Conjunctivitis at children - the disease of a forward piece of an eye which is characterized by inflammatory reaction of a conjunctiva to infectious or allergic irritants. Conjunctivitis at children proceeds with hyperaemia, hypostasis of a mucous membrane of an eye, dacryagogue, a photophobia, the burning and discomfort in eyes separated from a conjunctival cavity of mucous or purulent character. Diagnosis of conjunctivitis at children is carried out by means of ophthalmologic inspection (survey of the oculist, biomicroscopy, the microbiological, cytologic, virologic, immunological research separated from a conjunctiva). For treatment of conjunctivitis at children local medicines are used: eye drops and ointments.
Conjunctivitis at children
Conjunctivitis at children – infectious and inflammatory diseases of a mucous membrane of an eye of various etiology. At children of the first 4 years of life conjunctivitis makes up to 30% of all cases of all eye pathology. With age this indicator progressively decreases, and in structure of incidence in children's ophthalmology violations of a refraction (an astigmatism, short-sightedness, far-sightedness) begin to prevail. At children's age conjunctivitis can lead to development of terrible complications – violations of sight, a keratit, a dakriotsistit, phlegmon of a plaintive bag. In this regard conjunctivitis at the child requires special attention from children's experts – the pediatrician, the children's ophthalmologist, the children's allergist.
The conjunctivitis reasons at children
Among children the viral, bacterial and allergic conjunctivitis having the specific current is widespread.
Most often in pediatrics it is necessary to face bacterial conjunctivitis at children. By the form the activator allocate staphylococcal, pnevmokokkovy, streptococcal, diphtheritic, sharp epidemic (Koch-Uixa's bacteria) conjunctivitis at children, etc. The special group of bacterial infections of eyes at children is made by conjunctivitis of newborns – and paratrachoma. They arise owing to infection of the child during passing of a head in patrimonial ways of mother having a venereal disease (gonorrhea, clamidiosis).
Bacterial conjunctivitis at children can arise not only at infection with external agents, but also owing to increase in pathogenicity of own microflora of eyes or existence is purulent - septic diseases (otitis, tonsillitis, sinusitis, an omfalit, a piodermiya and so forth). The plaintive liquid containing immunoglobulins, complement components, , lizotsy a beta lysine, has a certain antibacterial activity, but in the conditions of easing of local and general immunity, mechanical injury of an eye, obturation of the nososlezny channel children easily have a conjunctivitis.
Viral conjunctivitis at children usually develops against the background of flu, an adenoviral infection, simple herpes, an enteroviral infection, measles, chicken pox and so forth. In this case, except the conjunctivitis phenomenon, at children clinical symptoms of rhinitis and pharyngitis are noted. Conjunctivitis can be caused in children not only separate activators, but also their associations (bacteria and viruses).
Allergic conjunctivitis at children accompanies a current of 90% of all allergoz and is quite often combined with allergic rhinitis, pollinozy, atopic dermatitis, bronchial asthma. Development of allergic reaction in a conjunctiva can be coherently with effect of food, medicinal, pollen, dust, bacterial, virus, fungal, parasitic and other allergens.
High frequency of conjunctivitis among children is explained by features of children's physiology and specifics of socialization. Spread of an eye infection in children's collectives happens in very quickly contact or airborne way. As a rule, throughout the incubatory period the child carrier of an infection continues to communicate actively with other children, being a source of infection of a large number of contact persons. Development of conjunctivitis in children is promoted by defects of care of the child, dryness of air indoors, bright light, to a diet error.
Conjunctivitis symptoms at children
Conjunctivitis at the child can proceed separately; in certain cases eye symptoms are preceded by catarrhal signs. At conjunctivitis of any etiology at children the simptomokompleks including hypostasis a century, conjunctiva hyperaemia, the raised dacryagogue, fear of light, feeling of a foreign matter or eye pain, develops.
At kids it is possible to suspect an eye infection even before emergence of clinically significant manifestations on uneasy behavior, frequent crying, continuous attempts to rub eyes cams. At the isolated conjunctivitis at children body temperature usually normal or subfebrilny; in case of the general infection can rise to high values.
Owing to a thickening of a conjunctiva and its injection blood vessels during a disease visual function slightly decreases. This deterioration has temporary and reversible character: at adequate treatment of conjunctivitis sight is restored right after recovery of children.
Bacterial conjunctivitis at children
At conjunctivitis of a bacterial etiology damage of eyes bilateral, is more often consecutive – at first the infection demonstrates on one eye, in 1–3 days other eye is surprised. Mucopurulent or viscous purulent separated from a conjunctival cavity, adhesion a century, drying up of crusts on eyelashes is a typical sign of bacterial conjunctivitis at children. Color of conjunctival separated can vary from light yellow to flavovirent.
The course of bacterial conjunctivitis at children can become complicated blefarity, keratokonjyunktivity. Deep keratita and ulcers of a cornea develop seldom, mainly, against the background of the general weakening of an organism – hypovitaminoses, anemia, a hypotrophy, a bronkhoadenit, etc.
Gonoblennorey of newborns develops for 2-3 days after the birth. The symptomatology of conjunctivitis of a gonorrheal etiology is characterized by dense hypostasis a century, cyanotic-crimson coloring of skin, infiltration and hyperaemia of a conjunctiva, serous and hemorrhagic, and then - plentiful purulent separated. Danger of gonokokkovy conjunctivitis at children consists in high probability of development of the purulent infiltrates and ulcers of a cornea inclined to a perforation. It can lead to formation of a cataract, sharp decrease in sight or a blindness; at penetration of an infection into internal departments of an eye – to emergence of an endoftalmit or panoftalmit.
Chlamydial conjunctivitis at children develops for 5-10 day after the birth. At more advanced age infection can occur in the closed reservoirs in this connection disease outbreaks at children are quite often designated as basin conjunctivitis. The clinical picture is characterized by hyperaemia and infiltration of a mucous membrane a century, ptozy a century, existence in a conjunctival cavity of a plentiful liquid purulent secret, a hypertrophy of nipples. At children extra eye displays of an infection are often possible: pharyngitises, otitises, pneumonia, vulvovaginita.
Diphtheritic conjunctivitis usually develops against the background of pharynx diphtheria, mainly at children is younger than 4 years. It should be noted that now, thanks to obligatory vaccination of children against diphtheria, isolated cases of an infection are celebrated. Damage of eyes is characterized by painful hypostasis and consolidation a century at which cultivation the muddy serous and hemorrhagic secret is allocated. The gray, hardly removed films are defined on surfaces of a conjunctiva; after their removal the bleeding surface is bared. Complications of diphtheritic conjunctivitis at children can include infiltrates and ulcerations of a cornea, turbidity of a cornea, a perforation of an ulcer and death of an eye.
Viral conjunctivitis at children
Viral conjunctivitis at children usually accompanies the course of a SARS therefore are characterized by temperature reaction and the catarrhal phenomena. In this case involvement of eyes in an inflammation happens consistently. The plentiful liquid watery allocations from a conjunctival bag making an impression of constant dacryagogue are characteristic of viral conjunctivitis at children.
At herpetic conjunctivitis on skin the century and conjunctivas can be found rashes in the form of bubbles in children; at clumsy conjunctivitis – korepodobny rash; at chicken pox - ospenny pustula which after opening turn into scars. Sometimes viral conjunctivitis at children is complicated by accession of a secondary bacterial infection that is followed by emergence of purulent allocations from eyes.
Diagnosis of conjunctivitis at children
Establishment of the diagnosis of conjunctivitis at children assumes collecting the anamnesis, consultation of the child by the children's ophthalmologist (if necessary – the children's allergist-immunologist), carrying out special ophthalmologic and laboratory inspection.
The direct research of an organ of vision includes external examination of eyes, survey with side lighting, biomicroscopy. At children the cytologic research of dab from a conjunctiva allows to perform approximate etiologichesky diagnosis of conjunctivitis; final - bacteriological, virologic, immunological, serological (REEF) of a research.
At allergic conjunctivitis at children determination of the IgE level and eosinophils, skin allergoproba, inspection on dysbacteriosis, a helminthic invasion is carried out.
Treatment of conjunctivitis at children
The child with bacterial or viral conjunctivitis has to be isolated from healthy children. Suitable therapy has to be appointed by the ophthalmologist or the pediatrician; self-treatment of conjunctivitis at children is inadmissible. Categorically it is impossible to tie and stick eyes, to impose compresses as in this case conditions for reproduction of activators and an inflammation of a cornea are created.
Carrying out a toilet of eyes with use of infusion of a camomile, solution of Furacilin or boric acid is recommended. Processing of each eye it is necessary to carry out 4-8 times a day by separate wadded tampons in the direction from an external corner to internal. The basis of therapy of conjunctivitis at children is made by local use of medicines – instillations of eye drops and mazevy applications.
At conjunctivitis of a bacterial etiology antibacterial medicines are appointed (drops with levomitsetiny, fusidic acid; tetracycline, eritromitsinovy, ofloksatsinovy ointment, etc.) which should be started in both eyes. At viral conjunctivitis at children use of antiviral eye medicines on a basis an alpha of interferon, oksolinovy ointment, etc. is shown.
Prevention of conjunctivitis at children
Big prevalence and high contageousness of conjunctivitis among children demands their timely recognition, the correct treatment and prevention of distribution. The leading role in prevention of conjunctivitis at children is assigned to respect of personal hygiene by children, careful processing of objects of care of newborns, isolation of sick children, disinfection of rooms and furnishings, increase in the general resilience of an organism.
The prevention of conjunctivitis of newborns consists in identification and treatment of an urogenital infection at pregnant women; to processing of patrimonial ways antiseptics, carrying out preventive processing of eyes of children right after the birth.