Conjunctivitis in older children presents no unusual diagnostic problems.  Aetiological factors may be:-   

1. Bacterial Conjunctivitis

Clinical Findings
-Red eyes – usually bilateral, sore (but not painful)      

 Bacterial Conjunctivitisbacterial conjunctivitisacute bacterial cojunctivitis


- Muco-purulent discharge

Diagnosis
- Gram stain and culture

Therapy   - Eye toilets + Local antibiotic drops second hourly   

2. Viral Conjunctivitis (adenovirus) Adeno Viral Conjunctivitis

Clinical Findings
- Frequently unilateral initially
- Red eye
- Watery discharge
- Tender preauricular lymph node
- Follicles visible on tarsal conjunctival

Diagnosis
– Clinical features + Culture (e.g. Adeno Virus)

Therapy    
- Supportive
- Hot Spoon bathing

3.Allergic Conjunctivitis- Spring catarrh, vernal conjunctivitis
spring catarrh papillae

 Clinical Findings                   
- Itchy eye, Rubbing of eyes
- Watery discharge
- No injection
- Cobblestone papillae on tarsal conjunctival
- Beware of Photophobia or reduced vision –This signifies corneal involvement and possible serious loss of vision!

  due to Keratitis

 Diagnosis
– Eosinophils in conjunctival scraping

Therapy 
- Minor case –trial with vasoconstrictors- Naphcon A, Albalon A
- Mast Cell Stabilisers-Patanol  Lomide, Opticrom. Effectivity is limited in children. Drops must be used regularly 3 or 4 times daily even when asymptomatic to stabilise Mast Cells. They are of no value used only when symptoms occur because they take some time to have an effect. Compliance with these medications is extremely poor and I find their practical value is minimal.
-Local steroid drops- Continue to be the most effective available topical medication for severe Vernal conjunctivitis. Their use requires monitoring because of their possible effect on Intra Ocular Pressure. I have often seen vision lost as a result of failure to control Allergic Keratoconjunctivitis because of fears regarding steroid use. Steroid raised pressure in children is rare, I have not seen vision lost from this complication in childhood. Monitor the dose of steroids, adjusting the dose according to the response. There is usually a gradual reduction in the number of applications required and eventual cessation in teenage life.

4. Neonatal Conjunctivitis
Conjunctivitis in the neonate may be a sight threatening condition.

Severe Purulent conjunctival infection in this age group can result in corneal involvement and even rupture.

gonococcal conjunctivitis

Aetiological Agents:
- Gonococcal – (classical but rare) culture
- Other Bacteria – culture, gram stain
- Chlamydia – smear
- Herpes simplex – culture

Therapy :
- Admit to hospital
- Hourly eye toilets
-Hourly antibiotic drops
-Appropriate systemic antibiotics

Prompt adequate therapy in patients with neonatal conjunctivitis should prevent corneal complication and permanent visual impairment.