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Ophthalmology for meical students
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Ophthalmology for meical students

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Ophthalmology

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  • 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… 9 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… 10  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… 13 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 16 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 18
  • 19. 19  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
  • 20. 20  Maternal screening -The most effective measure to prevent both gonococcal and chlamydial infections is to diagnose and treat these infections in pregnant women Ophthalmology by Kiros 2/1/2014
  • 21. 21  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
  • 22. 22   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
  • 23. 23    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
  • 24. 24  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
  • 25. 25  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
  • 26. 26    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
  • 27. 27  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
  • 28. 28   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
  • 29. 29  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
  • 30. 30   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
  • 31. 31  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 Ophthalmology by Kiros 2/1/2014
  • 32. 32 Ophthalmology by Kiros 2/1/2014