Ophthalmia Neonatorum

What is Ophthalmia Neonatorum?

Ophthalmia Neonatorum, also known as Neonatal Conjunctivitis is an eye infection in the infants. Especially it happens in the first month (28 days) of baby’s birth. It’s a conjunctiva inflammation which affects the eyes of newborns. It is a potential threat to the infant’s eye and in rare cases results in the death of the baby. It may cause corneal blindness and permanent scarring if untreated.

ICD9 CODE: 098.40

Causes & Types of Ophthalmia Neonatorum

Infectious

The bacterial presence such as chlamydia and N. gonorrheae in the birth canal of the mother can give rise to neonatal conjunctivitis. Chlamydia trachomatis is the most common bacteria that causes this infection which persists for up to 3 weeks. Other bacterial and viral pathogens causing infectious ON are:

  • Chlamydia trachomatis
  • Neisseria gonnorhea (characterized by inflammation and vaginal discharge)
  • Pseudomonas aeruginosa
  • Streptococcus aureus
  • Streptococcus haemolyticus
  • S. pneumonia
  • Staphylococcus epidermis
  • Escherichia coli
  • Herpes simplex virus (HSV)
  • Adenovirus

Non-infectious

Silver nitrate is from the family of chemical irritants which is often responsible for chemical conjunctivitis in newborns. This form of neonatal conjunctivitis generally persists for either 3 or 5 days. Therefore, Chloramphenicol and neomycin should be used while avoiding silver nitrate.

Other risk factors of Ophthalmia Neonatorum

  • Blocked tear duct
  • Premature delivery
  • Unhygienic delivery conditions
  • Poor parental care

Symptoms

  • Pain, irritation, and tenderness in the eyeballs
  • Swollen eyelids
  • Crusty eyes
  • Conjunctival discharge, i.e., mucoid, mucopurulent, purulent
  • Corneal involvement

Diagnosis

The diagnosis is carried out promptly and properly by a highly trained physician because the eyes of newborns are very sensitive and consequently needs extra care. Investigating the cornea with blue cobalt light or fluorescein is one of the techniques to examine the disease physically. There are different methods to perform the diagnostic functions.

  • Culture of the eye’s conjunctival discharge:  It is a tissue culture practice in medical laboratory to identify the causing agents.
  • Slit lamp examination: It examines the eyeball condition of an infant in very detailed manner.
  • Ophthalmia Neonatorum Differential Diagnosis: There are some similar eye diseases such as:
    1. Glaucoma
    2. Secondary Congenital Keratitis
    3. Bacterial Keratitis
    4. Herpes Simplex Nasolacrimal duct
    5. Obstruction Glaucoma
    6. Bacterial Cellulitis
    7. Orbital Cellulitis
    8. Funga
    This method is broadly used to identify the actual disease and pathogen. The method also involves culture on chocolate agar and blood agar to study the frequently differentiating tissues.
  • Direct antibody testing or Polymeric Chain Reaction(PCR)
  • Enzyme immunoassays & nucleic acid testing (NAT)

Treatment

  • Maintain hygiene and proper care
  • Doctor recommended eye drops and ointments
  • Erythromycin drops and oral erythromycin syrup
  • Tetracycline eye drops
  • Injections
  • Antibiotic therapy (For Bacterial Infection)
  • Warm compresses along with a regular message to the baby.

Complications

Few complications like corneal edema, pseudomembrane formation, loss of eyes (in exceptional cases), anus are high but early diagnosis with immediate checkup can avoid these complexities.

Prevention & control

It’s a known fact that “prevention is better than cure.” Therefore to prevent the newborn from this disease, mothers should be examined and treated for sexually transmitted diseases.

As discussed above, neonatal conjunctivitis seems to be a serious eye disease. So, appropriate medical therapy and regular probation are highly appreciable. This disease is commonly referred to as newborn pink eye/red eye or newborn eye goop. Yellow or white eye discharge is a visible sign of this disease, hence one should immediately visit a pediatrician.

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