Brief Description, Types, Sign and Symptoms, Causes And Treatment Of Ophthalmia Neonatorum

Ophthalmia neonatorum is a bilateral inflammation of the conjunctiva occurring in an infant, less than 30 days old. It is a preventable disease which usually occurs as a result of carelessness at the time of birth.
As a matter of fact any discharge or even watering from the eyes in the first week of life should arouse suspicion of opthalmia neonatorum, as tears are not formed till then.

The inflammation of the conjunctiva that occurs in ophthalmia neonatorum may cause blood vessel dilation, chemosis, and excessive secretion. This tends to be more serious due to the following: lack of immunity, absence of lymphoid tissue in the conjunctiva, and absence of tears at birth.

The cause of neonatal conjunctivitis can be chemical or microbial. Although various noninfectious and infectious agents can inflame the conjunctiva, the more common causes of neonatal conjunctivitis are silver nitrate solution or antibiotics used for prophylaxis and chlamydial, gonococcal, staphylococcal, and herpetic infections.

Silver nitrate solution

Crede's method was a major advance in preventing neonatal conjunctivitis and is performed by instilling a drop of 2% silver nitrate into a newborn's eyes.
The silver nitrate acts as a surface-active chemical, facilitating agglutinate gonococci and inactivating them. Ironically, silver nitrate solution was later found to be toxic to the conjunctiva, potentially causing a sterile neonatal conjunctivitis.

 

Chlamydial conjunctivitis

The causative agent of chlamydial conjunctivitis is chlamydia trachomatis which is an obligate intracellular parasite and has been identified as the most common infectious cause of neonatal conjunctivitis. The reservoir of the chlamydia trachomatis is the maternal cervix or urethra. Infants who are born to infected mothers have about 25-50% risk of developing chlamydial conjunctivitis.

Neisserial conjunctivitis

Neisseria gonorrhoeae is a gram-negative diplococcus that causes a sexual transmitted disease known as gonorrhea in adults and is potentially the most dangerous and virulent infectious cause of neonatal conjunctivitis. Similar to chlamydia, the reservoir of N gonorrhoeae is the maternal cervix or urethra and the infant acquires the disease from the infected mother during birth.

Other bacteria

The most commonly identified gram-positive organisms which make up 30-50% of all cases of neonatal conjunctivitis include Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, and Staphylococcus epidermidis.
Gram-negative organisms include Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, and Proteus, Enterobacter, and Pseudomonas species. In addition, Eikenella corrodens has been reported in 1 case of neonatal conjunctivitis.

NOTE: Herpes simplex ophthalmia neonatorum is a rare condition caused by herpes simplex-II virus.

Signs and Symptoms

1. Eye redness and swollen eyelids.
2. Pain and tenderness in the eyeball.
3. Conjunctival discharge. It is purulent in gonococcal cases and mucoid or mucopurulent in other bacterial cases. Any eye discharge in the first week of life is abnormal.

Treatment

Treatment is by saline lavage to eliminate discharge and application of antibiotic ointments and oral antibiotic syrup. When the cornea is involved, atropine sulphate ointment is applied.
The best treatment for neonatal conjunctivitis is prophylaxis treatment in which antenatal, natal and postnatal cares are considered.

In addition, the parents or care providers are advised to wash their hands frequently to prevent transmission of neonatal conjunctivitis and pregnant women should be educated on the importance of treating sexually transmitted infections such as herpes simplex, gonorrhea, and chlamydia in order to decrease the incidence of neonatal conjunctivitis.