Neonatal conjunctivitis ( Ophthalmia neonatorum )
Ophthalmia neonatorum ( neonatal conjunctivitis ) is conjunctivitis of the newborn occurring within the first 28 days of life
Gonococcal ( < 1 % cases ) incubation 2-5 days ( presents early usually 1st 24 hrs ) transmission is vaginal ( acquired during passage through an infected birth canal ) or from finger contamination after birth ( occasional intra-uterine ) presentation can be with hyperacute conjunctival injection & chemosis , lid oedema and sever purulent discharge maternal h/o STI’s , high risk behaviour , concurrent suspected infectious respiratory illness complications include corneal ulceration and perforation ( rarely can cause disseminated infection as meningitis , pneumonia , septicaemia )
Chlamydia trachomatis incubation period is 5-14 days most common cause of STI related conjunctivitis , usually presents 7-14 days after delivery but may present up to 28 days after birth usually develops in one eye but affects the other eye after 2-7 days discharge can be watery followed with purulent and bloody discharge systemic complications include rhinitis , otitis , chlamydial pneumonitis cornea is rarely affected
Other bacteria as Gr +ve organisms as Streptococcus aureus , S. Pneumoniae , Beta hemolytic streptococci , beta hemolytic streptococci , Gr -ve as H influenza , Moraxella catarrhalis , E coli , Pseudomonas species , Klebsiella pneumoniae
Viruses – Herpes simplex ( can be associated with potential severe outcome as keratitis & rarely encephalitis ) admit if suspected , Adenovirus
Blocked naso-lacrimal ducts , shampoo , detergents etc
Differentials – foreign body , orbital or preseptal cellulitis , entropion , trichiasis , eye trauma ( for e,g corneal abrasion following delivery ) , dacryocystitis , keratitis , S/C haemorrhage , congenital anomalies of the nasolacrimal system , corneal epithelial disease , congenital glaucoma , neonatal abstinence.
mucoid or mucopurulent discharge U/L or B/L purulent discharge indicates bacterial infection whereas a watery discharge can suggest viral etiology pseudomonas has greenish discharge conjunctival congestion eyelid stuck together oedema / erythema of the eyelid
check red reflex look for any features suggestive of ulceration corneal or conjunctival other signs of respiratory or any systemic infection.
cleaning ( for e,g with 0.9 % saline / sterile water regularly ) topical chloramphenicol 0.5 % drops is 1st line ( 5-7 day course ) safe to use- advice to continue Rx for 5 days after or 48 hrs after the symptoms have settled frequency based on severity of infection fusidic acid 1 % eye drops 2nd line severe neonatal conjunctivitis ( consider urgent referral to secondary care )
No investigation in mild cases Severe / established / treatment failure ○ swab for MC&S ○ Gen Probe Aptima swab if chlamydial or gonococcal infection is suspected ( urgent ) Copan swab for bacterial conjunctivitis.
PATIENT INFORMATION
RCPCH Conjunctivitis in children – https://abbhealthiertogether.cymru.nhs.uk/professionals/nhs-111-clinicians/clinical-pathways/conjunctivitis-children-advice-sheet
Babies with blocked tear duct – information from University Hospital Dorset https://www.uhd.nhs.uk/uploads/about/docs/our_publications/patient_information_leaflets/Eye_Department/Babies_with_blocked_tear_ducts_009-21.pdf
REFERENCES
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Eye infections in the neonate: Ophthalmia Neonatorum and the management of systemic Gonococcal and Chlamydial infections NHSGGC Paediatric for Health Professionals https://www.clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/neonatology/eye-infections-in-the-neonate-ophthalmia-neonatorum-and-the-management-of-systemic-gonococcal-and-chlamydial-infections/
- Conjunctivitis Neonatal (Ophthalmia Neonatorum) – Guideline for the Management Leeds Teaching Hospital http://www.lhp.leedsth.nhs.uk/detail.aspx?id=1678
- Makker K, Nassar GN, Kaufman EJ. Neonatal Conjunctivitis. [Updated 2021 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441840/
- Sandwell and West Birmingham Hospitals NHS Trust Opthalmia Neonatorum http://bmec.swbh.nhs.uk/wp-content/uploads/2013/03/OPHTHALMIA-NEONATORUM.pdf
