Ophthalmia neonatorum (Neonatal conjunctivitis)

Notes

## Basic introduction

  • Ophthalmia neonatorum (ON) is defined as conjunctivitis occurring in the first 28 days of life as a result of chemical irritants and mostly infections
  • The bacterial infections that are mostly associated with ON are Chlamydia trachomatis, Neisseria gonorrhoeae, Staphylococcus aureus and Streptococcus pneumoniae
  • Herpes simplex virus (HSV) is associated with few cases of ON

## Statistics

  • Global prevalence: 1.6% to 12% of all newborns
  • Prevalence of ON in Kenya due to chlamydia is 28.7% and that due to gonorrhea is 20.2%.
Symptoms
  • Purulent, mucoid or mucopurulent discharge
  • Swollen eyelids
  • Pain in the eyeball
  • Tenderness in the eyeball
  • Corneal ulcer, mainly due to HSV
  • Edema (swelling) of the conjunctiva (chemosis)
  • Red eye (hyperemia)
  • Blindness
Diagnosis
  • Clinical review
  • Swab, culture, and sensitivity
Differential
  • Fungal keratitis
  • Herpes simplex keratitis
  • Obstruction nasolacrimal duct
  • Orbital and preseptal cellulitis
  • Primary and secondary congenital glaucoma
Prevention
  • Screening and treatment of STDs in the mother
  • Tetracycline eye ointment 1% TID OR 5% erythromycin ointment to all newborns
Reference
  • Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf
  • Matejcek, A; Goldman, RD (November 2013). "Treatment and prevention of ophthalmia neonatorum.” Canadian Family Physician. 59 (11): 1187–90.
  • Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf
  • Wagner RS, Aquino M. Pediatric ocular inflammation. Immunol Allergy Clin North Am 2008;28 (1):169-88
Management
  • Tetracycline eye ointment 1% TID OR
  • Gentamycin eye drops 2 hourly OR
  • IM Gentamycin 5mg/kg STAT OR
  • IM Kanamycin 25mg STAT OR
  • 5% erythromycin ointment OR
  • 1% silver nitrate solution (old Crede's method)
  • IM or IV ceftriaxone  STAT given to infants born to mothers with untreated gonococcal infection.
  • Herpes simplex virus infection is self-limiting
Drug Index 2.0 is here
Our new update features a more powerful search feature and easier login. Having any issues? Contact us today. Contact Us