''~~ (neonate or sexually active adolescent)		*Chlamydial conjunctivitis (neonate or sexually active adolescent)
	*~~'''~~[[Herpes keratitis]]~~'''~~ (dendritic ulcer on fluorescein)		*[[Herpes keratitis]] (dendritic ulcer on fluorescein)
	*~~'''~~[[Corneal ulcer]]~~'''~~ (contact lens users)		*[[Corneal ulcer]] (contact lens users)
	*~~'''~~[[Orbital cellulitis]]~~'''~~ (lid swelling, proptosis, restricted EOM)		*[[Orbital cellulitis]] (lid swelling, proptosis, restricted EOM)
	*~~'''~~[[Preseptal cellulitis]]~~'''~~ (lid swelling, but normal EOM and vision)		*[[Preseptal cellulitis]] (lid swelling, but normal EOM and vision)

	===Non-Infectious===		===Non-Infectious===
	*~~'''~~[[Corneal abrasion and foreign body]]~~'''~~ (tearing, pain, fluorescein uptake)		*[[Corneal abrasion and foreign body]] (tearing, pain, fluorescein uptake)
	*~~'''~~Allergic conjunctivitis~~'''~~ (bilateral itching, watery, seasonal)		*Allergic conjunctivitis (bilateral itching, watery, seasonal)
	*~~'''~~Chemical/irritant exposure~~'''~~		*Chemical/irritant exposure
	*~~'''~~[[Iritis]]/[[uveitis]]~~'''~~ (photophobia, pain, ciliary flush)		*[[Iritis]]/[[uveitis]] (photophobia, pain, ciliary flush)
	*~~'''~~Congenital/infantile [[glaucoma]]~~'''~~ (epiphora, photophobia, cloudy/enlarged cornea)		*Congenital/infantile [[glaucoma]] (epiphora, photophobia, cloudy/enlarged cornea)
	*~~'''~~[[Kawasaki disease]]~~'''~~ (bilateral non-exudative conjunctivitis with other features)		*[[Kawasaki disease]] (bilateral non-exudative conjunctivitis with other features)
	*~~'''~~Subconjunctival hemorrhage~~'''~~ (traumatic or spontaneous — benign)		*Subconjunctival hemorrhage (traumatic or spontaneous — benign)
	*~~'''~~Non-accidental trauma~~'''~~ (unexplained subconjunctival hemorrhage, retinal hemorrhages)		*Non-accidental trauma (unexplained subconjunctival hemorrhage, retinal hemorrhages)

	{{Unilateral red eye DDX}}		{{Unilateral red eye DDX}}
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	===Bedside===		===Bedside===
	*Visual acuity (age-appropriate)		*Visual acuity (age-appropriate)
	*~~'''~~Fluorescein exam with Wood's lamp or slit lamp~~'''~~: rule out corneal abrasion, dendrites (herpes keratitis), corneal ulcer		*Fluorescein exam with Wood's lamp or slit lamp: rule out corneal abrasion, dendrites (herpes keratitis), corneal ulcer
	*Pupillary exam		*Pupillary exam
	*IOP measurement if concern for glaucoma (tonometry)		*IOP measurement if concern for glaucoma (tonometry)
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	===Laboratory/Cultures===		===Laboratory/Cultures===
	*Not routinely needed for typical viral or bacterial conjunctivitis		*Not routinely needed for typical viral or bacterial conjunctivitis
	*~~'''~~Neonatal conjunctivitis~~'''~~: Gram stain and culture of discharge (specifically request for N. gonorrhoeae and Chlamydia), chlamydia NAAT		*Neonatal conjunctivitis: Gram stain and culture of discharge (specifically request for N. gonorrhoeae and Chlamydia), chlamydia NAAT
	*Culture if: neonatal, severe/hyperacute, not responding to empiric therapy, suspected gonococcal		*Culture if: neonatal, severe/hyperacute, not responding to empiric therapy, suspected gonococcal

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	===Neonatal Conjunctivitis===		===Neonatal Conjunctivitis===
	*~~'''~~Gonococcal~~'''~~: emergent — [[ceftriaxone]] 25-50 mg/kg IV/IM (max 125mg) single dose; frequent saline irrigation; ophthalmology consultation		*Gonococcal: emergent — [[ceftriaxone]] 25-50 mg/kg IV/IM (max 125mg) single dose; frequent saline irrigation; ophthalmology consultation
	*~~'''~~Chlamydial~~'''~~: oral [[erythromycin]] 50 mg/kg/day divided QID x 14 days (topical alone insufficient — risk of chlamydial pneumonia)		*Chlamydial: oral [[erythromycin]] 50 mg/kg/day divided QID x 14 days (topical alone insufficient — risk of chlamydial pneumonia)
	*~~'''~~HSV~~'''~~: IV [[acyclovir]], ophthalmology consultation		*HSV: IV [[acyclovir]], ophthalmology consultation

	===Herpes Keratitis===		===Herpes Keratitis===
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	===Other===		===Other===
	*~~'''~~Allergic~~'''~~: topical antihistamine/mast cell stabilizer drops, cool compresses, oral antihistamines		*Allergic: topical antihistamine/mast cell stabilizer drops, cool compresses, oral antihistamines
	*~~'''~~Corneal abrasion~~'''~~: topical antibiotics, pain management (see [[Corneal abrasion and foreign body]])		*Corneal abrasion: topical antibiotics, pain management (see [[Corneal abrasion and foreign body]])
	*~~'''~~[[Iritis]]~~'''~~: ophthalmology referral, cycloplegics for pain		*[[Iritis]]: ophthalmology referral, cycloplegics for pain
	*~~'''~~[[Orbital cellulitis]]~~'''~~: IV antibiotics, CT orbits, ophthalmology/ENT consultation (see [[Orbital cellulitis]])		*[[Orbital cellulitis]]: IV antibiotics, CT orbits, ophthalmology/ENT consultation (see [[Orbital cellulitis]])

	==Disposition==		==Disposition==

Danbot: Expanded with EM-focused content: neonatal conjunctivitis by timing, red flags, herpes keratitis warning, management by etiology, disposition

2026-03-20T23:48:38Z

Expanded with EM-focused content: neonatal conjunctivitis by timing, red flags, herpes keratitis warning, management by etiology, disposition

Show changes

Rossdonaldson1: /* Background */

2026-02-04T18:13:20Z

Background

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	==Background==		==Background==
			[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]
			*This page describes a general approach to the complaint of eye redness for pediatric patients

	==Clinical Features==		==Clinical Features==

ClaireLewis at 20:14, 6 October 2019

2019-10-06T20:14:19Z

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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Corneal Abrasion and Foreign Body]]		*[[Corneal Abrasion and Foreign Body]]
	*Corneal infection (consider [[herpes]]/chlamydia)		*[[conjunctivitis (peds)\|Corneal infection]] (consider [[herpes]]/chlamydia)

			{{Unilateral red eye DDX}}
			{{Bilateral Red Eyes}}

	==Evaluation==		==Evaluation==
	*EXAM: Fluorescein to rule out [[corneal abrasion]] and herpes keratitis		*EXAM: Fluorescein to rule out [[corneal abrasion]] and [[herpes keratitis]]

	==Management==		==Management==
	*Infectious: oral [[erythromycin]] + [[ceftriaxone]] (for [[N. ~~gonorrhoea~~]])		*Infectious: oral [[erythromycin]] + [[ceftriaxone]] (for [[N. gonorrhoeae]])
	*[[Conjunctivitis]] + respiratory symptoms/abnormal CXR or [[otitis media]]: (if younger than 3 mos) oral [[macrolide]]		*[[Conjunctivitis]] + respiratory symptoms/abnormal CXR or [[otitis media]]: (if younger than 3 mos) oral [[macrolide]]

Rossdonaldson1: /* See Also */

2019-04-03T04:39:05Z

Rossdonaldson1 at 04:32, 3 April 2019

2019-04-03T04:32:20Z

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			==Background==


			==Clinical Features==


	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Corneal Abrasion and Foreign Body]]		*[[Corneal Abrasion and Foreign Body]]
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	==Evaluation==		==Evaluation==
	EXAM: Fluorescein to rule out [[corneal abrasion]] and herpes keratitis		*EXAM: Fluorescein to rule out [[corneal abrasion]] and herpes keratitis

	==Management==		==Management==
	Infectious: oral [[erythromycin]] + [[ceftriaxone]] (for [[N. gonorrhoea]])		*Infectious: oral [[erythromycin]] + [[ceftriaxone]] (for [[N. gonorrhoea]])
			*[[Conjunctivitis]] + respiratory symptoms/abnormal CXR or [[otitis media]]: (if younger than 3 mos) oral [[macrolide]]

			==Disposition==

	~~[[Conjunctivitis]] + respiratory symptoms/abnormal CXR or [[otitis media]]: (if younger than 3 mos) oral [[macrolide]]~~

	==See Also==		==See Also==
	*[[Eye ~~Algorithm~~ (~~Main~~)]]		*[[Eye algorithm (main)]]
	*[[Red ~~Eye~~ (~~Unilateral~~)]]		*[[Red eye (unilateral)]]
	*[[Red ~~Eye~~ (by Sx)]]		*[[Red eye (by symptoms)]]
	*[[Neonatal conjunctivitis]]		*[[Neonatal conjunctivitis]]

			==External Links==


	==References==		==References==
	<references/>		<references/>
	~~Adapted from Pani~~

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Ophthalmology]][[Category:Symptoms]]		[[Category:Ophthalmology]]
			[[Category:Symptoms]]

Rossdonaldson1: Rossdonaldson1 moved page Red Eye (Peds) to Red eye (peds)

2019-04-03T04:23:08Z

Rossdonaldson1 moved page Red Eye (Peds) to Red eye (peds)

← Revisión anterior	Revisión del 04:23 3 abr 2019
(Sin diferencias)

Neil.m.young at 19:51, 21 November 2016

2016-11-21T19:51:23Z

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	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Ophthalmology]]		[[Category:Ophthalmology]][[Category:Symptoms]]

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T22:28:15Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

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	*Corneal infection (consider [[herpes]]/chlamydia)		*Corneal infection (consider [[herpes]]/chlamydia)

	==~~Diagnosis~~==		==Evaluation==
	EXAM: Fluorescein to rule out [[corneal abrasion]] and herpes keratitis		EXAM: Fluorescein to rule out [[corneal abrasion]] and herpes keratitis

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	==See Also==		==See Also==
	*[[Eye ~~algorithm (main)]]~~		{{Eye algorithms}}
	*[[Red eye (unilateral)]]
	*[[Red eye (by symptoms)]]
	*[[Neonatal conjunctivitis]]

	==External Links==		==External Links==