**14.1.1 Conjunctivitis**

Conjunctivitis in children is one of the most common reasons to visit a pediatrician. Majority of these infections are self-limited and does not require therapy. This section covers a variety of infectious conjunctival diseases that might be confronted in routine pediatrics practice.

Red eye is one of the most important ophthalmological emergencies. There are several causes such as conjunctivitis, keratitis, uveitis etc. Fortunately, majority of the red eye occurs due to conjunctivitis. The underlying etiology is almost always bacterial in children. However, it can be viral or allergic. During examination there are some key points that will help to differentiate the etiology:

Symptoms: Allergic cases will always have prominent itching. Bacterial cases will always have discharge.

Presence and nature of discharge: Bacterial infections will have a purulent, yellow-green discharge. Viral cases will have a serous or mucoid discharge. Allergic cases will have serous discharge with excessive tearing.

Laterality: Bacterial cases can be either unilateral or bilateral. Viral and allergic conjunctivitis occur almost always bilateral.

Cul-de-sac: Always pull the lower eyelid away from the globe to examine the cul-de-sac. Bacterial conjunctivitis will have tarsal papillae. Viral and allergic conjunctivitis will have tarsal follicles.

Systemic associations: Viral conjunctivitis might be associated with upper respiratory infections. Allergic conjunctivitis might be seen with upper respiratory allergic symptoms.

First-line therapy for bacterial conjunctivitis is topical flouroquinolone. In many cases polysporin, erythromycin or trimethoprim/sulfa is effective. Viral conjunctivitis is selflimited. For allergic cases topical antihistaminic drops are effective.
