Pediatrics 405378.A 2-week-old girl is brought to the ED with the complaint of eye dis-
charge. The patient was born full-term to a mother who received scant pre-
natal care, but states she was treated for a vaginal infection during her
pregnancy. The infant has been feeding well and gaining weight. She has
had no fever. Mother notes that the patient has had a mild, dry sounding
cough. She has had no vomiting or irritability. Her examination is nonfocal
and benign except for bilateral redness of the conjunctivae, palpebral more
than bulbar, and bilateral purulent discharge. She has her 2-week office
visit scheduled for 2 days from now. Which of the following is the most
appropriate course of action?
a. Initiate a full sepsis workup and administer ceftriaxone.
b. Obtain a blood and urine and eye culture and treat systemically for gonorrhea
infection.
c. Perform a conjunctival scraping for direct fluorescent antibody, culture, and
begin topical erythromycin.
d. Perform a conjunctival scraping for direct fluorescent antibody, culture, and
begin systemic treatment with erythromycin.
e. Reassure that this is likely to be a clogged tear duct, which is a common and self
limiting condition in such a well-appearing infant, and plan for close follow-up.