Ophthalmia Neonatorum

Ophthalmia neonatorum is an infection or inflammation of the conjunctiva that occurs during the first 4 weeks of life. Possible causes include chemical conjunctivitis, Neisseria gonorrhoeae, and chlamydial infection. The increased incidence of venereal disease and shortcomings in silver nitrate prophylaxis are significant factors in the constantly evolving clinical picture. Ophthalmia neonatorum frequently is a manifestation of a systemic infection, requiring determination of the exact cause in all but the most transient cases. Table 41-3 outlines the management of the various types of ophthalmia neonatorum. At present, erythromycin is the medication of choice. Povidone-iodine ophthalmic solution (0.5%) is less toxic, inexpensive, and effective, but is not generally used because of confusion over povidone solution versus povidone soap.

Silver nitrate has been replaced by erythromycin, so the incidence of chemical conjunctivitis has decreased significantly. Before the neonatal prophylaxis, gonorrhea was a common cause of ophthalmia neonatorum. Half of patients with gonococcal conjunctivitis develop corneal clouding, a major cause of blindness. Gonococcal conjunctivitis still occurs, despite erythromycin prophylaxis. Frequently, the infant with gonococcal conjunctivitis presents with swollen lids, purulent exudates, beefy-red conjunctiva, and conjunctival edema. The gonococcal organism can rapidly penetrate the intact corneal epithelium and produce corneal perforation if recognition and treatment are delayed. When gonococcal conjunctivitis is suspected, referral to an ophthalmologist is critical. Patients may also have systemic involvement, with associated central nervous system (CNS) signs. Both parents should be examined for venereal disease and treated, if necessary.

Table 41-2 Conjunctivitis Clues

Finding

Cause

Purulent discharge

Bacterial

Serous or clear discharge

Viral

Stringy, white discharge

Allergic

Preauricular lymph node enlargement

Viral

Figure 41-2 Corneal abrasion. The patient had a fingernail injury caused by the daughter (left). Characteristic fluorescein staining is displayed in the adjacent photomicrograph (right).

Table 41-3 Management of Ophthalmia Neonatorum

A recommended regimen for ophthalmia neonatorum prophylaxis is a single application of silver nitrate 1% aqueous solution, erythromycin 0.5% ophthalmic ointment, or tetracycline 1% ophthalmic ointment (CDC, 2002b).

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