The red eye in childhood

Causes and management of red eye in pediatric ophthalmology

Red eye is the most common ocular sign encountered in emergency and outpatient settings. Recognition of vision-threatening causes and those requiring referral to an ophthalmologist is of utmost importance. This article reviews causes and management of red eye in children with an emphasis on allergic etiology, pathophysiology, and recent advances in therapy.

[Periodic fever, aphthous stomatitis, pharyngitis and adenitis: PFAPA syndrome in Argentina]

INTRODUCTION

PFAPA syndrome is a benign, non-hereditary condition, of unknown etiology and pathogenesis. There are few reports of it in South America. The purpose of this article is to communicate the experience in a large pediatric hospital in Argentina.

PATIENTS AND METHODS

A total of 18 patients were diagnosed with PFAPA between 2002 and 2009 at the Medium Risk Clinic, Prof. Dr. Juan P. Garrahan Pediatrics Hospital, Buenos Aires City. The modified criteria reported by Thomas et al were used for diagnosis. The follow up continued with evaluations during new febrile episodes, clinic check ups and telephone calls.

RESULTS

The mean age at onset of symptoms was 2.5 years (range: 0.4-7.5) and the mean lag time from onset of symptoms and diagnosis was 3.2 years (range: 0.4-10.9). Fever episodes lasted for a mean of 4.5 days (range: 2-8), with a mean interval of 23 days (range: 15-30) between the beginning of the attacks. Febrile episodes were treated with methyl prednisone at a dose of 1mg/kg or betamethasone at a dose of 0.15mg/kg in a single dose. With a mean follow up of 2.6 years (range: 0.5-5.9) 13 patients remain with febrile episodes at a mean interval of 4.6 months (range: 1-12). Five patients did not have febrile crisis for more than a year during the study period and they are considered cured; in this group the disease lasted a mean of 4.7 years (1-9.7).

CONCLUSIONS

PFAPA syndrome is a sporadic, difficult to diagnose, condition. Both methyl-prednisone and betamethasone have shown to be effective in controlling the symptoms during the febrile crisis. The definitive remission of the syndrome may occur in the first years of onset, although in most patients the febrile episodes continue with an increase of free intervals and attenuated symptoms, and full recovery in prepuberty or adolescence with no sequelae.

Periorbital and orbital infections

Practitioners frequently have the opportunity to manage the child for whom the chief complaint is a swollen eye. Some children have trivial or self-limited disorders, but others can have sight- or life-threatening problems. Noninfectious causes of the swollen eye include blunt trauma, tumor, local edema, and allergy. Infectious causes can be preseptal or orbital in origin. The differential diagnosis and management of these conditions are considered in this article.