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A. Epidemiologynavigator

  1. Referred to ophthalmia neonatorum in newborns
  2. Occurs in between 1.6 and 12 % of newborns
  3. Prior to routine prophylaxis, gonorrhea conjunctivitis was a major cause of
    1. Visual impairment
    2. Blindness

B. Etiologynavigator

  1. Chemical
    1. Silver nitrate caused conjunctivitis in 10% of newborns
    2. Erythromycin ointment used currently less irritating
    3. Presents in first days of life
  2. Bacterial
    1. Chlamydia trachomatis
    2. Haemophilus influenza
    3. Streptococcus pneumonia
    4. Staphylococcus aureus (also isolated from healthy eyes)
    5. Rarely gram negatives: Escherichia coli, Klebsiella pneumonia, or Pseudomonas species
    6. Neisseria gonorrhea
  3. Chlamydia
    1. 18% of women in child bearing age infected
    2. Risk of conjunctivitis 20-50% for infants born to infected mothers
    3. Presents from first week to first month of life
    4. Causes moderate hyperemia moderate discharge
    5. Associated with lid edema
  4. Neisseria
    1. Rare cause due to mandated prophylaxis
    2. Onset 3 to 5 days after birth
    3. Prominent mucopurelent discharge
    4. Capacity to invade superficial conjunctiva causing ulcerations
  5. Herpes Simplex Virus (HSV)
    1. Associated with mucocutaneous or disseminated infection
    2. Causes vesicles and corneal ulcerations

C. Pathogenesisnavigator

  1. Conjunctiva inhabited with a normal flora of nonpathogenic bacteria
  2. Neonatal conjunctivitis due to inoculation with virulent organisms during birth
  3. Alternately inoculation can occur with in utero ascending bacterial infection

D. Diagnosisnavigator

  1. Complete eye examination
  2. Gram stain and culture from affected eye
  3. Dacron swab for Chlamydia EIA isolation
  4. Tzank prep shows multinucleated giant cell or by positive serology for HSV

E. Treatmentnavigator

  1. Gonococcal infection treated with cefotaxime for 7 days
  2. Chlamydiae conjunctivitis requires systemic erythromycin
  3. Herpes simplex keratoconjunctivitis requires intravenous ayclovir
  4. Topical ophthalmologic antibiotic ointment for S. aureus infections

References navigator

  1. Simon JW and Kaw P. 2001. Am Fam Phys. 64(4):623 abstract