Infectious Diseases of Ocular Adnexa in Children

Common infectious diseases of the ocular adnexa in children include conjunctivitis, episcleritis, preseptal cellulitis, blepharitis, dacryocystitis, molluscum contagiosum, insect bite, and others. Each of these conditions can present with overlapping features such as redness, swelling, and discomfort, but an accurate diagnosis is essential for targeted treatment. Parents often seek medical care for such conditions from pediatricians, rather than ophthalmologists, at the first level. The following images are aimed to sensitize pediatricians and enable them to identify such common conditions in children.Image 1: (a) Acute adenovirus conjunctivitis in a boy showing conjunctival congestion and discharge; (b) membranous conjunctivitis in the same child with formation of a pseudo-membrane over the palpebral conjunctiva. The main causative organism includes Streptococcus and Staphylococcus. Treatment includes broad-spectrum antibiotics (moxifloxacin 0.5% and azithromycin 1% ointment)Image 2: A female child with (a) temporal as well as nasal episcleral congestion suggestive of episcleritis associated with (b) nasal crusting suggestive of infective etiology, which upon treatment with oral amoxicillin acid got resolved. Episcleritis is an immune reaction involving the episcleral tissue due to certain inflammatory disordersImage 3: (a) A child with mild blepharitis with whitish deposits on upper eyelashes; (b) child with severe blepharitis with upper and lower lid edema along with seborrheic dermatitis over the nose and cheeks. Blepharitis is mainly caused by Staphylococcus species (like S. epidermidis and S. aureus). Treatment includes warm compressors, lid massage, and topical azithromycin 1% ointment)Image 4: A 9-year-old girl with (a) preseptal cellulitis with upper lid and lower lid edema; (b) same patient after treatment with intravenous cloxacillin and metronidazole. It is important to differentiate preseptal from orbital cellulitis on the basis of visual acuity, pupillary reaction, and extraocular movements (all are normal in preseptal cellulitis). Imaging such as contrast-enhanced computed tomography or magnetic resonance angiography/magnetic resonance venography may be required to rule out cavernous sinus thrombosis (end stage of orbital cellulitis, considered as surgical emergency)Image 5: (a) An 8-year-old boy with upper lid abscess and eyelid edema; (b) A 6-year-old boy with multiple folliculitis lesions with upper and lower lid edema suggestive of pre-septal cellulitis. Management includes broad-spectrum antibiotics, most common organism being Staphylococcus aureus in adults and H. influenza in children. Breaches in the skin barrier, such as trauma and insect bites, may be more commonly associated with preseptal cellulitis than orbital cellulitis. Orbital cellulitis may be associated with paranasal sinusitis, especially ethmoidal sinusitisImage 6: A 6-year-old child with (a) bilateral dacryocystitis with left eye having undergone external dacryocystorhinostomy (DCR); (b) same patient with right eye regurgitation test positive, planned for DCR of the same eye. Main causative organism of infective dacyrocystitis is Streptococcus pneumonia. Congenital nasolacrimal duct obstruction is the most common cause for positive regurgitation test in children. Treatment includes Crigler lacrimal massage up to 1 year of age, therapeutic syringing and probing up to 2 years of age, and DCR (external or endoscopic) in children above 4 years of ageImage 7: (a) A 2-year-old child with localized skin excoriation due to insect bite; (b) A 9-month-old infant with paederus dermatitis involving left eye. Skin irritation caused by contact with toxin from rove beetle of genus paederus. The ophthalmic manifestations of Paederus dermatitis are periorbital dermatitis, conjunctivitis, and persistent epithelial defects. This condition mimics infectious periorbital cellulitis and Herpes viral infection. Treatment includes cold compresses, administration of systemic antihistamine, and topical corticosteroids. Systemic antibiotics are usually considered to prevent secondary bacterial infectionImage 8: Molluscum contagiosum (MC) in a 3-year-old child showing (a) localized and (b) diffuse; (c) gross specimen of the same lesion after excision. Clinical diagnosis of ocular MC is based on the presence of characteristic lid lesions (umbilicated) and follicular conjunctivitis. Management of ocular MC and chronic anterior segment involvement is lesion excision by de-roofing and curettageImage 9: (a) Showing tubercular lymphadenitis in a young 9-year-old girl with positive mantoux (28 mm) and positive CBNAAT for Mycobacterium tuberculosis, associated with (b) Right eye corneal ulcer due to superadded bacterial keratoconjunctivitis upon a pre-existing peripheral ulcerative keratitis (PUK); (c) showing left eye with infiltrates and thinning at limbus (at corneoscleral junction) depicting early PUK (black arrow). Treatment was initiated with cefazoline 5% and tobramycin 1.4%, along with antitubercular therapy. As the patient has deep corneal ulcer involving 3/4th of the cornea, corneal transplantation was neededImage 10: Shows matting and crusting of eyelashes due to hair louse causing phthiriasis palpebrarum. Phthiriasis palpebrarum, also called “phthiriasis ciliaris” or “ciliary phthiriasis,” is caused by an infestation with Phthirus pubis (pubic or crab louse). The primary mode of treatment involves the manual removal of lice and nits using fine forceps or tweezers, and petrolatum ointment application daily for 10 days. Oral ivermectin may be prescribed in extensive casesDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.