According to the standard diagnostic and therapeutic procedureManagement of conjunctivitis in children in general practiceThe pediatrician in the general practice may carry out diagnostics, differential diagnosis, treatment and prevention of conjunctivitis in children.
The objective of this standard is to improve the diagnostic accuracy and uniformity of procedures, to strengthen the role of the primary paediatrician in the management of mild forms of conjunctivitis, to promote rational use of antibiotics, to prevent complications and the development of chronic disease and to reduce the number of redundant consultations. The standard procedure applies to outpatient care for children under 18 and 364 days, including infants and newborns.
The primary paediatrician has competence to diagnose, treat and monitor most acute, uncomplicated forms of conjunctivitis. The ophthalmologist enters care in cases of complicated progress, presence of risk factors or the need for specialised diagnostics.
Pediatric competence in general practice in the management of conjunctivitis in children:
- conducts primary examination of a child suspected of conjunctivitis,
- removes a history of discharge nature, duration, laterality, associated symptoms and contacts,
- perform an indicative physical examination of the eyes, including an age-appropriate assessment of visual acuity,
- decide on probable aetiology (bacterial, viral, allergic, mechanical, chemical, neonatal)
- indicates symptomatic and antibiotic treatment in uncomplicated forms of conjunctivitis,
- provide parents' education on the hygiene, prevention and conditions of child return to the collective;
- monitor the effect of treatment and ensure that the condition is controlled within 48-72 hours,
- decide to send a child for specialised ophthalmological examination in a specialised ambulance in the presence of warning signs.
The primary paediatrician's role is:
- identify the type of conjunctivitis according to the clinical picture,
- exclude severe conditions (keratitis, uveitis, orbitocellulitis)
- indicate antibiotics only in highly probable bacterial aetiology,
- ensure proper hygiene, isolation and family education;
- refer the patient to an ophthalmologist for warning symptoms
- send the patient to an immunoallergologist in case of suspected allergic aetiology, recurrent course and VKC/AKC.
Putting this standard into practice can help rationalise antibiotic treatment, reduce the risk of complications and improve coordination between the primary paediatrician and ophthalmologist.
The current text of the standard diagnostic and therapeutic procedure -Manažment of conjunctivitis in children in the general practice-- is published in the Pediatrics Primary: https://www.health.gov.sk/?Standard-Procedures-V-Health