Ophthalmia neonatorum

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Compiled by: Dr. Iddi Ndyabawe
OPHTHALMIA NEONATORUM
Ophthalmia neonatorum is the name given to bilateral inflammation of the conjunctiva occurring
in an infant, less than 30 days old.
It is a preventable disease usually occurring as a result of carelessness at the time of birth.
As a matter of fact any discharge or even watering from the eyes in the first week of life should
arouse suspicion of ophthalmia neonatorum, as tears are not formed till then.
Etiology
Source and mode of infection
Infection may occur in three ways: before birth, during birth or after birth.
1. Before birth infection is very rare through infected liquor amnii in mothers with ruptured
membrances.
2. During birth. It is the most common mode of infection from the infected birth canal especially
when the child is born with face presentation or with forceps.
3. After birth. Infection may occur during first bath of newborn or from soiled clothes or fingers
with infected lochia.
Causative agents
1. Chemical conjunctivitis It is caused by silver nitrate or antibiotics used for prophylaxis.
2. Gonococcal infection was considered a serious disease in the past, as it used to be responsible
for 50 per cent of blindness in children. But, recently the decline in the incidence of gonorrhoea
as well as effective methods of prophylaxis and treatment have almost eliminated it in developed
countries. However, in many developing countries it still continues to be a problem.
3. Other bacterial infections, responsible for ophthalmia neonatorum are Staphylococcus
aureus, Streptococcus haemolyticus, and Streptococcus pneumoniae.
4. Neonatal inclusion conjunctivitis caused by serotypes D to K of Chlamydia trachomatis is
the commonest cause of ophthalmia neonatorum in developed countries.
5. Herpes simplex ophthalmia neonatorum is a rare condition caused by herpes simplex-II
virus.

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Clinical features
Incubation period
It varies depending on the type of the causative agent as shown below:
Symptoms and signs
1. Pain and tenderness in the eyeball.
2. Conjunctival discharge. It is purulent in gonococcal ophthalmia neonatorum and mucoid or
mucopurulent in other bacterial cases and neonatal inclusion conjunctivitis.
3. Lids are usually swollen.
4. Conjunctiva may show hyperaemia and chemosis.
There might be mild papillary response in neonatal inclusion conjunctivitis and herpes simplex
ophthalmia neonatorum.
5. Corneal involvement, though rare, may occur in the form of superficial punctate keratitis
especially in herpes simplex ophthalmia neonatorum.
Complications
Untreated cases, especially of gonococcal ophthalmia neonatorum, may develop corneal
ulceration, which may perforate rapidly resulting in corneal opacification or staphyloma
formation.
Treatment
Prophylactic treatment is always better than curative.
A. Prophylaxis needs antenatal, natal and postnatal care.
1. Antenatal measures include thorough care of mother and treatment of genital infections when

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suspected.
2. Natal measures are of utmost importance, as mostly infection occurs during childbirth.
Deliveries should be conducted under hygienic conditions taking all aseptic measures.
The newborn baby's closed lids should be thoroughly cleansed and dried.
3. Postnatal measures include:
Use of either 1 percent tetracycline ointment or 0.5 percent erythromycin ointment or 1
percent silver nitrate solution (Crede's method) into the eyes of the babies immediately after
birth.
Single injection of ceftriaxone 50 mg/kg IM or IV (not to exceed 125 mg) should be given to
infants born to mothers with untreated gonococcal infection.
B. Curative treatment. As a rule, conjunctival cytology samples and culture sensitivity swabs
should be taken before starting the treatment.
1. Chemical ophthalmia neonatorum is a self-limiting condition, and does not require any
treatment.
2. Gonococcal ophthalmia neonatorum needs prompt treatment to prevent complications.
i. Topical therapy should include:
-Saline lavage hourly till the discharge is eliminated.
-Bacitracin eye ointment 4 times/day. Because of resistant strains topical penicillin therapy is not
reliable. However in cases with proved penicillin susceptibility, penicillin drops 5000 to 10000
units per ml should be instilled every minute for half an hour, every five minutes for next half an
hour and then half hourly till the infection is controlled.
If cornea is involved then atropine sulphate ointment should be applied.
ii. Systemic therapy.
Neonates with gonococcal ophthalmia should be treated for 7 days with one of the following
regimes:
-Ceftriaxone 75-100 mg/kg/day IV or IM, QID.
-Cefotaxime 100-150 mg/kg/day IV or IM, 12 hourly.
-Ciprofloxacin 10-20 mg/kg/day or Norfloxacin 10 mg/kg/day.
If the gonococcal isolate is proved to be susceptible to penicillin, crystalline benzyl penicillin G
50,000 units to full term, normal weight babies and 20,000 units to premature or low weight
babies should be given intramuscularly twice daily for 3 days.
3. Other bacterial ophthalmia neonatorum should be treated by broad spectrum antibiotic drops
and ointments for 2 weeks.

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4. Neonatal inclusion conjunctivitis responds well to topical tetracycline 1 per cent or
erythromycin 0.5 per cent eye ointment QID for 3 weeks. However, systemic erythromycin
(125mg orally, QID for 3 weeks should also be given since the presence of chlamydia agents in
the conjunctiva implies colonization of upper respiratory tract as well. Both parents should also
be treated with systemic erythromycin.
5. Herpes simplex conjunctivitis is usually a self-limiting disease. However, topical antiviral
drugs control the infection more effectively and may prevent the recurrence.