Chapter 93 The sticky eye in infancy
Ophthalmia neonatorum
Purulent discharge within 48 hours of birth should alert the physician to Neisseria whereas chlamydial infection presents at around 10 days (See Chapter 12). Conjunctival culture is useful to identify the organism but, increasingly, microarray techniques are being used for more rapid diagnosis.1 The parents should undergo contact tracing in a genitourinary clinic. Systemic therapy is required for chlamydial disease to treat other complications such as pneumonitis. Neonatal prophylaxis of ophthalmia neonatorum has been abandoned in the UK and Sweden. Povidone iodine 1.25−2.5%, topical tetracycline, or fusidic acid can be used particularly where antenatal care has not been well documented, but iodine may cause irritation.2
Bacterial conjunctivitis
Bacteria cause the majority of cases of acute conjunctivitis in infants.3 Although most clear without treatment, antibiotic therapy results in earlier clinical and microbiological resolution. Most comparative studies of treatment of acute conjunctivitis show little difference between the broad-spectrum antibiotics.4 Antibiotic resistance is increasingly recognized, particularly with gram-positive isolates.5
