Neonatal Conjunctivitis (Ophthalmia Neonatorum)

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This is a conjunctival infection of neonates contracted by new-borns during delivery

Causes

  • Neisseria gonorrhoeae or Chlamydia trachomatis
  • Non-STI causes: difficult labour; early rupture of membranes; vacuum extraction or other assisted vaginal delivery; Staphylococcus aureus; viral
  • Conjunctival discharge: purulent, mucoid or mucopurulent, depending on the cause
  • Conjunctivae show hyperaemia and chemosis; eyelids are usually swollen
  • Pain and tenderness in the eyeball

Complications

  • If untreated, may lead to: corneal ulceration, perforation, scaring and blindness

Investigations

  • Pus swab, Gram stain, microscopy, culture & sensitivity

Treatment objectives

  • Eradicate the causative organism
  • Prevent complications

Non-pharmacological treatment

  • Clean eyes with normal saline or sterile water

Pharmacological treatment

Ophthalmia neonatorum

Erythromycin 12.5 mg/kg in 4 divided doses orally, daily for 14 days

 

Prophylaxis

Tetracycline hydrochloride 1% eye ointment

Apply to both eyes immediately after birth

OR

Silver nitrate 1% solution

Apply to both eyes immediately after birth

OR

Chloramphenicol 1% eye ointment

Apply to both eyes immediately after birth

Prevention

  • Screen and treat all infected mothers in antenatal care

Referral

  • Refer neonate to an eye specialist if symptoms worsen