Ophthalmia Neonatorum Ophthalmia neonatorum in its broad sense refers to any infection of the newborn conjunctiva.

In its narrow and commonly used sense, however, it refers to a conjunctival infection, chiefly gonococcal, that follows contamination of the baby's eyes during its passage through the mother's cervix and vagina or during the postpartum period. Because gonococcal conjunctivitis can rapidly cause blindness, the cause of all cases of ophthalmia neonatorum should be verified by examination of smears of exudate, epithelial scrapings, cultures, and rapid tests for gonococci. Gonococcal neonatal conjunctivitis causes corneal ulceration and blindness if not treated immediately. Chlamydial neonatal conjunctivitis (inclusion blennorrhea) is less destructive but can last months if untreated and may be followed by pneumonia. Other causes include infections with staphylococci, pneumococci, haemophilus, and herpes simplex virus and silver nitrate prophylaxis. The time of onset is important but not entirely reliable in clinical diagnosis since the two principal types, gonorrheal ophthalmia and inclusion blennorrhea, have widely differing incubation periods: gonococcal disease 23 days and chlamydial disease 512 days. The third important birth-canal infection (HSV-2 keratoconjunctivitis) has a 2- to 3-day incubation period and is potentially quite serious because of the possibility of systemic dissemination. Treatment for neonatal gonococcal conjunctivitis is with ceftriaxone, 125 mg as a single intramuscular dose; a second choice is kanamycin, 75 mg intramuscularly. To treat chlamydial conjunctivitis in newborns, erythromycin oral suspension is effective at a dosage of 50 mg/kg/d in four divided doses for 2 weeks. In both gonococcal and chlamydial conjunctivitis, the parents need to be treated. Herpes simplex keratoconjunctivitis is treated with acyclovir, 30 mg/kg/d in three divided doses for 14 days. Neonatal disease from HSV requires hospitalization because of the potential neurologic or systemic manifestations. Other types of neonatal conjunctivitis are treated with erythromycin, gentamicin, or tobramycin ophthalmic ointment four times daily. Cred 1% silver nitrate prophylaxis is effective for the prevention of gonorrheal ophthalmia but not inclusion blennorrhea or herpetic infection. The slight chemical conjunctivitis induced by silver nitrate is minor and of short duration. Accidents with concentrated solutions can be avoided by using wax ampules specially prepared for Cred prophylaxis. Tetracycline and erythromycin ointment are effective substitutes. Treatment About 60% of cases resolve within 5 days without treatment. 1 Topical antibiotics (q.i.d. for up to 1 week) are frequently administered to speed recovery and prevent re-infection and transmission. There is no evidence that any particular antibiotic is more effective. Ointments and gels provide a higher concentration for longer periods than drops but daytime use is limited because of blurred vision. The following antibiotics are available: Chloramphenicol, aminoglycosides (gentamicin and neomycin), quinolones (ciprofloxacin, ofloxacin, levofloxacin, lomefloxacin, gatifloxacin and moxifloxacin),

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polymyxin B, fusidic acid and bacitracin. Some practitioners believe that chloramphenicol should not be used for routine treatment because of a possible link with aplastic anaemia. Gonococcal and meningococcal conjunctivitis should be treated with a quinolone, gentamicin, chloramphenicol or bacitracin 12 hourly as well as systemic therapy (see below). Systemic antibiotics are required in the following circumstances: a Gonococcal infection is usually treated with a third-generation cephalosporin such as ceftriaxone; quinolones and some macrolides are alternatives. It is advisable to seek advice from a microbiologist and/or genitourinary specialist. b H. influenzae infection, particularly in children, is treated with oral amoxicillin with clavulanic acid because there is a 25% risk of developing otitis and other systemic problems. c Meningococcal conjunctivitis, also particularly in children, in whom early systemic prophylaxis may be life-saving as up to 30% develop invasive systemic disease. The advice of paediatric and infectious disease specialists should be sought but if in doubt treatment with intramuscular benzylpenicillin, ceftriaxone or cefotaxime, or oral ciprofloxacin should not be delayed. d Preseptal or orbital cellulitis (see Ch. 3). Topical steroids may reduce scarring in membranous and pseudomembranous conjunctivitis, although evidence for their use is unclear. Irrigation to remove excessive discharge may be useful in hyperpurulent cases. Contact lens wear should be discontinued until at least 48 hours after complete resolution of symptoms. Contact lenses should not be worn whilst topical antibiotic treatment continues. Risk of transmission should be reduced by hand-washing and avoiding sharing towels. Review is unnecessary for most mild/moderate adult cases, although patients should be cautioned to seek further advice in the event of deterioration. Statutory notification of public health authorities may be required locally in some cases.