Ophthalmia Neonatorum

  • 1.

    How does ophthalmia neonatorum typically present?

    Inflammation of the conjunctiva within the first month of life is classified as ophthalmia neonatorum (neonatal conjunctivitis). A purulent or mucoid discharge from one or both eyes is present. In addition to conjunctival injection, edema and erythema of the lids are often present.

  • 2.

    What is the usual means of transmission for neonatal conjunctivitis?

    Conjunctivitis is usually transmitted to the newborn by passage through the mother’s infected cervix at the time of delivery and reflects the sexually transmitted infections prevalent in the community. The organisms can ascend into the uterus as well, and so may cause conjunctivitis even in the setting of cesarean section. It may also be spread by people handling the baby soon after birth.

  • 3.

    What is the most common cause of neonatal conjunctivitis in the United States?

    Neonatal conjunctivitis is the most common ocular disease of newborns. It is most often caused by Chlamydia trachomatis (6.2/1000 live births). One hundred years ago Neisseria gonorrhoeae was the leading cause of blindness in infants. Today gonococcal conjunctivitis is seen less in industrialized nations (3/1000 live births) because of neonatal ocular prophylaxis and better prenatal screening.

  • 4.

    List the common causes of ophthalmia neonatorum, their usual clinical presentations, and their approximate times of onset after birth.

    See Table 9-1 .

    Table 9-1

    Common Causes of Ophthalmia Neonatorum with Time of Onset and Typical Characteristics

    Type Time of Onset Typical Characteristics
    Chemical (e.g., silver nitrate drops) Within hours of instillation

    • Self-limiting, mild, serous discharge (occasionally purulent)

    • Lasts 24-36 h

    Chlamydia trachomatis 5-14 days

    • Mild-to-moderate, thick, purulent discharge (severity is variable)

    • Erythematous conjunctiva, with palpebral more than bulbar involvement

    Neisseria gonorrhoeae 24-48 h

    • Hyperacute, copious, purulent discharge

    • Lid swelling and chemosis common

    Bacterial (nongonococcal) After 5 days Variable presentation, depending on organism
    Herpetic Within 2 weeks

    • Conjunctiva only mildly injected

    • Serosanguineous discharge

    • Vesicular rash on lids sometimes seen

    • Most have concomitant systemic herpetic disease

    Staphylococcus aureus , Staphylococcus epidermidis , Streptococcus pneumoniae , Streptococcus viridans , Haemophilus influenzae , Escherichia coli , Pseudomonas aeruginosa .

  • 5.

    What type of neonatal conjunctivitis is associated with the most severe complications to the eye?

    N. gonorrhoeae has the ability to penetrate intact epithelial cells and divide within them. Its onset is rapid and can quickly lead to corneal perforation and endophthalmitis.

Key Points: Most Common Causes of Neonatal Conjunctivitis

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Jul 8, 2019 | Posted by in OPHTHALMOLOGY | Comments Off on Ophthalmia Neonatorum
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