Ophthalmia Neonatorum (Neonatal Conjunctivitis): Causes, Symptoms & Treatment Notes

Ophthalmia Neonatorum
Neonatal Conjunctivitis
Definition: Bilateral inflammation of the conjunctiva occurring in an infant less than 30 days old. It is a preventable disease often due to carelessness at birth.

Clinical Tip: Any discharge or watering in the 1st week of life = Suspicion of Ophthalmia Neonatorum (as tears are not formed till then).
Ophthalmia Neonatorum (Neonatal Conjunctivitis)
Ophthalmia Neonatorum (Neonatal Conjunctivitis)

1. Etiology

A. Mode of Infection

  • 1.
    Before Birth (Rare): Infected liquor amnii (ruptured membranes).
  • 2.
    During Birth (Most Common): Infected birth canal (face presentation/forceps delivery).
  • 3.
    After Birth: First bath, soiled clothes, or fingers with infected lochia.

B. Causative Agents

  • ➤
    Chemical: Caused by antibiotics or Silver Nitrate (historical) used for prophylaxis.
  • ➤
    Gonococcal: Severe, used to cause 50% of childhood blindness. Rare in developed nations but still a problem in developing countries.
  • ➤
    Other Bacterial: Staph. aureus, Haemophilus, Strep. haemolyticus, Strep. pneumoniae.
  • ➤
    Neonatal Inclusion (Chlamydial): Caused by Serotypes D to K. Most common cause in developed countries.
  • ➤
    Herpes Simplex (HSV-II): Rare. From infected birth canal.

2. Clinical Features

A. Incubation Period

Causative Agent Incubation Period
Chemical 6 hours
Gonococcal 2 – 5 days
Other Bacterial 5 – 8 days
Neonatal Inclusion 5 – 14 days
Herpes Simplex 6 – 15 days

B. Symptoms & Signs

Symptoms
  • •
    Pain and tenderness in the eyeball.
  • •
    Discharge:
    - Purulent: Gonococcal (Severe).
    - Mucoid/Mucopurulent: Other bacteria & Chlamydia.
Signs
  • •
    Lids: Swollen. Vesicles may occur in HSV.
  • •
    Conjunctiva: Hyperaemia and chemosis.
  • •
    Response: Papillary response (mild) in Chlamydia/HSV.
    Note: Follicular response is absent due to immature lymphoid system (until 6-8 weeks).
  • •
    Cornea: Rare involvement. SPKs may be seen in HSV.

3. Complications

Untreated cases (esp. Gonococcal) may lead to:

  • ⚠
    Corneal Ulceration.
  • ⚠
    Rapid Perforation → Opacification or Staphyloma.

4. Prophylaxis

Antenatal
Treat maternal infections (Gonorrhea/Chlamydia) in 3rd trimester.
↓
Natal
Hygienic delivery. Clean & dry baby's lids.
↓
Postnatal
Povidone-Iodine 2.5% OR Tetracycline 1% / Erythromycin 0.5%
Historical Note: Crede’s Method
In the past, 1% Silver Nitrate solution was used. (Now obsolete).

High Risk Mothers:
Infants born to mothers with untreated Gonorrhea require single inj Ceftriaxone 50 mg/kg (IM/IV).

5. Treatment

Rule: Cytology and Culture Sensitivity swabs should be taken before starting treatment.

A. Specific Therapy

1. Chemical: Self-limiting. No treatment required.
2. Gonococcal (Emergency):
  • Rx
    Topical:
    • Saline lavage (Hourly).
    • Bacitracin ointment (4x/day).
    • Penicillin drops (Only if susceptible).
    • Atropine (If cornea involved).
  • Rx
    Systemic (7 Days):
    • Ceftriaxone 75-100 mg/kg/day (IV/IM).
    • OR Cefotaxime / Ciprofloxacin.
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3. Other Bacterial:
  • Rx Broad-spectrum drops/ointment (Neomycin-bacitracin or Tobramycin) for 2 weeks.
4. Neonatal Inclusion Conjunctivitis (Chlamydia):
  • Rx
    Topical: Tetracycline 1% or Erythromycin 0.5% (4x/day for 3 weeks).
  • Rx
    Systemic: Erythromycin 50 mg/kg/day (2-3 weeks) OR Azithromycin suspension.
Important: Systemic treatment is needed because Chlamydia colonizes the upper respiratory tract. Both parents must also be treated!
5. Herpes Simplex:
  • Rx Self-limiting, but topical antivirals prevent recurrence.
  • Rx High dose IV Acyclovir if systemic infection suspected.
• Ophthalmia Neonatorum

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