🦠 Conjunctivitis
• Bacterial: purulent discharge, may be unilateral or bilateral. Common: H. influenzae, S. pneumoniae, S. aureus
• Viral: watery discharge, preauricular lymphadenopathy (adenovirus)
• Allergic: itching, chemosis, stringy discharge, seasonal
👶 Ophthalmia Neonatorum (first 28 days)
• Chemical (first 24h, prophylaxis)
• Gonococcal (2-6 days, fulminant purulent, emergency)
• Chlamydial (>6 days, may have pneumonitis)
• HSV: unilateral, vesicles on lid, thin discharge
⚠️ Red Flag Emergencies
• Orbital cellulitis: proptosis, pain with EOM, vision changes
• Corneal abrasion: fluorescein uptake, photophobia
• Acute glaucoma: corneal enlargement >12mm, clouding, tearing
• Herpes simplex keratitis: dendritic lesion
🔬 Other Causes
• Uveitis/iritis: photophobia, small/non-reactive pupil, JRA association
• Subconjunctival hemorrhage: Valsalva, trauma
• Dacryostenosis: excessive tearing, crusting (congenital nasolacrimal duct obstruction)
📌 Decision strategy: Age, discharge character, associated symptoms (photophobia, vision changes, pain with eye movement) determine urgency. Neonatal red eye requires immediate evaluation for gonorrhea and HSV. Fluorescein exam for corneal abrasion.