OPHTHALMIA NEONATORUM

• Inflammation of the conjunctiva in the first 28 days of life.
• Also known as Neonatal Conjunctivitis.

TYPES:

Aseptic – 

• Chemical conjunctivitis mostly
• Silver nitrate – prophylaxis  of infectious conjunctivitisNot as common anymore because of the use of erythromycin ointment
• Crede’s method of prophylaxis

Septic-

• Bacterial, chlamydial (the most common cause), and viral infections are major causes  
• Acquired by passage through birth canal

ETIOLOGY:

Chemical or Microbial

• Silver nitrate: surface-active chemical, facilitating agglutinate gonococci and inactivating them., toxic to the conjunctiva, potentially causing a sterile neonatal conjunctivitis.

Microbial

Chlamydia trachomatis

• Most common infectious cause
• 4-10% pregnant women infected
• Infants whose mothers have untreated chlamydial infections antepartum have a 30% to 40% chance of developing chlamydial neonatal conjunctivitis postpartum.
• Reservoir- maternal cervix or urethra

Neisseria gonorrhea

• Ability to penetrate intact epithelial cells, and once inside the cell, they divide rapidly.
• Most dangerous and virulent infectious cause

Other bacteria

• Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, and Staphylococcus epidermidis.
• Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, and Proteus, Enterobacter, and Pseudomonas species
• Herpes simplex can cause neonatal keratoconjunctivitis

 CLINICAL FEATURES: 

• Main findings are erythema, chemosis & purulent eye discharge
• Incubation PeriodChemical Conjunctivitis:mild, transient tearing
  • Chemical conjunctivitis (silver nitrate)- 1st day of life- disappear spontaneously in 2-4 days
  • Gonococcal- 3-5 days or later
  • Chlamydial- 5-14 days
  • Other bacteria- longer
  • Herpetic- within 2wks 

Gonococcal: Bilateral purulent conjunctivitis – classical (75%), 

• More severe (hyperacute conjunctivitis)
• Chemosis and ulceration – perforation of cornea and endophthalmitis (inflmn. of ocular cavity & adj. structures)
• Rhinitis, stomatitis, arthritis, meningitis, anorectal infection, septicemia…
• Conjunctival membrane plus blindness

Chlamydial

• From Mild hyperemia with scant mucoid discharge
• Eyelid swelling, chemosis and pseudo membrane formation
• unilateral or bilateral watery discharge
• Blindness-rare and slower to develop-b/s of eyelid scarring and pannus (non suppurating inflamed lymph gland)
• Pneumonitis, pharyngeal and rectal colonization

Other Bacteria

• Similar findings like edema of eye lids, chemosis and eye discharge.
• Pseudomonas is rare but can cause accelerated corneal ulceration and perforation; if left untreated endophthalmitis and death can occur.

Herpes simplex-

• Keratoconjunctivitis, generalized herpes simplex, encephalitis (low immunity)
• Nonspecific lid edema, moderate conjunctival congestion
• Non-purulent, unilateral or bilateral discharge
• Geographic ulcers around the skin of the eye are typical

DIAGNOSIS:

• Gram stain/ Geimsa stain of conjunctival scrapings (rule out Chlamydia…intracellular inclusion bodies)
• Culture (Thayer-Martin/ chocolate/ blood Agar)
• Direct immunofluorescent antibody
• HSV culture if vesicles are present 

TREATMENT:

• Prophylaxis Medical treatment:Systemic treatment of erythromycin, gentamycin and bacitracin are used for the treatment
  • Antenatal – thorough care of mother and treatment of genital infections when suspected.
  • Cesarean Delivery
  • Natal – Topical 0.5% silver nitrate, 1% tetracycline for gonococcal infection

• Treatment prior to laboratory results
  • Topical erythromycin ointment and
  • IV or IM third-generation cephalosporin (ceftriaxone 30-50mg/kg/d IV or IM. Max 125mg)
•  Chemical Conjunctivitis
  • Eye is regularly flushed and the eyelids cleaned – symptoms disappear within 1 to 2 days