OPHTHALMIA

NEONATORUM
OUTLINE
 Definition
 Route of transmition
 Agents that cause ophthalmia neonatorum
 Clinical features
 Diagnostic modality
 Treatment
 Prophylaxis for ophthalmia neonatorum
 Also known as neonatal conjunctivitis.
 Bilateral inflammation of the conjuctiva occuring in
an infant,less thann 30 days old.
Source of infection

 Before Birth
 Infected liquor amnii in mothers with ruptured membranes(very rare)
 During Birth
 Infected birth canal;especially in face presentation /forces delivery (most
common)
 After Birth
 First bath,fingers with infected lochia
PREDISPOSING FACTORS

 Organisms in vagina shed during delivery

 Premature rupture of membranes
 Few tears and low levels of IgA
 Trauma to epithelial barrier
 Prophylaxis (antibiotics, silver nitrate)
AGENTS THAT CAUSE OPTHALMIA
NEONATORUM
 Bacterial

 Viral

 Chemical
1. Gonococcal Ophtalmia
 Gram- negative, coffee bean-shaped, diplococci, Facultative intracellular bacteria.
 Motile and non capsulated.
 The most dangerous and virulent infectious cause
 Must be absolutely excluded in every case
 Serious consequences including systemic involvement
 Incidence: 40/1000 live births
Clinical Features
 Incubation Period: 3-4 days or longer
 Main findings are erythema, chemosis & yellow-green purulent eye discharge and lid swelling.
 Bilateral purulent conjunctivitis-classical
 More severe (hyperacute conjunctivitis)
 Chemosis and ulceration-perforation of cornea and endophthalmitis

 Rhinitis, stomatitis, arthritis, meningitis, anorectal infection, septicemia…

DIAGNOSIS
 Sample– conjunctival discharge

 Gram stain– Gram negative intra cellular diplococci

 Culture– confirms the diagnosis

-- Differentiates N.Gono from N.Meningitidis
TREATMENT
 Patient Should be admitted and treatment started immediately
* Ceftriaxon 20-50 mg/kg per day for 1 wk

* Crystalline peniciline 62.5mg every 6 hourly for 1 wk

* frequent irrigation of the eye

* Topical antibiotics like Gentamicin – for patients

with corneal ulcer
N.MENEGITIDIS

 Causes ophthalmia neonatorum—less commonly

* patients have similar manifestation like N.Gono

*milder form
CHLAMYDIAL CONJUNCTIVITIS
 One of the most frequent causes of neonatal
conjunctivitis
 Has been estimated to occure in 2-6 % of newborns
 Usually caused by chlamydia trachomatis subtyes D-K
 Characterized by onset of a mild to moderate unilateral or bilateral mucopurulent discharge
 No follicular reaction
 The incubation period for C. trachomatis conjunctivitis is 5 to 14 days after delivery.
-Transmission occurs during delivery

-Onset—1 week
(Earlier in mothers who has PROM)
Clinical Features
 Typical signs:
 Eye lid edema
 Chemosis
 Mucopurulent discharge
 Sometimes cornea is involved including punctate opacities& micropannus formation
 Systemic chlamydial infection may develop in more than 50% of neonates
 pneumonia
Complications

 Pneumonia
 Otitis media
 Rhinitis
 GIT infection.
Diagnosis
 Gram stain/ Geimsa stain of conjunctival scrapings (rule out Chlamydia…intracellular inclusion
bodies)

 Culture (Thayer-Martin/ chocolate/ blood Agar)

 Direct immunofluorescent antibody

Treatment
 Treated with oral erythromycin (50mg/kg/day in divided QID ) for 2 weeks
 Topical erythromycin or tetracycline ointments
 Concurrent therapy of the mother & her sexual partner
Other Bacterial Causes
 relatively rare

 Similar findings like edema of eye lids, chemosis and eye discharge.
 Gram stain/ Geimsa stain of conjunctival scrapings ,Culture (Thayer-Martin/ chocolate/ blood
Agar) Direct immunofluorescent antibody
VIRAL CONJUNCTIVITIS

 Usually caused by HSV

 Infection may be local or disseminated
 Ocular signs develop 5-12 days after birth&include:
 Lid edema
 Conjunctival hyperemia
 Serous discharge
 Occasional lid eruption
*Often associated with corneal involvment
 Most serious complications include:
 Cataract
 Chorioretinitis
 Optic neuritis
DIAGNOSIS

 Direct immunofluorescent antibody

 HSV culture if vesicles are present
 Gram stain
 Treatment

 Acyclovir 3% ointment 4 times a day

 Systemic treatment should be considered in neonates with disseminated
infection
 acyclovir 40-60 mg/kg/day IV TID , for 14 days up 21 days
Chemical conjuncivitis
 Results from prophylactic silver nitrate drops
 It begins some hours after delivery (24 hrs after instillation of the drug)
 Characterized by:
 Mild conjunctival hyperemia
 Watery discharge

 Resolves spontaneously after 24 -36 hours

 No treatment necessary
Prevention

 Antenatal measures:
Treatment of genital infections .
 Natal measures
Aseptic delivery
Newborn's closed eyelids should be thoroughly cleansed and dried.
 Postnatal measures:(Prophylactic drugs)
Reference
 Eye Disease in Hot climate 4th edition,2008
 Pediatric ophtalmology: instant clinical diagnosis in ophtalmology.
 uptodate