Opthalmia

Neonatorum

Dr.Ananda K. Sharma , MD
 Introduction

Opthalmia Neonatorum:- Neonatal

Conjuctivitis
One of the Imp. cause of ocular
morbidity
Incidence is rare in developed
country.
 Introduction

However remains a significant

source of ocular morbidity,
blindness &death in medically
underserved areas around the
world.
 Introduction
Neonates Infants within the age
of one month.
Risk Factors:
Maternal Infections Chlamydial,
Gonococcal , Viral (Herpes Simplex)
etc.
Early membrane rupture
Cesarean delivery- not immune.
 Etiology

Bacteria
Viral
Chemical agents
 How it occurs?

Infected birth canal

Direct contact of infants eyes
Because of premature rupture of
the membrane.
 How it occurs?

Ascending infection from the

birth canal to the uterus are
known.
Hence LSCS delivery is not
always immune to Ophthalmia
Neonatorum
 Causative Agents

Neisseria gonorrhoeae,
Neisseria meningitides- rare
Chalmydia Trachomatis
Herpes Simplex Type II is more
common
Chemical agents: Silver nitrate.
 Gonococcal Ophthalmia
Neonatorum

Usually occurs in first 2-5 days of

life
Acute onset
Clinical Features:
Lid edema
Chemosis & congestion
Copious Discharge
Some times keratitis (corneal ulcer).
 Gonococcal Infection

Systemic infection
Sepsis
Meningitis
Arthritis, etc.
 How do you diagnose?

Clinical history
Ocular symptoms & signs
Features of hyperacute
conjunctivitis
Presence of risk factors.
 How do you diagnose?
Conjunctival swab staining
&Culture
Gram stain
Culture medias-
chocolate agar &
Thyer-Martin media.
 How do you diagnose?
If Gram stain shows: Gram ve
diplococci- diagnostic
Sometimes necessity of getting
reports of High Vaginal Swab
from gynecologist.
 Treatment
Frequent irrigation of the eyes
Intensive topical antibiotics
IV / IM Ceftriaxone .
Irrigation of eyes & cleaning of
discharge - decrease the
bacterial load & toxin.
 Ophthalmia neonatorum-
Chlamydial infection

Chlamydial trachomatis most

common cause of Ophthalmia
Neonatorum in USA

TRIC Infection (conjunctivitis)

 Ophthalmia neonatorum-
Chlamydial infection
Chlalmydia trachomatis
obligatory intracellular organism

Infection occurs in the birth

canal

Onset usually on 5-7 day of life.

 Risk Factors

Maternal infections( STD)

Vaginal delivery
Early rupture of the
membrane.
 Clinical features
Mild lid swelling
Conjunctival Congestion
Papillary reaction
Mild to moderate discharge
Rarely membrane formation.
 Diagnosis

Conjunctival scraping
Direct fluorescent test
ELISA
 Treatment
Self limiting disease
However treatment is necessary.
Topical Antibiotics :
Eye drops: Sulfacetimide
Eye Ointments :Erythromycine,
Tetracycline.
 Treatment.

Systemic: Oral Erythromycin

50mg /kg

Treat the contacts as usual in STDs

 Ophthalmia Neonatorum
Virus is the rare cause of
ophthalmia neonatorum
Herpes simplex II infection is the
commonest among.
Usually on set after 2 weeks of life
HSV Type II (genital herpes) :
more common neonatal infection.
 Clinical features of HSV
conjunctivitis

Redness
Watery Discharge
F.B. sensation ,
Discomfort
Infants usually rub their eyes
 Clinical features of HSV
conjunctivitis
Watering
Pre-auricular lymph nodes
Sometimes typical herpetic
vesicles on lids helpful for
diagnosis
 Clinical features
Recurrent disease- Dendritic &
geographical ulcers
Sometimes also seen in those
conditions where immunity has
been decreased. Eg. HIV
 Treatment
Acyclovir eye ointment
Antibiotics Eye drops
In Corneal involvement (Keratitis)-
needs more judicious and long
term treatment
Severe cases require systemic
acyclovir.
 Ophthalmia neonatorum
(Chemical Induced)
Occurs usually after instillation of
Silver Nitrate Solution >24 hours
Conjunctivitis Mild , self limiting
irritation and redness of
conjunctiva
Diagnosis - Obvious
 Prophylaxis
In 1880 Crede introduced the
concept of widespread prophylaxis
for gonococcal infections.
2% Silver Nitrate Solution ( AgNO3)
Has decreased significantly the
incidence of Ophthalmia Neonatorum
due to gonococcal infection.
 Prophylaxis
Credes prophylaxis Not effective
against TRIC infection.
Hence , Supplemented by effective
treatment, eg. Tetracycline,
Erythromycin ointments.

Recently , Povidone Iodine solution

becoming more popular.
Thank you.