Ophthalmology

1. 1
OPHTHALMIA
NEONATORUM
by : Kiros Weldegerima C-II
Ophthalmology by Kiros
2/1/2014

2. outline
2
Definition
 Epidemiology
 Etiology
 Clinical picture
 Diagnosis
 Treatment and prognosis
 Prevention strategies

Ophthalmology by Kiros
2/1/2014

3. 3
DEFINITION :
 Conjunctival inflammation during
the neonatal period.
 Watering of the eyes should
create a suspicion of this as
tears are not formed before 3-4
weeks post partum

Ophthalmology by Kiros
2/1/2014

4. epidemiology
4
It’s the most common eye
infection in new borns
 Ophtalmia neonatorum acquired
during vaginal delivery reflects
the prevalence of STD in the
community

Ophthalmology by Kiros
2/1/2014

5. Cont…
5

History : in 1880 10% of
European new borns developed
gonococcal conjunctivitis
: in 1881 crede introduced
2% silver nitrate as a prophylaxis
which reduced the incidence to
0.3%
Ophthalmology by Kiros
2/1/2014

6. Cont…
6

Gonococcal ophtalmia
neonatorum has an incidence of
0.3/1000 live births in USA , while
Chlamydia trachomatis has an
incidence of 8.2/1000 live births
making it the commonest cause.
Ophthalmology by Kiros
2/1/2014

7. Etiology
7
modes of infection could be:
 Before birth
 During(most common) or
 After birth
Ophthalmology by Kiros
2/1/2014

8. Etiology
8
Source of infection could be:
 Maternal genital tract
 Non sterile towels and clothing,
infected hands
 The environment…
Ophthalmology by Kiros
2/1/2014

9. cont…
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PREDISPOSING FACTORS:
 Premature rupture of membranes
 prolonged labor
 Untreated maternal infections
 Trauma to epithelial barrier
 Prophylaxis (antibiotics, silver
nitrate)
Ophthalmology by Kiros
2/1/2014

10. cont…
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
The causes can be broadly
classified as : Infectious and
Non infectious
Ophthalmology by Kiros
2/1/2014

11. chemical
11

Chemical conjunctivitis – is the
commonest of the non infectious
and it is usually due to silver
nitrate which causes a transient
conjunctival irritation after 6 hours
of installation of silver nitrate and
self limits by 24-48 hours
Ophthalmology by Kiros
2/1/2014

12. Chlamydial
12

Chlamydia trachomatis – is the
commonest infectious cause. It’s
a sexually transmitted pathogen,
Infants whose mothers have
untreated chlamydial infections
antepartum have a 30% - 40%
chance of developing chlamydial
neonatal conjunctivitis
postpartum.
Ophthalmology by Kiros
2/1/2014

13. Cont…
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It causes a form of conjunctivitis
called neonatal inclusion
conjunctivitis.
 Neonatal infection is usually caused
by C. trachomatis serovariants B
and D through K
 Associated systemic infections like
ottitis media and chlamydial
pneumonitis are devastating so
treatment is mandatory.

Ophthalmology by Kiros
2/1/2014

14. Gonococcal
14
N. gonorrhoeae is a gram-negative
diplococcus. Humans are its only
known reservoir. Gonococci have
the ability to penetrate intact
epithelial cells-the basis for corneal
perforation.
 Co infection with Chlamydia is
common

Ophthalmology by Kiros
2/1/2014

15. Cont…
15

Systemically it can be
complicated with septicemia and
meningitis
Ophthalmology by Kiros
2/1/2014

16. Miscelanious bacteria
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Those include – staph. aureus ,
strep. Hemolyticus , strep.
Pneumoneae , pseudomonas
auruginosa , and heamophilus
influenza
 Pseudomonas poses a serious
concern

Ophthalmology by Kiros
2/1/2014

17. Herpes simplex virus
17
Although either HSV-1or HSV-2 can
cause neonatal conjunctivitis, up to
70% of neonatal herpetic infections
have been attributed to the genital
strain, HSV-2
 Most HSV-1 infections are transmitted
due to contact with active infections
while
HSV-2 is usually transmitted during
passage through the birth canal or by
Ophthalmology by Kiros 2/1/2014
transplacental mechanisms.


18. Ophthalmology by Kiros
PREVENTION
2/1/2014
YOHANNA AREGAWI
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
1.
2.
3.
Prophylaxis
Antenatal : care of mother
Natal : hygienic delivery
Postnatal : 1% tetracycline, 0.5%
erythromycin or 1% silver nitrate solution
Ophthalmology by Kiros
2/1/2014

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
Maternal screening -The most effective
measure to prevent both gonococcal and
chlamydial infections is to diagnose and treat
these infections in pregnant women
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2/1/2014

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
The CDC recommends screening for gonorrhea
in women who are at increased risk for infection
those
 with previous gonorrheal infection or other
STDs,
 new or multiple sex partners,
 inconsistent condom use,
 those who engage in commercial sex work
and
 drug use,
Ophthalmology by Kiros
2/1/2014

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

neonatal prophylaxis — The risk of contracting
gonococcal conjunctivitis is markedly reduced
by effective prophylaxis
Eye prophylaxis should be performed shortly
after birth within the first hour of life in all
infants
Ophthalmology by Kiros
2/1/2014

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


Drops of 0.5% erythromycin or 1% silver
nitrate(Credé’s method of prophylaxis) are
instilled directly into the open eyes at birth
using wax or plastic single-dose containers.
Saline irrigation after silver nitrate application
is unnecessary
Tetracycline (1 percent) ophthalmic ointment;
tetracycline ophthalmic ointment is not
available in the United States.
Ophthalmology by Kiros
2/1/2014

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
Erythromycin ophthalmic ointment
causes less chemical conjunctivitis
than does silver nitrate solution but
silver nitrate is more effective as a
prophylaxis for penicillinase-producing
Neisseria gonorrhoeae than
erythromycin and should be used in
areas where that organism is
prevalent
Ophthalmology by Kiros 2/1/2014

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
Asymptomatic infants whose mothers have
untreated gonococcal infection are at high risk
for acquiring infection.
should receive systemic
treatment with a single dose of
ceftriaxon (25 to 50 mg/kg, up to a
total dose of 125 mg, IV or IM) in
addition to topical prophylaxis

Ophthalmology by Kiros
2/1/2014

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


A single instillation of povidoneiodine 2.5%
solution is effective against the common
pathogens
diagnosis and treatment of chlamydial
infections in pregnant women is the best
method for preventing chlamydial disease.
Infants born to mothers known to have
untreated chlamydial infection are at high risk
for infection; however, prophylactic
antimicrobial treatment is not indicated
Ophthalmology
Kiros 2/1/2014
because the efficacy is notbyknown

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
Complications include
Ὕ corneal ulceration and perforation,
Ὕ iridocyclitis,
Ὕ anterior synechiae, and
Ὕ rarely panophthal-mitis
Ὕ blindness, and death
Ophthalmology by Kiros
2/1/2014

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

If bacterial conjunctivitis is left untreated,
corneal involvement can occur and is
characterized by punctate corneal epithelial
erosions.
In the case of disease with N. gonorrhoeae,
large, punctate, superficial lesions may be
seen, which coalesce and progress to corneal
perforation thus Gonococcal conjunctivitis
should be considered a medical emergency
Ophthalmology by Kiros
2/1/2014

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
When staphylococcal conjunctivitis is
complicated by corneal involvement, the lower
portion of the cornea is infected more
frequently than the upper half, and marginal
corneal infiltrates with peripheral
vascularization can be seen
Ophthalmology by Kiros
2/1/2014

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

Untreated chlamydial conjunctivitis, especially
when associated with nasopharyngeal
colonization, can progress to pneumonia in
some infants.
Even without invasive eye disease, systemic
complications such as bacteremia and
meningitis often develop in infants with P.
aeruginosa conjunctivitis.
Ophthalmology by Kiros
2/1/2014

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
Reference
Jack j kaniski and brad bowling, clinical
ophthalmology 7th edition
Up to date 19.3 verison
Nelson textbook of pediatrics 19th edition
Fanaroff and martins neonatal- perinatal
medicine 8th edition
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2/1/2014

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Ophthalmology by Kiros
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