This document discusses ophthalmia neonatorum, an inflammation of the eyes of an infant less than 30 days old. It is usually caused by carelessness during birth that allows bacteria or viruses to enter the eyes. Common causes include gonorrhea, chlamydia, other bacteria, or viruses like herpes simplex. Symptoms include pain, discharge from the eyes, swelling, and in severe cases it can lead to corneal scarring. Treatment involves topical and oral antibiotics, with systemic treatment being necessary. Proper hygiene during birth can prevent this condition, including cleaning and drying the eyes after delivery.

1. OPHTHALMIA
NEONATORUM
Presenter: Prakash Khanal
INTERN, CMC-TH

2. Introduction
Opthamia Neonatorum is B/L inflammation of the
conjuctivities of an infant less than 30 days old.
It is a Preventable disease occurring usually as a
result of carelessness during the time of birth.
Any discharge or even watering from eyes in first
week of life is suspicious of Opthamia Neonatorum ,
as tears are not formed till then.

3. ETIOLOGY
 Source and mode of Infection
Infection usually occurs mainly in three ways: Before Birth, During Birth , After
Birth.
Before Birth:
- Via infected liquor amnii in mothers with ruptured membrane
During Birth:
- From infected Birth Canal During Vaginal Delivery
After Birth:
- During 1st Bath, or From soiled clothes, fingers with infected lochias.

4. ETIOLOGY cont….
Causative Agents:
-Chemical Cause: Silver Nitrate, Antibiotics used for Prophylaxis
-Gonococcal Infection: has ability to penetrate intact epithelial
cells, once inside the cells,divides rapidly
-Other bacterial infections including Staphylococcus aureus,
Hemophilus species , Streptococcus hemolyticus, Streptococcus
pneumonia, E coli, Klebsiella, Proteus

5. - Chlamydia trachomatis serotype D to K: Most common
infectious cause of Neonatal Inclusion
Conjuctivitis(Chlamydia trachomatis serotype D to K Causes
Neonatal Inclusion Conjuctivitis)
- Herpes simplex Opthalmia neonatorum Caused by Herpes
Simplex virus Usually HSV-II. Can cause Neonatal
keratoconjunctivis

6. Incubation Period
Chemical Cause: 6 hours
Gonococcal Infection: 2 to 5 days
Other bacterial: 5 to 8 days
Chlamydia trachomatis: 5 to 14 days
Herpes simplex Opthalmia neonatorum: 6 to 15 days

7. Clinical Features
- Pain
- Tenderness
- Conjunctival Discharge:
Gonococcal: Purulent Discharge
Chlamydial: Watery/Mucopurulent
Viral: Non-purulent, watery
- Conjunctival Hyperemia & Chemosis

8. Clinical Features conti..
- Conjunctival Papillary Response in HSV, Chlamydial
infection(Follicular response is absent as newborn has
immature lymphoid)
- Cornial Involvement: Usually Rare but may occurs in HSV
which can cause Keratitis, can complicate to Corneal
ulceration & Opacity
- Eyelids: Swelling, Vesicle formation in case of HSV

9. Investigations
 Giemsa Staining: Conjunctival scrappings can be used to rule
out Chlamydial infection(Chlamydia shows inclusion bodies
on Giemsa staining)
 Culture: Thayer Martin Media, Blood agar, Choclate agar
 Direct Immunofluorocent Antibody

11. PROPHYLAXIS
Antenatal: thorough care of mother and treatment of genital
infections when suspected.
Natal:
- Delivery under hygienic condition taking all aseptic
measures, Cesarean mode of delivery
- Closed eyelids of newborn thoroughly cleansed and
dried.

12. Postnatal:
- Use of 1% tetracycline ointment or 0.5% erythromycin
ointment into the eyes of babies immediately after bith to
prevent bacterial and chlamydial ophthalmia neonaturum
- Single injection of Ceftriaxone 50mg/kg IM or IV (not
more than 125 mg) to infants born to mothers with untreated
gonococcal infection

13. TREATMENT
Systemic Treatment is mandatory as topical therapy alone is not
effective though helpful
Acute Neonatal conjunctivitis must be treated as gonococcal
until culture reports are obtained
Until lab reports are available,
- Topical erythromycin ointment and
- IM or IV Ceftriaxone 30 to 50 mg/kg/day (max 125mg) is
given

14. TREATMENT cont….
Chemical Ophthalmia Neonaturum: Usually Self limiting
condition, doesn’t require any treatment, but regular saline wash
can be done, symptoms disappears within 1 to 2 days

15. TREATMENT cont….
 Gonococcal Conjuctivitis:
Topical Broad-spectrum antibiotics, Gentamycin 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 for 7
days)

16. TREATMENT cont….
 Neonatal Inclusion Conjunctivitis(Chlamydial):
Topical Erythromycin Eyedrop 5 times a day
+
Oral Erythromycin 50mg/kg/day in divided QID

17. TREATMENT cont….
 Herpetic Conjunctivitis:
-Acyclovir Eye Ointment
-Systemic Acyclovir 30mg/kg/day IV TID For 14 days upto
21 days in severe cases.

18. THANK YOU