Ophthalmia neonatorum

Alternative names
Newborn conjunctivitis; Conjunctivitis of the newborn; Neonatal conjunctivitis

Definition
Neonatal conjunctivitis is a red eye in a newborn caused by irritation, a blocked tear duct, or infection.

Causes, incidence, and risk factors

Conjunctivitis in a newborn may be caused by a blocked tear duct, or by irritation produced by the antibiotic eyedrops given at birth. However, if it is caused by an infection, it can be very serious.

Many organisms can cause infection in the eyes of newborn infants. The most common bacterial infections with potential to cause serious eye damage are gonorrhea (Neisseria gonorrhea) and chlamydia (Chlamydia trachomatis), which can be passed from mother to child during birth.

The viruses that cause genital and oral herpes can also cause neonatal conjunctivitis and severe eye damage. These viruses may also be acquired during passage through the birth canal, however herpes conjunctivitis is less common than those caused by gonorrhea and chlamydia.

All of these organisms are generally picked up by the expectant mother as a sexually-transmitted disease (STD). Chlamydia may be the most common STD in the United States today and chlamydial conjunctivitis in the newborn is seen 10 times as frequently as gonorrheal conjunctivitis.

The mother may be without symptoms (asymptomatic) at the time of delivery, yet still harbor bacteria or viruses capable of causing conjunctivitis in the newborn. Infected newborn infants develop drainage from the eyes within 1 day to 2 weeks after birth. The eyelids become puffy, red, and tender.

Gonorrhea may cause perforation of the cornea and very significant destruction of the deeper eye structures. Chlamydia is somewhat less destructive.

Because of the significance of neonatal conjunctivitis, all hospitals (most required by state law) routinely use silver nitrate or antibiotic drops, such as erythromycin, in a newborn’s eyes to prevent disease. Silver nitrate is no longer commonly used, and has been mostly replaced by antibiotic eye drops.

Symptoms

     
  • Maternal history of any STD  
  • Watery, bloody (serosanguineous) drainage from the infant’s eyes  
  • Thick pus-like (purulent) drainage from the infant’s eyes  
  • Swollen, red eyelids  
  • Tensely swollen eyelids

Signs and tests

     
  • Standard ophthalmologic examination  
  • Slit-lamp examination to look for corneal ulceration, perforation, or other changes (called iridocyclitis and inclusion blennorrhea)  
  • Culture of the drainage from the eye to look for Neisseria gonorrhea and Chlamydia trachomatis

Treatment

Topical antibiotic eye drops and ointments, oral antibiotics, and intravenous antibiotics are all used depending on the severity of the infection and the organism responsible for it.

Occasionally, topical and oral (or topical and intravenous) routes may be used simultaneously. Irrigation of the eye with normal saline is done to remove the purulent drainage that accumulates.

If the conjunctivitis is caused by a blocked tear duct, gentle warm massage between the eye and nasal area may help. If it is not cleared by one year of age, surgery may be required.

Eye irritation caused by the eye drops given at birth should resolve on its own.

Expectations (prognosis)
Early recognition of infected mothers and good hospital preventive practices have reduced conjunctivitis of the newborn to very low levels. Infants who do develop conjunctivitis and are quickly treated generally have good outcomes.

Complications

     
  • Perforation of the cornea  
  • Iritis (inflammation of the iris)  
  • Corneal scarring  
  • Blindness  
  • Chlamydial pneumonia

Calling your health care provider
Talk to your health care provider if you have given birth (or expect to give birth) to a baby in a setting where antibiotic or silver nitrate drops are not routinely placed in the infant’s eyes - for example, an unsupervised birth at home. This is especially important if you have had, or are at risk for, any sexually-transmitted disease.

Prevention

Treatment of a pregnant woman for sexually-transmitted diseases will prevent conjunctivitis in the neonate. Even if the mother’s infection has not been recognized, prophylactic eye drops put into the infant’s eyes immediately after birth help prevent many infections, and these drops are used routinely for all births.

A cesarean section is recommended when the mother has active herpes lesions at the time of delivery. Antibiotics, given intravenously, may be given to infants of mothers with untreated gonorrhea. However, antibiotic eye drops may not prevent chlamydial conjunctivitis.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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