Pediatric Conjunctivitis & Orbital Cellulitis Tool · Newborn to Teen

About this tool

This tool walks a clinician through the red or swollen eye in a child, from the newborn period to adolescence. It separates neonatal conjunctivitis by timing and appearance into chemical, gonococcal, chlamydial and herpes simplex causes, and gives the systemic treatment each needs, along with testing and treatment of the mother and her partners.

For older children it first screens for red flags that need same-day ophthalmology, such as reduced vision, photophobia, contact lens use or a herpetic dendrite. It then sorts bacterial, viral, allergic and sexually transmitted conjunctivitis, and flags the conjunctivitis-otitis syndrome that needs oral amoxicillin-clavulanate rather than drops. Return-to-school advice follows the Red Book: most children do not need exclusion.

For a swollen eyelid it separates periorbital (preseptal) from orbital (postseptal) cellulitis using orbital signs. Orbital signs lead to contrast CT, IV ceftriaxone and vancomycin, and same-day ophthalmology and ENT; mild preseptal cellulitis gets oral treatment chosen by source. Doses are per kilogram with maximums, and the weight entry is optional.

Common questions

How do you treat gonococcal conjunctivitis in a newborn?

Admit and give a single dose of ceftriaxone 25–50 mg/kg IV or IM (max 250 mg), or cefotaxime 100 mg/kg if IV calcium is running. Evaluate for disseminated infection, irrigate the eyes, test for chlamydia, and treat the mother and her partners.

What is the treatment for chlamydial conjunctivitis in a newborn?

Oral therapy, because topical drops do not clear it: erythromycin 50 mg/kg/day in 4 doses for 14 days, or azithromycin 20 mg/kg once daily for 3 days. Both carry a pyloric stenosis risk under 6 weeks, and a second course is sometimes needed.

Do children with pink eye need to stay home from school?

No, for most. The Red Book and AAP child care guidance do not require exclusion for conjunctivitis in a child without fever or behavior change. Good handwashing matters more.

How do you tell periorbital from orbital cellulitis?

Orbital cellulitis causes proptosis, pain with eye movement, limited eye movement, or reduced vision. Any of these needs contrast CT of the orbits and sinuses, IV antibiotics, and ophthalmology and ENT review.

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