This is acute bacterial infection of the eyes that affect newborn baby during the first 28days of life. The infection is acquired from mother’s birth canal secretions. It is characterized by inflammation of the conjunctivae, sticky eyes to abundant purulent discharge and eyelids oedema. Causative organisms are Neisseria Gonorrhea, Chlamydia spp and Staphylococcus spp.
Clinical presentation
- Patients present with massive edema and redness of eyelids and with purulent and copious discharge from the eyes, clinical presentation ranges from mild (small amount of sticky exudates) to severe form (profuse pus and swollen eye lids) depending on the causative organism
- There is usually rapid ulceration and perforation of corneal which eventually leads to blindness if treatment is delayed
- It usually presents 3–4days of life
- Late and mild presentation is due to Staphylococcus or undefined
- Treat parents of a neonate with purulent discharge appropriately
Investigations
- Pus swab for Gram Stain
- Pus for Culture and sensitivity
- Vaginal swab for Gram stain and culture and sensitivity
Non-pharmacological Treatment
Cleanse or wipe eyes of all newborn babies with a clean cloth, cotton wool or swab, taking care not to touch or injure the eye
Pharmacological Treatment
Screen women in the antenatal clinics and treat both parents for Sexually Transmitted Diseases. In Ophthalmia neonatorum, prevention is better than cure.
A: Apply chloramphenicol 1% eye ointment, both eyes, to all newborn babies as soon as possible after birth
OR
A: povidone iodine 2.5% Eye Drops, both eyes
Sticky eye(s) without purulent discharge:
A: chloramphenicol 1% eye ointment, apply 6hourly for 7days
Purulent discharge
Mild discharge without swollen eyelids and no corneal haziness:
A: compound sodium lactate eye wash, immediately then 2–3hourly until discharge clears
AND
B: ceftriaxone (IM) 50mg/kg immediately stat
Given at District Hospital (Treatment to be initiated by Clinical Eye Care Professional eg. Assistant Medical Officer in Ophthalmology)
Abundant purulent discharge and/or swollen eyelids and /or corneal haziness:
A: compound sodium lactate eye wash, immediately then hourly until referral
AND
B: ceftriaxone (IM) 50mg/kg immediately stat
Referral: To high level health facilities for proper management.
Note:
- Ceftriaxone should not be used in neonates that are seriously ill or are jaundiced
- Ceftriaxone should not be administered if calcium containing intravenous infusion e.g Compound Sodium Lactate is given or is expected to be given
Treat both parents of newborns who develop purulent conjunctivitis after 24 hours of birth for N- gonorrhea and Chlamydia with
B: ceftriaxone (IM) 250mg stat
(For ceftriaxone IM injection: Dissolve Ceftriaxone 250mg in 0.9 mL Lidocaine 1% without adrenaline)
AND
B: azithromycin (PO) 1g stat
Note: For more details on prevention and treatment see the “Neonatal Conjunctivitis (NC) Flow Chart Number 12.8" under the Sexual Transmitted disease chapter
Referral: Urgently
- Neonates with abundant purulent discharge and/or swollen eyelids and/or corneal haziness
- Neonates unresponsive to treatment within 2days.