OPHTHALMIA NEONATORUM

Ophthalmia neonatorum is the name given to bilateral
inflammation of the conjunctiva occurring in an infant,
less than 30 days old. It is a preventable disease
usually occurring as a result of carelessness at the
time of birth. As a matter of fact any discharge or
even watering from the eyes in the first week of life
should arouse suspicion of ophthalmia neonatorum,
as tears are not formed till then.
Etiology
Source and mode of infection
Infection may occur in three ways: before birth, during
birth or after birth.
1. Before birth infection is very rare through infected
liquor amnii in mothers with ruptured membrances.

2. During birth. It is the most common mode of
infection from the infected birth canal especially
when the child is born with face presentation or
with forceps.
3. After birth. Infection may occur during first bath
of newborn or from soiled clothes or fingers with
infected lochia.
Causative agents
1. Chemical conjunctivitis It is caused by silver
nitrate or antibiotics used for prophylaxis.
2. Gonococcal infection was considered a serious
disease in the past, as it used to be responsible
for 50 per cent of blindness in children. But,
recently the decline in the incidence of gonorrhoea
as well as effective methods of prophylaxis and
treatment have almost eliminated it in developed
countries. However, in many developing countries
it still continues to be a problem.
3. Other bacterial infections, responsible for
ophthalmia neonatorum are Staphylococcus
aureus, Streptococcus haemolyticus, and
Streptococcus pneumoniae.
4. Neonatal inclusion conjunctivitis caused by
serotypes D to K of Chlamydia trachomatis is
the commonest cause of ophthalmia neonatorum
in developed countries.
5. Herpes simplex ophthalmia neonatorum is a rare
condition caused by herpes simplex-II virus.
Clinical features
Incubation period
It varies depending on the type of the causative agent
as shown below:
Causative agent Incubation period
1. Chemical 4-6 hours
2. Gonococcal 2-4 days
3. Other bacterial 4-5 days
4. Neonatal inclusion
conjunctivitis 5-14 days
5. Herpes simplex 5-7 days
Symptoms and signs (Fig. 4.19)
1. Pain and tenderness in the eyeball.
2. Conjunctival discharge. It is purulent in
gonococcal ophthalmia neonatorum and mucoid
or mucopurulent in other bacterial cases and
neonatal inclusion conjunctivitis.
3. Lids are usually swollen.
4. Conjunctiva may show hyperaemia and chemosis.
There might be mild papillary response in neonatal
inclusion conjunctivitis and herpes simplex
ophthalmia neonatorum.
5. Corneal involvement, though rare, may occur in
the form of superficial punctate keratitis especially
in herpes simplex ophthalmia neonatorum.
Complications
Untreated cases, especially of gonococcal ophthalmia
neonatorum, may develop corneal ulceration, which
may perforate rapidly resulting in corneal
opacification or staphyloma formation.
Treatment
Prophylactic treatment is always better than curative.
A. Prophylaxis needs antenatal, natal and postnatal
care.
1. Antenatal measures include thorough care of
mother and treatment of genital infections when
suspected.
2. Natal measures are of utmost importance, as
mostly infection occurs during childbirth.
Deliveries should be conducted under hygienic
conditions taking all aseptic measures.
The newborn baby's closed lids should be
thoroughly cleansed and dried.
3. Postnatal measures include :
Use of either 1 percent tetracycline ointment
or 0.5 percent erythromycin ointment or 1
percent silver nitrate solution (Crede's method)
into the eyes of the babies immediately after
birth.
Single injection of ceftriaxone 50 mg/kg IM or
IV (not to exceed 125 mg) should be given to

infants born to mothers with untreated
gonococcal infection.
B. Curative treatment. As a rule, conjunctival
cytology samples and culture sensitivity swabs
should be taken before starting the treatment.
1. Chemical ophthalmia neonatorum is a self-limiting
condition, and does not require any treatment.
2. Gonococcal ophthalmia neonatorum needs
prompt treatment to prevent complications.
i. Topical therapy should include :
Saline lavage hourly till the discharge is
eliminated.
Bacitracin eye ointment 4 times/day. Because
of resistant strains topical penicillin therapy is
not reliable. However in cases with proved
penicillin susceptibility, penicillin drops 5000
to 10000 units per ml should be instilled every
minute for half an hour, every five minutes for
next half an hour and then half hourly till the
infection is controlled.
If cornea is involved then atropine sulphate
ointment should be applied.
ii. Systemic therapy. Neonates with gonococcal
ophthalmia should be treated for 7 days with one
of the following regimes:
Ceftriaxone 75-100 mg/kg/day IV or IM, QID.
Cefotaxime 100-150 mg/kg/day IV or IM, 12
hourly.
Ciprofloxacin 10-20 mg/kg/day or Norfloxacin
10 mg/kg/day.
If the gonococcal isolate is proved to be
susceptible to penicillin, crystalline benzyl
penicillin G 50,000 units to full term, normal
weight babies and 20,000 units to premature or
low weight babies should be given
intramuscularly twice daily for 3 days.
3. Other bacterial ophthalmia neonatorum should
be treated by broad spectrum antibiotic drops and
ointments for 2 weeks.
4. Neonatal inclusion conjunctivitis responds well
to topical tetracycline 1 per cent or erythromycin 0.5
per cent eye ointment QID for 3 weeks. However,
systemic erythromycin (125 mg orally, QID for 3 weeks
should also be given since the presence of chlamydia
agents in the conjunctiva implies colonization of
upper respiratory tract as well. Both parents should
also be treated with systemic erythromycin.
5. Herpes simplex conjunctivitis is usually a selflimiting
disease. However, topical antiviral drugs
control the infection more effectively and may prevent
the recurrence.