GRAND WARD ROUND

03/08/2022
PREMAALOSHINEE THANABAL
Baby Y , 10 days ,male , born via SVD ( 38 weeks and 2 days )
presented with right eye lid swelling since 21/7/2021
associated with yellowish discharge
no eye redness
no fever
no vomiting
feeding as usual

Patient was brought to klinik kesihatan on 21/7/22 , for jaundince

check. Noted patient had two episodes of hypotermia at klinik
kesihatan , hence referred to paeds team to rule out sepsis and to
ophthal team for neonatrum ophthalmia
• ANC:
- 1. PROM <18 H
UFEME(13/7/2022) : NO UTI PICTURE
HVS( 13/7/2022): NO GROWTH
-2.RESOLVED ANEMIA IN PREGNANCY
OCULAR Examination 22/07/2022
RE LE
unable to visual acquity VA unable to do visual acquity
swelling , erythematous , Lid EVERTED LID NO PSM ,
yellowish purulent discharge ++, MINIMAL YELLOWISH
everted minimal DISCHARGE, NOT SWOLLEN
pseudomembrane
Round/Negative Pupil/RAPD Round/Negative
White, no chemosis Conjunctiva WHITE, no chemosis

Clear, no stain uptake Cornea Clear

formed, no obvious hypopyon AC D/Q

Clear LENS Clear,

OD Pink CDR 0.2, Macula Fundus OD Pink CDR 0.2, Macula

normal, Retina flat normal, Retina flat
DIAGNOSIS
BILATERAL EYE NEONATRUM OPHTHALMIA
MANAGEMENT
• G. VIGAMOX 2 HOURLY RIGHT EYE
• G. VIGAMOX 4 HOURLY LEFT EYE
• BILATERAL EYE LID HYGIENE TDS
• EYE SWAB C& S
• IV CEFOTAXIME 145MG 6 HOURLY
BLOOD IX Result
Ix Result

FBC WCC: 21.1 ( predominant neutrophil )

Hb 13.1, Plt 376
LFT normal
RP Normal
blood no growth
c&s
eye no growth
swab
c&s
OCULAR Examination 23/07/2022
RE LE
unable to visual acquity VA unable to do visual acquity
lid sweollen , erythematous , Lid EVERTED LID NO PSM ,
discharge ++, everted minimal MINIMAL YELLOWISH
pseudomembrane DISCHARGE, NOT SWOLLEN
Round/Negative Pupil/RAPD Round/Negative
White Conjunctiva WHITE

Clear, no stain uptake Cornea Clear

formed, no obvious hypopyon AC D/Q

Clear LENS Clear

OD Pink CDR 0.2, Macula Fundus OD Pink CDR 0.2, Macula

normal, Retina flat normal, Retina flat
OCULAR Examination 25/07/2022
RE LE
unable to visual acquity VA unable to do visual acquity
minimal dischar ge, no psm, lid Lid EVERTED LID NO PSM ,
swelling reducing MINIMAL YELLOWISH
DISCHARGE, NOT SWOLLEN
Round/Negative Pupil/RAPD Round/Negative
White Conjunctiva WHITE

Clear, no stain uptake Cornea Clear

formed, no obvious hypopyon AC D/Q

Clear LENS Clear,

OD Pink CDR 0.2, Macula Fundus OD Pink CDR 0.2, Macula

normal, Retina flat normal, Retina flat
OCULAR Examination 27/07/2022
RE LE
unable to visual acquity VA unable to do visual acquity
normal Lid normal
Round/Negative Pupil/RAPD Round/Negative
White Conjunctiva WHITE

Clear, no stain uptake Cornea Clear

formed, no obvious hypopyon AC D/Q

Clear LENS Clear,

OD Pink CDR 0.2, Macula Fundus OD Pink CDR 0.2, Macula

normal, Retina flat normal, Retina flat
ABOUT NEONATRUM OPHTHALMIA
• Ophthalmia neonatorum (ON), or neonatal
conjunctivitis, is defined as an acute, mucopurulent
conjunctivitis occurring in the first 4weeks of life.
Characteristic

-eye discharge watery , mucopurulent in one or both eye

-swollen eyelids
-conjuctiva show hyperemia or chemosis
DIAGNOSIS
• TIMING OF ONSET
-CHEMICAL IRRITATION : FIRST FEW DAYS
-GONOCOCCAL : FIRST WEEK
-STAPHYLOCOCCI AND OTHER BACTERIA : END OF THE FIRST WWEEK
- HSV : 1- 2 WEEKS
CHLAMYDIA: 1-3 WEEKS
HISTORY
• INSTILLATION OF A PROPHYLATIC CHEMICAL PREPARATION

• PARENTAL SYMPTOMS OF STI

• RECENT CONJUCTIVITIS IN CLOSE CONTACTS.

• FEATURES OF SYSTEMIC ILLNESS IN THE CHILD : PNEUMONITIS, RHINITIS AND

OTITIS IN CHLAYMDIAL INFECTION , SKIN VESICLES AND FEATURES OF
ENCEPHALITIS IN HSV; DISSEMINATED GONOCOCCAL INFECTION IN RELATIVELY
RARE .

• PRIOR PERSISTENT WATERING WITHOUT INFLAMATION MAY INDICATE AN

UNCANALIZED NASOLACRIMAL DUCT.
SIGNS
• A mildly sticky eye may occur in staphylococcal infection , or with delayed
nasolacrimal duct canalization.
• Discharge is characteristically watery in chemical and HSV infection ,
mucopurulent in chlamydial infection, purulent in bacterial infection and
hyperpurulent in gonococcal conjuctivitis.
• Severe eyelid oedma occurs in gonococcal infection.
• eyelid and periocular vesicles may occur in HSV infection
• corneal examination
• Pseudomembranes
• cogenital glaucoma
Predisposing Factor
• organism in vagina shed during delivery
• premature rupture of membrane
• long delivery
• low level igA
• trauma to epithelial barrier
• prophylaxis ( antibiotic , silver nitrate )