Neonatal conjunctivitis
Ophthalmia neonatorum is conjunctivitis presenting in the first month of life, caused by chemical irritation, Neisseria gonorrhoeae, Chlamydia trachomatis, or herpes simplex virus acquired at delivery. Age of onset and discharge character point to the organism, and treatment is organism-specific because gonococcal and herpetic disease can destroy the eye within days.
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What this article covers
- Overview
Conjunctivitis presenting in the first month of life, acquired at or after delivery: caused by chemical irritation, bacterial infection (chiefly Neisseria gonorrhoeae and Chlamydia trachomatis), or…
- Epidemiology
Worldwide prevalence ranges from 0.1% to 10% of live births, driven by local sexually transmitted infection (STI) rates and access to prenatal care and postnatal prophylaxis.
- Risk factors
Untreated or unscreened maternal gonococcal or chlamydial infection at delivery, the dominant risk factor for the corresponding disease.
- Pathophysiology
Direct inoculation during vaginal delivery: the neonate's conjunctiva contacts infected cervical or vaginal secretions in the birth canal, seeding gonococci, chlamydiae, or HSV onto the ocular surface.
- Clinical features
Onset timing separates the four causes: chemical within the first day of life, gonococcal within the first week (typically 2 to 5 days), chlamydial at 7 to 14 days, and HSV within about 2 weeks.
- Differential diagnosis
Gonococcal ophthalmia neonatorum: the most dangerous cause; hyperacute onset in the first week, marked purulence, and gram-negative intracellular diplococci on Gram stain distinguish it.
- Diagnosis
Ophthalmia neonatorum is diagnosed by conjunctival Gram stain and Giemsa stain, supported by culture and NAAT, read alongside the age-of-onset pattern above; a gram-negative intracellular diplococcus…
- Management
First, irrigate the affected eye(s) with saline to mechanically remove purulent discharge, repeated between each topical or systemic dose, regardless of suspected organism.
- Complications
Corneal ulceration, opacification, or perforation, most feared with gonococcal disease because of its rapid, directly invasive course (24-48 hours if untreated); can also occur with severe HSV keratitis.
- Prognosis
Excellent with prompt organism-specific treatment: gonococcal, chlamydial, and chemical conjunctivitis resolve without visual sequelae when treated before corneal involvement.
- Prevention
Universal ocular prophylaxis at birth for every newborn, regardless of delivery route: erythromycin 0.5% ophthalmic ointment, a 1 cm ribbon to the lower conjunctival fold of each eye, single…
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Related articles
- Conjunctivitis
Conjunctivitis is inflammation of the conjunctiva from viral, bacterial, or allergic causes presenting with red eye, discharge, and preserved vision, diagnosed clinically by discharge character and managed with supportive care, targeted topical antibiotics, or topical antihistamine/mast-cell-stabilizer therapy.
- Neisseria gonorrhoeae gonococcal infection
Neisseria gonorrhoeae is a gram-negative intracellular diplococcus that infects columnar and transitional epithelium of the cervix, urethra, rectum, pharynx, and conjunctiva, and disseminates hematogenously in 1% to 3% of infections to cause the arthritis-dermatitis syndrome or purulent monoarthritis; treatment is ceftriaxone-based because cephalosporin resistance is emerging and fluoroquinolones are no longer reliable.
- Chlamydia trachomatis infection
Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted infection in the United States, frequently asymptomatic, and diagnosed by nucleic acid amplification testing of urine or genital/rectal/oropharyngeal swabs. Uncomplicated genital infection is treated with a single dose of azithromycin or a course of doxycycline, complications include pelvic inflammatory disease and epididymitis, and LGV serovars require a 21-day course and are an increasing cause of proctitis.
- Herpes simplex virus (HSV) infection
Herpes simplex virus type 1 or 2 establishes lifelong latency in sensory ganglia after mucocutaneous infection, causing painful vesicular-to-ulcerative outbreaks of the mouth or genitals with intermittent asymptomatic shedding; diagnosis is by NAAT of an ulcer swab and treatment is oral nucleoside analogues, escalating to intravenous acyclovir for encephalitis, severe mucocutaneous disease, or disseminated infection in immunosuppressed hosts.
- Herpes simplex keratitis
Herpes simplex keratitis is reactivation of latent HSV along the trigeminal nerve causing a corneal dendritic ulcer with pain, photophobia, and decreased corneal sensation. Diagnosis is clinical on slit lamp with fluorescein staining; treatment is a topical or oral antiviral, and topical corticosteroids are contraindicated in active epithelial disease.
- Corneal abrasion
A corneal abrasion is a traumatic or foreign-body-related defect of the corneal epithelium diagnosed by fluorescein uptake under cobalt-blue light. Uncomplicated cases heal in days with lubrication and pain control, but contact-lens wear mandates antipseudomonal coverage and any red flag (rust ring, infiltrate, Seidel sign, hypopyon) demands same-day ophthalmology referral.