Pediatric Conjunctivitis Practice Standard Summary

The Pediatric Conjunctivitis Practice Standard supports the diagnosis and treatment of different types of conjunctivitis- viral, bacterial, and allergic conjunctivitis. 

Background 

The Pediatric Conjunctivitis Practice Standard will launch if all of the following criteria are met:

• Patient is between the ages of 1 to 17 years old

• Based on the patient’s Chief Complaint, the diagnoses predicted by machine learning relate to conjunctivitis

Clinical Content

Medical Interview Summary

The Pediatric Conjunctivitis Practice Standard asks about red flag symptoms. These questions intend to identify patients who may be experiencing a severe infection or other condition that would warrant a referral to the emergency department or eye doctor. In those cases, the clinician will be prompted to consider referring the patient to the emergency department or eye doctor. The list of red flag symptoms can be found in the Virtual Care Management Pearls section below. 

If red flag symptoms are not identified, the interview will proceed by eliciting relevant eye symptoms and other pieces of patient history. The list of pertinent history questions can be found in the Virtual Care Management Pearls section below. 

At the end of the interview, a diagnosis will be presented for the provider’s consideration, along with relevant medication(s), and documentation to support the provider’s medical decision making. In addition, referrals will be displayed. Based on the diagnosis selected by the clinician, care plans will be entered in for the patient’s education. The clinician can choose to use the suggestions provided, or change them based on their clinical decision making. 

Virtual Care Management Pearls

Red flag symptoms that are NOT typical conjunctivitis:

• Eye trauma/Injury

• Eye foreign body sensation

• Photophobia (Light sensitivity)

• Severe eye pain (>=8 yo)

• Constant blurred or acute vision changes (>=8 yo)

• Limited or painful extraocular movements

Pertinent History Questions (in addition to asking red flag symptoms):

• Photo of both eyes

• Determine if contact lens wearer (>=8 yo)

• Onset of symptoms 

• Drainage consistency: purulent or serous

• Laterality of symptoms

• Eye itching

• Eye crusting

• Eye redness

• Eye burning (>=8 yo)

• Other allergy symptoms

• Other viral symptoms/exposure

• Eye hemorrhage

Differential Diagnoses:

• Viral Conjunctivitis

  • Redness, watery/serous discharge, burning sensation in eye, gritty feeling, morning crusting, may have other viral symptoms

• Bacterial Conjunctivitis

  • Redness, purulent discharge throughout the day (yellow, white, or green)

• Allergic Conjunctivitis

  • Redness, watery/serous discharge, itching, morning crusting, may have other allergy symptoms

• Suspected Corneal abrasion/ulcer, keratitis, uveitis, acute angle closure glaucoma

  • Diagnose as Unspecified eye disorder & in person referral

Medication Guidelines

• Allergic Conjunctivitis 

  • Over-the-counter 

    • Olopatadine 0.2% eye drops daily (>=2 yo)

    • Lubricating eye drops as needed

    • Cetirizine daily

  • Cool compresses to soothe

• Viral Conjunctivitis

  • Over-the-counter 

    • Lubricating eye drops as needed

  • Cool compresses to soothe

• Bacterial Conjunctivitis

  • Ofloxacin 0.3% OR Trimethoprim-Polymixin B (Polytrim) 

    • 1-2 drops QID for 5-7 days (PS suggests 1 drop QID for 5 days)

  • Erythromycin 

    • 0.5 inch ointment QID for 7 days

  • Contact Lens Wearers

    • Ofloxacin 0.3% OR Ciprofloxacin 0.3%

      • Ofloxacin 0.3%: 1-2 drops QID for 5-7 days  (PS suggests 1 drop QID for 5 days)

      • Ciprofloxacin 0.3%: 1-2 drops QID for 5-7 days (PS suggests 1 drop QID for 5 days)

  • Over-the-counter 

    • Lubricating eye drops as needed

  • Cool compresses to soothe

Follow-up Recommendations Identified

• Viral Conjunctivitis

  • If discharge thickens, return to the virtual clinic for an evaluation

• Bacterial Conjunctivitis 

  • If symptoms don’t improve after using prescription medication for 1-2 days

• Allergic Conjunctivitis

  • If discharge thickens, return to the virtual clinic for an evaluation

  • If symptoms last longer than 14 days, return to the virtual clinic for an evaluation

• ER or Ophthalmology/Optometry

  • Eye trauma, severe or deep eye pain, photophobia, constant blurry vision or acute vision changes, severe headache with nausea/vomiting, foreign body sensation, limited or painful extraocular movements

ICD-10 Codes Provided

Associated Available Text Expanders (if needed)

Please see your institution's Text Snippet document on available options.

Chat and Documentation Suggestions

In addition to presenting diagnostic and treatment suggestions for consideration by the provider, the Conjunctivitis Practice Standard presents chat and documentation suggestions to the provider for consideration based on previous machine learning. The suggestions are tied to the selection of a diagnosis suggested for consideration by the provider. 

Citations

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075432/

2. https://www.aafp.org/pubs/afp/issues/1998/0215/p735.htm