Acute Conjunctivitis
Francis Gigliotti MD1
1 Chief, Division of Pediatric Infectious Diseases, Associate Professor of Pediatrics and Microbiology and Immunology, The University of Rochester School of Medicine & Dentistry, Rochester, NY.
Conjunctivitis, or inflammation of the conjunctiva, usually occurs as a result of infection or allergy. It is an exceedingly common occurrence, certainly the most common acute disease of the eye seen by primary care physicians of children. When it occurs in the neonatal period, it has been given the appellation ophthalmia neonatorum; in older infants and children, it sometimes is called "pink eye." This review covers the etiology, epidemiology, pathogenesis, diagnosis, and therapy of conjunctivitis in infants and children.
Etiology
Neonatal conjunctivitis occurs in 1.6% to 12% of newborns during the first month of life. The chemical irritation from antimicrobial prophylaxis against bacterial infection is the most frequent cause, followed by Chlamydia trachomatis infection. Other important pathogens in this setting are Haemophilus influenzae and Streptococcus pneumoniae. It is unusual to isolate any of these organisms from healthy eyes. Various streptococci and Staphylococcus aureus have been isolated not only from significant numbers of infected eyes, but also from a substantial number of healthy eyes, leaving their exact role less clear. Rarely, gram-negative organisms such as Escherichia coli, Klebsiella, or Pseudomonas sp have been implicated as causes of neonatal conjunctivitis, especially in infants in intensive care units.
Neisseria gonorrhoeae no longer is a major cause of neonatal conjunctivitis in this country because of the mandated use of neonatal ocular prophylaxis.
