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: Chlamydia: 6.9 per 100,000 live births Gonococcus: 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: Chlamydia: 5-14 days Gonococcus: 3-5 days 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 gonococcal infection. Danger of infection of clinician when prising open lids NB in 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 gonococcal infection. Organism can pass through intact epithelium Signs usually bilateral; may be asymmetrical By definition, conjunctivitis occurring within the first 30 days of life is ON
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Opthalmia neonatorum Version 7 01.06.11

CLINICAL MANAGEMENT GUIDELINES

Ophthalmia neonatorum
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: urgent 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 chlamydia) Polymerase chain reaction (PCR) studies Treatment Bacterial conjunctivitis Systemic penicillin G or a cephalosporin for N. gonorrhoeae Topical erythromycin sometimes given in addition Frequent irrigation until discharge ceases Topical antibiotics for other bacteria Chlamydial conjunctivitis Systemic erythromycin 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 (North American practice) where the prevalence of maternal infection is low. (The Oxford 2011 Levels of Evidence = 1)

Opthalmia neonatorum Version 7 01.06.11

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