Pediatrician Knowledge in Management of ‘Red Eye’ in Children

Knowledge is important so that clinicians are aware of more serious causes of red eye in children, as well as to minimize antimicrobial resistance with indiscriminate use of antibiotics.

Baby Eye 1

The most common cause of red eye with discharge in children is viral conjunctivitis.

Conjunctivitis, or red or pink eye, is defined as sudden-onset redness of the eye conjunctiva (the “white of the eye,”) and can be accompanied by swelling in the eyelids, increased tearing, light sensitivity, or blurry vision. The most common cause for conjunctivitis is from a viral infection, but it is also important to note that a “red eye,” even in children, can be a sign of systemic conditions. Family doctors and pediatricians are the first healthcare specialists to see children suffering from “red eye.”

While most cases of red eye, due to its viral nature, are self-limiting, in rare cases one episode of conjunctivitis may cause some corneal scarring. This can be permanent and affect vision. It is therefore important that a good history, including asking for previous eye surgeries and trauma, and a thorough physical examination be conducted.

Should children have viral conjunctivitis, the recommended management plan is to do eyelid hygiene and use artificial tears, while monitoring for disease progression or resolution. However, previous studies have shown that most pediatricians do not adhere to these recommendations and start the patients on topical antibiotics. Previous studies across different countries also showed some knowledge discrepancies in non-eye specialist physicians with regards to the understanding of the treatment and causes of red eye.

The objective of this study was to examine the knowledge base of pediatricians in terms of treating children with red eye, as well as to elucidate the factors that affect this knowledge. This is important because some diseases that present with a red eye can be dangerous to a child’s vision or may even involve other organs, as in systemic disease.

This study was designed as a correlational quantitative questionnaire study. There were a total of 200 participants recruited, with only 152 questionnaires returned, corresponding to a response rate of 76%. A validated questionnaire was translated into Hebrew and adapted to Israeli practice, which was thereafter validated by ophthalmologists and pediatricians. This questionnaire had four parts: the first is about sociodemographic factors and medical experience, the second about experience in practice with red eye, the their about knowledge about this presentation, and the fourth about perceptions and attitudes on treatment of patients with red eye.

Results showed that the respondents’ level of knowledge was “moderate.” This meant that majority of the clinicians (89.5%) who responded were aware that the most common diagnosis of a child presenting a red eye is viral conjunctivitis. In addition, they were also aware that should there be other accompanying symptoms, such as eye pain or blurry vision, that more investigations are warranted. Majority (78.3%) of the clinicians also reported being aware that the management plan should include strict hygiene and eye flushing. However, almost 15% of the respondents surveyed were found to prescribe antibiotics.

In terms of associations, it was found that there was a negative association between the pediatrician’s age and years of experience and the level of knowledge about treating children with red eye: the older the clinician, the lower the level of knowledge. Meanwhile, the higher the level of knowledge, the better the attitude with regards to conducting eye examinations, and the less likely they are to prescribe antibiotics for children with red eye.

In conclusion, knowledge about the causes, possible disease associations, and treatment of red eye is important for pediatricians to correctly investigate, diagnose, and manage red eye in children.

Mostovoy, D. et al. (2023) ‘Pediatricians’ knowledge, attitude and practice on treating children with red eye disease’, BMC Ophthalmology, 23(1). doi:10.1186/s12886-022-02755-7.

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