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Managing Infectious Red Eye in Babies

Cause Characteristics Treatment
Chlamydia trachomatis About 80% of infectious red eyes in infants
Onset day 2 to week 8
Mild to Severe
Organisms seen on direct fluorescent antibody stain of conjunctival scrapings
Associated pneumonia common
Rarely causes ocular damage even untreated

Tetracycline ointment qid for 4 weeks; oral erythromycin for 4 weeks
Treat parents with oral doxycycline or erythromycin for 4 weeks
Neisseria gonorrhoeae Less than 5% of infectious red eyes in infants
Onset day 2 to 4
Usually hyperacute, but may be mild initially
Purulent discharge
Gram-negative intracellular cocci on scrapings
Inadequate treatment leads to corneal perforation and blindness

Topical aqueous penicillin 20,000 units/ml, one drop hourly
Intravenous aqueous penicillin 50,000 units daily or ceftriaxone 50 to 75mg/kg/day for 7 days
Staphylococcus, Streptococcus,
gram-negative bacteria
Onset usually after 5 days, but may be earlier
Mucopurulent discharge
May be associated with sepsis
Can lead to corneal perforation
Diagnosis by smear and culture

Gram-positive organisms and Haemophilus: erythromycin ointment 6 times daily
Other gram-negative organisms: topical gentamicin every 1 to 2 hours
Herpes Simplex Uncommon
Onset day 5 to 10
Usually type 2
Watery discharge
Lid often swollen
May be associated with mucocutaneous vesicles, systemic (including choroid, central nervous system) involvement
Conjunctival smears show absence of polymorphonuclear leukocytes
Viral cultures definitive

Topical trifluorothymidine, vidarabine, or idoxuridine qh
Intravenous acyclovir
Oral acyclovir 800mg 5x/day for 10 days

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