Aquifer Pediatrics: Case 31 - 5 yr old
with puffy eyes Questions and
Answers Verified Solutions Latest
Update (2026/2027)
Question:
Conjunctivitis
Answer:
Conjunctivitis
Conjunctivitis is any inflammation of the conjunctiva.
Presentation
The conjunctiva appears red and swollen, with some mild lid edema.
Depending on the type of conjunctivitis there is also either watery or
purulent drainage
associated. (Link to a photo showing a child with conjunctivitis.)
Etiology
Conjunctivitis can be caused by:
Allergies
Chemical irritation, or
Infection
Consider allergy in a child who has bilateral red, watery eyes, and who
complains of itchiness and
irritation. Discharge in allergic conjunctivitis tends to be mucoid and ropey.
There is usually a
history of hypersensitive reactions to seasonal allergens, such as pollens and
molds, or to
perennials such as dust mites and animal dander.
Infectious Conjunctivitis
Often difficult to distinguish bacterial from viral conjunctivitis on clinical
presentation.
,Children younger than 6 are more likely to have a bacterial than a viral
infection.
Both produce conjunctival redness and itching.
Bacterial conjunctivitis is more likely to cause a purulent exudate with
eyelids crusted closed upon
awakening.
Both viral and bacterial tend to begin in one eye, but both may spread to the
other eye.
Adenovirus conjunctivitis frequently becomes bilateral and may be
associated with pharyngitis
and pre-auricular lymphadenopathy.
Question:
Presentations of Periorbital Swelling
Answer:
URI
Seasonal/perennial allergic rhinitis and conjunctivitis
Sinusitis (ethmoid, frontal, or maxillary)
Acute allergic reaction
Periorbital cellulitis
Question:
URI
Answer:
Usually concurrent findings of nasal congestion, cough, and/or pharyngitis.
Question:
, Seasonal/perennial allergic rhinitis and conjunctivitis
Answer:
May be associated with
pruritis and mucoid discharge
Often associated sneezing, itchy nose, and clear rhinorrhea
On exam there may be allergic shiners (dark circles under the eyes),
Dennie's lines (an extra crease
below the lower eyelid), and cobblestoning of the conjunctiva (fine bumps on
the conjunctival
mucosa).
Link to a photo of a child with allergic eye swelling.
Question:
Sinusitis (ethmoid, frontal, or maxillary)
Answer:
Swelling with or without redness also
can result from inflammatory edema (usually painless swelling thought to
result from the
obstruction of venous drainage from periorbital structures into veins that
pass through the
sinuses because the veins are partially blocked by inflamed tissues in the
sinuses)
May be associated nasal congestion, headache, and cough.
(Inflammatory edema can also occur in the setting of a URI or allergic
rhinitis.)
Question:
Acute allergic reaction
Answer:
with puffy eyes Questions and
Answers Verified Solutions Latest
Update (2026/2027)
Question:
Conjunctivitis
Answer:
Conjunctivitis
Conjunctivitis is any inflammation of the conjunctiva.
Presentation
The conjunctiva appears red and swollen, with some mild lid edema.
Depending on the type of conjunctivitis there is also either watery or
purulent drainage
associated. (Link to a photo showing a child with conjunctivitis.)
Etiology
Conjunctivitis can be caused by:
Allergies
Chemical irritation, or
Infection
Consider allergy in a child who has bilateral red, watery eyes, and who
complains of itchiness and
irritation. Discharge in allergic conjunctivitis tends to be mucoid and ropey.
There is usually a
history of hypersensitive reactions to seasonal allergens, such as pollens and
molds, or to
perennials such as dust mites and animal dander.
Infectious Conjunctivitis
Often difficult to distinguish bacterial from viral conjunctivitis on clinical
presentation.
,Children younger than 6 are more likely to have a bacterial than a viral
infection.
Both produce conjunctival redness and itching.
Bacterial conjunctivitis is more likely to cause a purulent exudate with
eyelids crusted closed upon
awakening.
Both viral and bacterial tend to begin in one eye, but both may spread to the
other eye.
Adenovirus conjunctivitis frequently becomes bilateral and may be
associated with pharyngitis
and pre-auricular lymphadenopathy.
Question:
Presentations of Periorbital Swelling
Answer:
URI
Seasonal/perennial allergic rhinitis and conjunctivitis
Sinusitis (ethmoid, frontal, or maxillary)
Acute allergic reaction
Periorbital cellulitis
Question:
URI
Answer:
Usually concurrent findings of nasal congestion, cough, and/or pharyngitis.
Question:
, Seasonal/perennial allergic rhinitis and conjunctivitis
Answer:
May be associated with
pruritis and mucoid discharge
Often associated sneezing, itchy nose, and clear rhinorrhea
On exam there may be allergic shiners (dark circles under the eyes),
Dennie's lines (an extra crease
below the lower eyelid), and cobblestoning of the conjunctiva (fine bumps on
the conjunctival
mucosa).
Link to a photo of a child with allergic eye swelling.
Question:
Sinusitis (ethmoid, frontal, or maxillary)
Answer:
Swelling with or without redness also
can result from inflammatory edema (usually painless swelling thought to
result from the
obstruction of venous drainage from periorbital structures into veins that
pass through the
sinuses because the veins are partially blocked by inflamed tissues in the
sinuses)
May be associated nasal congestion, headache, and cough.
(Inflammatory edema can also occur in the setting of a URI or allergic
rhinitis.)
Question:
Acute allergic reaction
Answer:
