Ophthalmia neonatorum (neonatal conjunctivitis)

Ophthalmia neonatorum is defined as a inflamation of conjunctiva along with discharge from one or both eyes in the first month of life.

 Any discharge, even a watery secretion, from the babys eyes during the first week should be viewed with suspicion since tears are not secreted so early in life.

DDx
Congenitally blocked nasolacrimal duct. Acute dacrocystitis. Congenital glaucoma.

Causative Organisms
Bacterial:N.gonorrhoea, Chlamydia, Strep, Staph,etc Viral:HSV-II

Etiology Source and mode of infection

Before birth- through infected liquor amnii in mothers with ruptured membranes. During birth- from the infected birth canal especially when the child is born with face presentation or with forceps. After birth. Chemical cause- Silver nitrate, antibiotics

Symptoms and signs

Pain and tenderness in the eyeball. Conjunctival dischagei)gonococcal- purulent ii)others cases- mucoid Swollen lids. Conjunctiva may show hyperaemia and chemosis. Corneal involvement, superficial punctate keratitis- in HSV

Complications
Corneal ulceration, specially in gonococcal conjunctivitis. Perforation- Clinically manifesting as black spot. Sometimes there is prolapse of iris. Impaired development of central macular fixation resulting in nystagmus for rest of life. A complicating superficial keratitis in case of HSV.

 If left untreated, associated systemic disease such as chlamydial otitis, pneumonia may develop

Time of onset after birth Within the first 48hrs 48-72hrs 5-7 days >1 week

Differential diagnosis

Treatment

Neisseria Ceftriaxone gonorrhoea Chemical Other bacteria Erythromycin Herpes simplex virus Chlamydia trachomatis (D-K) Acyclovir, Vidarabine Erythromycin/ Chlortetracycline

Treatment (Prophylactic)
Antenatal Natal Postnatal Measures:
Use of 1% tetracycline ointment or 0.5% erythromycin ointment* or 1% AgNO3 into the eyes of babies soon after birth. Single injection of Ceftriaxone (IV/IM) not exceeding 125mg should be given to the mother.

 Chemical ophthalmia neonatorum is a self limiting condition and does not require any treatment. Gonococcal Topical therapy: Saline lavage, bacitracin, atropine sulphate ointment if cornea is involved. Systemic- Ceftriaxone 75-100mg/kg/day iv/im QID Cefotaxime 100-150mg/kgday iv/im BD Ciprofloxacin 10-20mg/kg/day

Treatment (Curative)

 Herpes Simplex conjunctivitis is usually self limiting, use of antivirals (Acyclovir/Vidarabine) control the infection more effectively

 Chlamydial can be treated with Erythromycin suspension 50mg/kg daily or by Azithromycin. Local treatment with Chlortetracycline 1% after feeds. In all the above cases both the women and her sexual partner/s must be informed about the disease and approp treatment should be given. *Erythromycin(topical) 1% is the USFDA approved drug for all types of neonatal conjunctivitis(bacterial)

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