Ophthalmia neonatorum

INTRODUCTION:
  • Inflammation of the conjunctiva in the first 28 days of life.
  • Also known as Neonatal Conjunctivitis.
TYPES:
  • Aseptic – 
  1. Chemical conjunctivitis mostly
  2. Silver nitrate - prophylaxis of infectious conjunctivitis
  3. Crede’s method of prophylaxis
  4. Not as common anymore because of the use of erythromycin ointment
  • 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
  1. Chlamydia trachomatis
  2. Most common infectious cause
  3. 4-10% pregnant women infected
  4. Infants whose mothers have untreated chlamydial infections antepartum have a 30% to 40% chance of developing chlamydial neonatal conjunctivitis postpartum.
  5. Reservoir- maternal cervix or urethra
  • Neisseria gonorrhea
  1. Ability to penetrate intact epithelial cells, and once inside the cell, they divide rapidly.
  2. Most dangerous and virulent infectious cause
  • Other bacteria
  1. Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, and Staphylococcus epidermidis.
  2. 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 Period
  • Chemical conjunctivitis (silver nitrate)- 1st day of life- disappear spontaneously in 2-4 days
  1. Gonococcal- 3-5 days or later
  2. Chlamydial- 5-14 days
  3. Other bacteria- longer
  4. Herpetic- within 2wks 
  • Chemical Conjunctivitis:mild, transient tearing
  • Gonococcal: Bilateral purulent conjunctivitis – classical (75%),
  1. More severe (hyperacute conjunctivitis)
  2. Chemosis and ulceration - perforation of cornea and endophthalmitis (inflmn. of ocular cavity & adj. structures)
  3. Rhinitis, stomatitis, arthritis, meningitis, anorectal infection, septicemia…
  4. Conjunctival membrane plus blindness
  • Chlamydial
  1. From Mild hyperemia with scant mucoid discharge
  2. Eyelid swelling, chemosis and pseudo membrane formation
  3. unilateral or bilateral watery discharge
  4. Blindness-rare and slower to develop-b/s of eyelid scarring and pannus (non suppurating inflamed lymph gland)
  5. Pneumonitis, pharyngeal and rectal colonization
  • Other Bacteria
  1. Similar findings like edema of eye lids, chemosis and eye discharge.
  2. Pseudomonas is rare but can cause accelerated corneal ulceration and perforation; if left untreated endophthalmitis and death can occur.
  • Herpes simplex-
  1. Keratoconjunctivitis, generalized herpes simplex, encephalitis (low immunity)
  2. Nonspecific lid edema, moderate conjunctival congestion
  3. Non-purulent, unilateral or bilateral discharge
  4. 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
  • 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
  • Medical treatment:Systemic treatment of erythromycin, gentamycin and bacitracin are used for the treatment
  • 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
Exam Question
  • Ophthalmia neonatorum is a common causes of childhood blindness
  • Systemic treatment of erythromycin, gentamycin and bacitracin are used for the treatment
  • N gonorrhoeae is the likely organism causing ophthalmia neonatorum on the 3rd day of birth
  • Chlamydial infection is causative organism of Ophthalmia neonatorum
  • Ophthalmia neonatorum is most commonly caused by Chlamydia trachomatis, Neisseria gonorrhea 
  • Ophthalmia neonatorum is Inflammation of the conjunctiva occurring in an infant less than 30 days old
  • Herpes Simplex Virus II is responsible for causing ophthalmia neonatorum on 5-7th day after birth
Don't Forget to Solve all the previous Year Question asked on Ophthalmia neonatorum