Paediatric Ophthalmology

 

In addition to condition specific guidelines, please see below for common conditions in children (this list is not exhaustive).

 

Epiphora/Persistent Sticky Eye in the absence of infection

Management prior to referral

• If child <1yr, advise lid cleaning and massage of mucocele – imperforate nasolacrimal duct may resolve within first year
   
• Avoid antibiotics unless the conjunctiva is inflamed. They are unnecessary and ineffective.

 

Referral Instructions

• >1yr old with a persistent sticky eye in the absence of infection
  • refer to routine Ophthalmology clinic

 

Peri-orbital and Orbital Cellulitis

Primary Care Management

·Peri-orbital cellulitis

• See RCHT link above for further guidance
   
• If systemically well and no concerning features on examination CKS guidance suggests Co-Amoxiclav as first line antibiotic, and Clarithromycin if penicillin allergic.

·Orbital Cellulitis

• Referral to Paediatric On Call Team

 

Referral Instructions

Refer to the Paediatric On Call Team:

• Peri-orbital cellulitis not responding to oral antibiotics, worsening symptoms, red flags as per link, systemically unwell, concerns regarding orbital cellulitis or any other clinical concerns.

 

Dacryocystitis (tear duct infection)

Pain and tenderness over the tear sac, often caused by nasolacrimal obstruction, and can be associated with fever. The infection may also cause conjunctivitisand cellulitis¹.

·Management prior to referral (in absence of concerns about peri-orbital/orbital cellulitis)

• Warm compresses may aid resolution
   
• Initially, treatment of acute dacryocystitis is with oral antibiotics. Empiric antibiotics should include Gram-positive and Gram-negative coverage². E.G Co-Amoxiclav³  as per CKS. If penicillin allergic Clarithromycin.

 

·Referral Instructions

• Dacryocystitis not responding to antibiotics in the absence of clinical concern for peri-orbital cellulitis and the patient is systemically well
  • refer to urgent Ophthalmology clinic
• Child is systemically unwell or there is spreading redness/worsening symptoms
  • please refer to on call Paediatrics

 

Leukocoria (Absent red reflex/white reflex)

·Referral Instructions

• Urgent Ophthalmology Clinic Referral

 

Ptosis

·Referral Instructions

• If covering visual axis (line of site) and risk of amblyopia (‘lazy eye’).
  • Urgent Referral to Orthoptist
• If no concerns as above
  • Refer routinely to Orthoptist who will triage to Optometrist +/- clinic as necessary

 

Squint

See Motility Guidelines

 

Lumps

Please see eyelid mass section on Lids/Lacrimal page

 

Advice and Guidance

Please send advice and guidance requests to Ophthalmology via eRS

 

Useful Information

Professional:

• https://cks.nice.org.uk/topics/conjunctivitis-infective/
• https://patient.info/doctor/infectious-disease/dacryocystitis-and-canaliculitis?utm_source=gpoptin
• https://bestpractice.bmj.com/topics/en-gb/734?q=Peri-orbital%20and%20orbital%20cellulitis&c=recentlyviewed
• Infections– Acute GP
• Preseptal and Orbital Cellulitis in Children Clinical Guideline

 

Patient:

• https://patient.info/eye-care/watering-eyes-epiphora
• Tear Duct Blockage in Babies: Causes, Symptoms, and Treatment

 

References

• https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/dacryocystitis_acute#tab-informationforpatients-7fb258d2
• https://pubmed.ncbi.nlm.nih.gov/29261989/
• Scenario: Management | Management | Cellulitis - acute | CKS | NICE

 

Page review information

Date reviewed                   06 March 2026

Next review due                06 March 2028 

GP Speciality Lead            Dr Kate Northridge

Contributor                         Dr David Jones, Consultant Ophthalmologist Royal Cornwall Hospital