CLINICAL MANAGEMENT GUIDELINES

Ophthalmia neonatorum
Aetiology

Ophthalmia Neonatorum (ON) (conjunctivitis of the newborn) occurs

within the first 30 days of life. It may be infective or non-infective
Infective
Bacterial, chlamydial or viral infection acquired during passage through
an infected birth canal
Historically, the commonest agent was Neisseria gonorrhoeae
(gonococcus) and the use of silver nitrate drops as prophylaxis was
introduced in the C19, although abandoned in the UK in the 1950s.
Nowadays the usual agent is Chlamydia trachomatis. The prevalence of
ON differs in different parts of the world and is dependent mainly upon
socioeconomic conditions, level of knowledge about general health,
standard of maternal healthcare as well as the type of prophylactic
programme used. In the UK, the incidence in 2003 was as follows:
C. trachomatis: 6.9 per 100,000 live births
N. gonorrhoeae: 3.7 per 100,000 live births
In developing countries, very much higher incidences have been
reported
Other bacteria that can cause ON include Haemophilus, Streptococcus,
Staphylococcus and Pseudomonas species. ON can also complicate
generalised neonatal Herpes simplex infection
The neonatal conjunctiva is particularly vulnerable to infection because
of the lack of immunity and the absence of local lymphoid tissue at birth
The incubation period is usually as follows:
C. trachomatis: 5-14 days
N. gonorrhoeae: 3-5 days

Predisposing factors

Symptoms

Signs

Opthalmia neonatorum
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Non-infective
Usually chemical conjunctivitis, induced by agents used for prophylaxis
Infection of the maternal birth canal as the result of sexually-transmitted
disease
This infection may be asymptomatic, especially in the case of C.
trachomatis
Symptoms (usually described by mother):
Redness
Discharge (may be profuse in gonococcal infection)
Swelling of lids (may be severe)
Symptoms usually bilateral
Lids
Oedema (may impede examination of ocular surfaces)
Conjunctival features
Mucopurulent conjunctivitis discharge may be profuse in C.
trachomatis infection. Danger of infection of clinician when
prising open lids
NB: in neonatal C. trachomatis infection there are no follicles as
in adults, because of the neonates lack of lymphoid tissue
Conjunctival oedema (chemosis)
Conjunctival membrane in severe cases
Corneal features
Cornea can be involved, especially in N. gonorrhoeae infection.
This organism can pass through intact corneal epithelium.
Perforation may result
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CLINICAL MANAGEMENT GUIDELINES

Ophthalmia neonatorum
Differential diagnosis

Signs usually bilateral; may be asymmetrical

By definition, conjunctivitis occurring within the first 30 days of life
is ON
Congenital obstruction of the nasolacrimal duct(s) is often
associated with epiphora, discharge and recurrent conjunctivitis
(see Clinical Management Guideline on Nasolacrimal Duct
Obstruction)

Management by Optometrist
Practitioners should recognise their limitations and where necessary seek further advice or refer
the patient elsewhere
Non pharmacological
None
Pharmacological
None
Management Category A1: emergency (same day) referral to Ophthalmologist; no intervention
ON may result in a severe and progressive conjunctivitis with corneal
complications and be associated with potentially serious systemic
infection
Possible management by Ophthalmologist
Diagnosis
Conjunctival cultures for bacteria (N. gonorrhoeae requires
special media)
Conjunctival scraping for Gram stain (bacteria) and Giemsa stain
(for C. trachomatis)
Polymerase chain reaction (PCR) studies
Treatment
Bacterial conjunctivitis
Systemic penicillin G or a cephalosporin for N. gonorrhoeae
Topical erythromycin sometimes given in addition
Other topical antibiotics, including azithromycin
Frequent irrigation until discharge ceases
Chlamydial conjunctivitis
Systemic erythromycin
Topical azithromycin
Herpetic conjunctivitis
Systemic aciclovir
Evidence base
Darling EK, McDonald H
A meta-analysis of the efficacy of ocular prophylactic agents used for the
prevention of gonococcal and chlamydial ophthalmia neonatorum
J Midwifery Womens Health 2010;55:319-27
Authors conclusions: Failure rates of universal eye prophylaxis support
reexamination of this policy where the prevalence of maternal infection is
low. (North American practice)
(The Oxford 2011 Levels of Evidence = 1)

Opthalmia neonatorum
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