How Should Eye Infections in Children be Managed?

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How Should Eye Infections in Children be Managed?


What is the best OTC treatment for children younger than 2 years of age with eye infections?

Response from Jessica Stovel, RPh
Pediatric Pharmacist, London Health Sciences Center, London, Ontario, Canada

Common Pediatric Eye Infections

A variety of over-the-counter (OTC) treatments are available for treating eye infections, but not all eye infections require pharmacologic therapy. Furthermore, selecting the best treatment depends on the particular type of infection, and it is often difficult to distinguish different types of eye infections, because symptoms can demonstrate nonspecific or indeterminate clinical signs. Ophthalmic problems in very young children present special concerns. Listed below are common pediatric eye infections and their recommended management.

Hordeolum (Stye)

This infection within the eyelid glands may be internal or external. It is characterized by unilateral, localized lid swelling, tenderness, and redness. The most common infecting organism is Staphylococcus aureus. Application of a warm compress to the eye for 10-15 minutes, 3-4 times daily is recommended to help drain the gland. Use of OTC ophthalmic antibacterial agents generally is not necessary or advised, except on the recommendation of a physician. If recommended, topical OTC antibiotics may help prevent infection spreading to other eye structures. If spontaneous drainage of the hordeolum does not occur within 48 hours or if there are signs of pain or a worsening infection, the child should be referred to a physician.

Figure 1. Stye (lat. hordeolum) on lower part of a person's eye. Source: Podzemnik/Wikimedia Commons.

Staphylococcal Blepharitis

This more chronic infection usually affects both eyelids and is commonly caused by S aureus or Staphylococcus epidermidis. The anterior margin of the eyelid often is red and inflamed, with crusts and ulcerations observed around the eyelashes. Other symptoms include irritation, burning, and itching of the eyelid margins. Because blepharitis is often confused with viral eye infections (eg, conjunctivitis), nonprescription antibiotic eye drops or ointment are not recommended unless advised by a physician.

For treatment, prescription anti-staphylococcal antibiotic ointment (eg, bacitracin, erythromycin) may be indicated. Eye ointments are preferred over eye drops due to increased contact time with infected tissue. If antibiotics are not required, proper eyelid margin hygiene is the mainstay of treatment and can be encouraged regularly during the acute infection and then twice a week once the infection has resolved to prevent similar future infections. Good lid hygiene includes gently scrubbing the lid margin only, using either a facecloth or cotton swabs dampened with warm water and a few drops of hypoallergenic baby shampoo.

Acute Bacterial Conjunctivitis

This infection is often characterized by a thick, mucopurulent discharge causing the eyelids to stick together and the eyelashes to become matted. It is thought to be self-limiting, with resolution within 2-3 weeks. However, treatment is often recommended to decrease transmission and symptom duration. Treating promptly may also decrease the risk for serious corneal complications. Bacteria implicated in pediatric infections include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Nonpharmacologic treatment includes soaking the eyelids that are stuck together in the morning with a warm compress and opening them very gently and carefully. Therapeutic options must be carefully considered for coverage of gram-positive and gram-negative bacteria. Self-treatment is not recommended for children under 2; young children should always be referred to a physician so that a proper and thorough assessment and diagnosis can be made.

Figure 2. A swollen, pus-filled eye with conjunctivitis. Source: Tanalai/Wikimedia Commons.

Neonatal Bacterial Conjunctivitis

This severe, sight-threatening infection is usually caused by Chlamydia trachomatis and Neisseria gonorrhoeae. Symptoms usually occur 3-5 days after birth and include bilateral purulent discharge, redness, irritation, and tenderness. This infection can progress very quickly, leading to severe corneal damage, perforation, and loss of vision. As such, it is imperative that infants be referred immediately to a physician or emergency department. Nonprescription treatment is not recommended because systemic antibiotics are required to cover atypical microbes.

Figure 3. A newborn with gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection. Source: CDC/J. Pledger.

Viral Conjunctivitis

This infection usually presents with a very red eye, watery discharge, and possibly small hemorrhages. The infection usually spreads and affects both eyes. Adenovirus is the most common cause; herpes simplex virus and varicella zoster virus may also be causes. As such, OTC treatment with antibacterials is not recommended, appropriate, or indicated, and may harm the child’s vision long-term through delay and improper therapeutic choice.

Patients should be referred to a physician for diagnosis and appropriate antiviral treatment if indicated. Nonprescription supportive therapy includes warm or cold compresses and ocular lubricants to increase patient comfort. Good personal hygiene is essential to prevent the transmission from the infant or young child to other members of the household or close contacts.

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