Ophthalmia Neonatorum

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Introduction

  • Infection in both eyes of a newborn baby in the first one month of life, without obstruction of the nasolacrimal ducts

Clinical features

  • Swollen eyelids: It may be impossible to see the baby's eye because of the swelling
  • Red eyes: The conjunctivae are less inflamed in chlamydial infection
  • Pus: Oozes out when the eyelids are opened
  • Fever: May or may not be present

Aetiology

Bacterial:

Especially Neisseria gonorrhoea: starts within 3 days after birth

Chlamydia (usually starts 1 week after birth)

Chemicals

Others

Differential diagnosis

  • Lid oedema following prolonged difficult labour

Complications

  • Corneal perforation
  • Endophthalmitis

Investigation

  • Conjunctival swab for microscopy, culture and sensitivity

Non-drug measures

  • Copious irrigation to wash pus from the eyes with cooled boiled water or sodium chloride 0.9%

Drug treatment

Topical antibiotics

Gentamicin 0.3% eye drops

  • Topical antibiotics
    • Gentamicin 0.3% eye drops: Apply 1 drop at least every 2 hours, and then reduce frequency as infection is controlled

Or:

  • Ofloxacin 3% eye drops: Apply twice daily (not to be used for more than 10 days).
  • Tetracycline 1% eye ointment: Apply 3 times daily for one week or more, depending on the severity of the condition

Plus

-     Ciprofloxacin 10 mg/kg per dose intramuscularly 12 hourly for 2 days

Or:

  • Ceftriaxone:
  • Adults: 100 mg/kg by deep intramuscular injection or intravenous injection over 2 - 4 minutes every 24 hours or by intravenous infusion: 1 g daily, 2 - 4 g in severe infections
  • Child:
  • Neonate: infuse over 60 minutes, 20 - 50 mg/kg daily (maximum 50 mg/kg daily) 

- Child under 50 kg: 20 - 50 mg/kg daily by deep intramuscular injection or by intravenous injection over 2 - 4 minutes, or by intravenous infusion; up to 80 mg/kg daily in severe infections

Notable adverse drug reactions, contraindications and caution

  • Do not use steroids eyedrops
  • Penicillin drops are not effective in the treatment of opthalmia neonatorum

Prevention

  • Apply tetracycline eye ointment or silver nitrate drops in both eyes of neonates immediately after delivery
  • Proper antenatal care for early detection of infection in mothers