Ophthalmia neonatorum is inflammation of the conjunctiva in newborns, usually caused by bacterial infection acquired during birth. Before modern treatment, it affected 10-15% of newborns and was a major cause of blindness. While silver nitrate drops reduced chemical conjunctivitis, gonorrhea and chlamydia remain common causes. Symptoms include eye redness and discharge. Prompt treatment with topical and systemic antibiotics can cure most cases and prevent complications like corneal scarring and blindness. Proper prenatal care and treatment of maternal infections helps reduce risk.
3. Epidemiology
Before introduction of silver nitrate eye drops in the late 19th
century, approximately 10% to 15% of newborns developed
bacterial conjunctivitis.
Current incidence varies by the availability of obstetric care.
Annual rates of gonococcal and chlamydial conjunctivitis per 1,000 live
births are approximately 0.3 and 5, respectively, in the United States but are
ten times greater in parts of Africa.
4. Epidemiology…
The risk of corneal complications from ophthalmia neonatorum is
higher among the poor.
Between 1,000 and 4,000 infants are blinded each year.
5. Predisposing Factors
Organisms in vagina shed during delivery
Premature rupture of membranes
Long delivery
Few tears and low levels of IgA
Trauma to epithelial barrier
Prophylaxis (silver nitrate)
7. Types…
Aseptic –
Chemical conjunctivitis mostly
Silver nitrate - prophylaxis of infectious
conjunctivitis
- Crede’s method of
prophylaxis
not as common anymore because of the use of erythromycin
ointment
9. Etiology
Chemical or Microbial
Chemical
Silver nitrate
surface-active chemical, facilitating agglutinate gonococci and inactivating them.
toxic to the conjunctiva,
potentially causing a sterile neonatal conjunctivitis.
10. Etiology…
Microbial
Chlamydia trachomatis
the most common infectious cause
4-10% pregnant women infected
Infants whose mothers have untreated chlamydial infections antepartum have a 30% to 40%
chance of developing chlamydial neonatal conjunctivitis postpartum.
reservoir- maternal cervix or urethra
11. Etiology…
Neisseria gonorrhea
have the ability to penetrate intact epithelial cells, and once inside the cell, they divide rapidly.
the most dangerous and virulent infectious cause
must be absolutely excluded in every case
serious consequences
12. Etiology…
Other bacteria
Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, and
Staphylococcus epidermidis.
Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, and Proteus,
Enterobacter, and Pseudomonas species
13. Etiology…
Herpes simplex
can cause neonatal keratoconjunctivitis
rare and is associated most often with a generalized herpes simplex infection
14. Incidence
Gonococcal 40 per 1000LB
Chlamydial 80 per 1000LB
50% has concomitant gonococcal infection
Chemical Conjunctivitis- decreased with substitution of silver
nitrate.
Incidence from other causes is relatively rare.
15. Clinical
Difficult to know cause on clinical ground only
Significant overlap in presentation
Main findings are erythema, chemosis & purulent eye
discharge
Therefore Lab studies are Important
16. Clinical…
Incubation Period
Chemical conjunctivitis (silver nitrate)- 1st day of life- disappear
spontaneously in 2-4 days
Gonococcal- 3-5 days or later
Chlamydial- 5-14 days
Other bacteria- longer
Herpetic- within 2wks
17. Clinical…
Chemical Conjunctivitis
mild, transient tearing
Gonococcal
Bilateral purulent conjunctivitis – classical (75%)
More severe (hyperacute conjunctivitis)
Chemosis and ulceration - perforation of cornea and endophthalmitis (inflmn. of ocular cavity & adj.
structures)
Rhinitis, stomatitis, arthritis, meningitis, anorectal infection, septicemia…
Conjunctival membrane plus blindness
18.
19. Clinical…
Chlamydial
From Mild hyperemia with scant mucoid discharge
Eyelid swelling, chemosis and pseudo membrane formation
unilateral or bilateral watery discharge
which may become more copious and purulent later
Blindness-rare and slower to develop-b/s of eyelid scarring and pannus (non suppurating inflamed
lymph gland)
Pneumonitis, pharyngeal and rectal colonization
20. Clinical…
Other Bacteria
Similar findings like edema of eye lids, chemosis and eye discharge.
Pseudomonas is rare but can cause accelerated corneal ulceration and
perforation; if left untreated endophthalmitis and death can occur.
21. Clinical…
Herpes simplex-
Keratoconjunctivitis, generalized herpes simplex, encephalitis (low immunity)
nonspecific lid edema, moderate conjunctival congestion
Non-purulent, unilateral or bilateral discharge
Geographic ulcers around the skin of the eye are typical
Conjunctival membrane may be there
22. Work Up
Gram stain/ Geimsa stain of conjunctival scrapings (rule out
Chlamydia…intracellular inclusion bodies)
Culture (Thayer-Martin/ chocolate/ blood Agar)
Direct immunofluorescent antibody
HSV culture if vesicles are present
23.
24. Treatment
Prophylaxis
Antenatal - thorough care of mother and treatment of genital infections
when suspected.
Cesarean Delivery
Natal - Topical 0.5% silver nitrate, 1% tetracycline for gonococcal
infection
25. Treatment…
Medical treatment
Systemic treatment is mandatory as topical alone in not effective though
helpful
acute neonatal conjunctivitis should be treated for gonococcal
conjunctivitis until culture results are available
26. Treatment…
Treatment prior to laboratory results
Topical erythromycin ointment and
IV or IM third-generation cephalosporin (ceftriaxone 30-50mg/kg/d IV
or IM. Max 125mg)
28. Treatment…
Gonococcal Conjunctivitis
Topical administration of broad-spectrum antibiotics (gentamicin
eyedrops every hour)
+
Systemic penicillin (penicillin G iv 2 million IU daily)
OR
A single dose of ceftriaxone (75-100 mg/kg/day IV or IM QID for 7
days) is an alternative treatment.
29. Treatment…
Chlamydial Conjunctivitis
Topical erythromycin eyedrops (5x/day)
+
Oral erythromycin (50 mg/kg/d divided QID)
Since the efficacy of systemic erythromycin therapy is approximately 80%,
a second course sometimes is required.