Red eye in children
Synonyms and keywords: Red eye in kids, Conjunctivitis, outbreak-epidemic-symptoms.

# Overview
Red eye in children is a common consultation purpose. Mostly benign, this sign may also cause visual impairment. We differentiate three kinds of red eye: localised, diffused and perikeratic injection. The last one must be recognized because of its association with severe ocular diseases. Diagnosis must be sure and treatment has to be efficient to not pertubate childrens visual development. Unfortunately, physical examination on children is not always easy. Consultation with an ophthalmologist is justified if a doubt remains, in case of chronic pathology or resistance to first intention treatment. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications rare.

# Historical Perspective
- Can not find any historical perspective in Red eye in children.

# Classification
- Red eye may be classified according to classification method into three subtypes/groups:
- Localised
- Diffused
- perikeratic injection

# Pathophysiology
- On microscopic histopathological analysis, viral, bacterial like   Streptococcus pneumonia, Haemophilus influenzae, Moraxella catarrhalis, or Staphylococcus aureus and   fungal  are characteristic findings of red eye.

# Causes
Common causes of Red Eye in Children
- Blepharitis
- Cellulitis
- Conjunctivitis (Pink Eye)
- Corneal Abrasion
- Corneal Ulcer
- Eye Allergies
- Fungal Keratitis
- Glaucoma
- Herpes Keratitis
- Pinguecula and Pterygium
- Retinoblastoma
- Subconjunctival Hemorrhage
- Uveitis
Common causes of Red Eye in Children
Life Threatening Causes
Life-threatening causes include conditions that could lead to death or permanent disability within 24 hours if left untreated.
- globe ruptures or perforations
- intraocular infections
- Carotidcavernous sinus fistula

# Differentiating Red eye from other Diseases
Red eye is diffrentiated from many disease, the most common is conjunctivitis . Others include: Bacterial conjunctivitis, Viral conjunctivitis, Allergic conjunctivitis,Chemical conjunctivitis, Foreign body, Blepharitis, Hordeola , Keratitis, Endophthalmitis , Dacrocystitis, Anterior uveitis (iridocyclitis) :associated with juvenile RA, Behcet diease and IBS; Sudden onset pain, photophobia, blurred vision, irregular pupil, poor vision, Posterior uveitis (choroiditis) and  Scleritis/Episcleritis 
Differential diagnosis of red eye with no injury

# Epidemiology and Demographics
- Of 840 patients, 525 were men (62.5%) and 315 were women (37.5%). Most of the patients were over 39 years of age. 55.7 percentage of them lived in cities and 44% were from villages. The most common eye symptoms with eye redness were: Eye abrasion (57%), tears in eyes (49%) and swollen eye lid (30%). Red eyes without any symptoms in eyes were diagnosed as runny nose (4.2%) and headaches (3.4%). 11.9% and 19.6% of the patients had a previous history of red eye and had visited doctors for red eyes respectively.

## Age
- Patients of all age groups may develop red eye.

## Gender
- males are more commonly affected with red eye in children than females.

## Race
- There is no racial predilection for red eye in children.

# Risk Factors
Common risk factors in the development of red eye in children are 
- The Upper Respiratory Infection
- Viral Conjunctivitis (Pink Eye)
- Irritant Conjunctivitis
Smog
Chlorinated pool
- Smog
- Chlorinated pool
- Bacterial Conjunctivitis

# Natural History, Complications and Prognosis
- Early clinical features include,  tearing, discharge, itching, pain, foreign body sensation, photophobia, and vision changes.
- Common complications of red eye include  severe pain, visual loss, marked pain or decreased vision with the use of contact lenses, trauma, chemical injury and recent eye surgery. On examination, signs for concern include decreased visual acuity, pupil irregularity, sluggish pupillary reaction to light, corneal opacification, hyphema or hypopyon, and elevated intraocular pressure.Be especially alert when a patient has unilateral redness. Patients with red-flag symptoms or signs require immediate referral to an ophthalmologist.
- Prognosis is generally excellent and the cure within days unless causes assisted with systemic illnesses.

# Diagnosis

## Diagnostic Criteria
- The diagnosis of red eye in children is made when detailed patient history and careful eye examination are token. at least  of the following  diagnostic criteria are met
- Reduced visual acuity
- ciliary flush (circumcorneal injection)
- corneal abnormalities including edema or opacities ("corneal haze")
- Corneal staining
- Abnormal pupil size
- Abnormal intraocular pressure

## Symptoms
- Red eye is usually asymptomatic.
- Symptoms of red eye may include the following:
- Eye discharge
- pain
- photophobia
- itching
- Visual changes and redness

## Physical Examination
- Patients with red eye in children usually appear with only red eye .
- Physical examination may be remarkable for:
- Redness of entire Eyelid or swollen Eyelid
Assess for Periorbital Cellulitis
Assess for acute Ethmoiditis
Associated Eye Pain or constant eye tearing, blinking
Assess for Corneal Ulcer
Assess for Herpes Simplex VirusKeratitis
Assess for Eye Foreign Body
Blurred Vision
Assess for Uveitis
- Redness of entire Eyelid or swollen Eyelid
Assess for Periorbital Cellulitis
Assess for acute Ethmoiditis
- Assess for Periorbital Cellulitis
- Assess for acute Ethmoiditis
- Associated Eye Pain or constant eye tearing, blinking
Assess for Corneal Ulcer
Assess for Herpes Simplex VirusKeratitis
Assess for Eye Foreign Body
- Assess for Corneal Ulcer
- Assess for Herpes Simplex VirusKeratitis
- Assess for Eye Foreign Body
- Blurred Vision
Assess for Uveitis
- Assess for Uveitis

## Laboratory Findings
- There are no specific laboratory findings associated red eye in children like in viral conjunctivitis, unless the causes associated with Bacterial conjunctivitis
- An  elevated concentration of serum CRP or WBC is diagnostic of  Bacterial Conjunctivitis in  red eye in children.
- Other laboratory findings consistent with the diagnosis of red eye in children include a systemic symptom if related to systemic illness like Rheumatic arthritis.

## Electrocardiogram
There are no ECG findings associated with red eye in children.

## X-ray
There are no x-ray findings associated with red eye in children. However, an x-ray may be helpful in the diagnosis of complications of traumatic red eye, which include a plain skull X-ray is performed to exclude cranial and facial fractures and will visualize radio-opaque foreign bodies FBs.

## Echocardiography or Ultrasound
There are no echocardiography  findings associated with red eye in children accept in some diseases like conjunctivitis in Kawasaki syndrome. However, an ultrasound  may be helpful in the diagnosis of complications of emergency red eye.

## CT scan
There are no CT scan findings associated with red eye in children. However, a CT scans are the test of choice for orbital and IOFB localization in traumatic red eye. A CT scan will often diagnose other unsuspected cranial and facial injuries .
. Computed tomography imaging of the orbits should be performed if a high-velocity penetrating injury is suspected. If acute glaucoma is suspected, intraocular       pressure should be measured in the emergency department.

## MRI
There are no MRI findings associated with red eye in children. However, a MRI may be helpful in the diagnosis of complications of traumatic red eye. The on-call ophthalmologist must be proficient at ocular ultrasound, as it is an indispensible tool for the diagnosis and triage of ophthalmic emergencies.

## Other Imaging Findings
New diagnostic instruments for imaging the anterior segment of the eye have been developed using the corneal topographer as optical coherence tomography (OCT) may be helpful in the diagnosis of red eye. Findings on an OCT suggestive of/diagnostic of  keratoconus or pellucid marginal corneal degeneration  include  epithelial edema  in the epithelial layer and stromal layer associated with intraocular pressure elevation.

## Other Diagnostic Studies
- Red eye  may also be diagnosed using  color-Doppler imaging echography of dural carotid-cavernous fistula of ophthalmological manifestation.
- Findings on include color-Doppler imaging echography  flow reversal with a systolic component in the superior and inferior enlarged ophthalmic veins and  Embolization.

# Treatment
treatment is based on the underlying etiology, and Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections. Clinical signs that require an urgent ophthalmic consultation are chemical burns, intraocular infections, globe ruptures or perforations, and acute glaucoma.

## Medical Therapy
- The mainstay of therapy for red eye in children is good hygiene, such as meticulous hand washing, is important in decreasing the spread of acute viral conjunctivitis.  and Any ophthalmic antibiotic may be considered for the treatment of acute bacterial conjunctivitis because they have similar cure rates .
- Mild allergic conjunctivitis may be treated with an over-the-counter antihistamine/vasoconstrictor agent, or with a more effective second-generation topical histamine H1 receptor antagonist
- Anti-inflammatory agents (e.g., topical cyclosporine ), topical corticosteroids, and systemic omega-3 fatty acids are appropriate therapies for moderate dry eye.
- Patients with chronic blepharitis who do not respond adequately to eyelid hygiene and topical antibiotics may benefit from an oral tetracycline or doxycycline. If the cornea is involved, refer to an eye centre where the baby will be treated with intensive antibiotic eye drops and, sometimes, systemic antibiotics.

## Surgery
- Surgical procedure can only be performed for patients with emergency case of  red eye like  intraocular infections, globe ruptures or perforations, and acute glaucoma or traumatic eye injury.

## Prevention
Practice good hygiene to control the spread of red eye. For instance:
- Don't touch your eyes with your hands.
- Wash your hands often.
- Use a clean towel and washcloth daily.
- Don't share towels or washcloths.
- Change your pillowcases often.
- Throw away your eye cosmetics, such as mascara.
- Don't share eye cosmetics or personal eye care items.
Keep in mind that red eye is no more contagious than the common cold. It's okay to return to work, school or child care if you're not able to take time off  just stay consistent in practicing good hygiene.

## Preventing red eye in newborns
Newborns' eyes are susceptible to bacteria normally present in the mother's birth canal. These bacteria cause no symptoms in the mother. In rare cases, these bacteria can cause infants to develop a serious form of conjunctivitis known as ophthalmia neonatorum, which needs treatment without delay to preserve sight. That's why shortly after birth all babies should have their eyes cleaned immediately, then an antibiotic ointment like tetracycline is applied to every newborn's eyes. The ointment helps prevent eye infection. During antenatal care, all mothers with vaginal infections should be treated. Educate traditional birth attendants, community health workers, and both parents as this is often a sexually transmitted disease.