1. Blepharitis
Internal blepharitis: blepharitis (meibomain gland). External blepharitis: sebaceous and sweat gland infections (zeis gland, moll gland).
Pathogenic bacteria: mostly Staphylococcus aureus infections.
The bacteria are virulent and resistant, and the lesion may progress to eyelid cellulitis, which may cause sepsis and life-threatening cavernous sinus thrombosis.
Treatment: topical levofloxacin ophthalmic solution; oxyfloxacin ophthalmic gel; fusidic acid ophthalmic gel; systemic neoterein, etc.
2. Neonatal dacryocystitis
The causative agent is mostly Haemophilus influenzae, and acute attacks can easily evolve into orbital cellulitis and septic sepsis.
If the acute attack of neonatal dacryocystitis is not easily distinguished from orbital cellulitis, the patient should be hospitalized with intravenous antibiotics. Cefuroxime (Cilixin) is recommended.
Topical use of levofloxacin ophthalmic solution; ofloxacin ophthalmic gel; fusidic acid ophthalmic gel, etc.
3. Acute or subacute bacterial conjunctivitis
The most common causative agents are: S. pneumoniae, S. aureus, and Haemophilus influenzae.
Haemophilus influenzae is the most common pathogen of bacterial conjunctivitis in children.
Children with bacterial conjunctivitis with pharyngitis and acute otitis media should receive oral cephalosporin antibacterial agents such as Xicloo and Schipper, etc. In severe cases, intravenous antibiotics such as Cilixin should be used.
4. Neonatal gonococcal conjunctivitis
Pathogenic bacteria: gonococcus
Special treatment: 5000-10000U/ml saline rinse and eye drops (skin test required)
Emphasis on systemic medication: penicillin G 100,000U/kg*d intravenous drip; or ceftriaxone (Rohypnol), cefotaxime (Keflon) intravenous drip. Systemic use of drugs for a total of 7 days.
5. Bacterial keratitis/ulcer
Pathogenic bacteria: worldwide: Staphylococcus epidermidis; the first causative agent of corneal ulcer in China: Pseudomonas aeruginosa; second: Staphylococcus epidermidis; third: Staphylococcus aureus; fourth Streptococcus pneumoniae.
The use of broad-spectrum antibiotics at first diagnosis has greater significance.
Topical use: recommended 5% cefazolin + 1.4% tobramycin; or 5% cefazolin + triple fluoroquinolones (norfloxacin, ofloxacin, ciprofloxacin, etc.).
Vancomycin, fusidic acid against resistant Staphylococcus aureus and Staphylococcus epidermidis as second-line use.
Ciprofloxacin has the strongest effect on Pseudomonas aeruginosa among fluoroquinolones; tobramycin is twice as active as gentamicin against Pseudomonas aeruginosa.
6 . Orbital cellulitis
The pathogens are mostly staphylococci and streptococci, with Haemophilus influenzae predominating in children.
Broad-spectrum antibiotics, conjunctival sac bacterial culture + drug sensitivity; dehydrating agents to lower orbital pressure; ultrasound-guided aspiration of pus or excision and drainage; complicated by cavernous sinus thrombosis, should be resuscitated in ICU, infection department, neurosurgery, ophthalmology, oral and maxillofacial surgery, ear, nose, throat, head and neck surgery and other departments of multidisciplinary collaboration.
Antibiotic use: choose to use cefuroxime, fusidic acid, Tylenol, Sever, Mepin, Vancomycin, etc. Bacterial culture + drug sensitivity is very important. Early on, broad-spectrum antibiotics can be used, and later on, according to the drug sensitivity report by targeted full dose and standardized use.