Ophthalmia Neonatorum/ Neonatal Conjunctivitis

Ophthalmology

-Neonatal conjunctivitis is the bilateral inflammation of the conjunctiva in an infant less than 30 days old.It is a preventable disease occurring as a result of carelessness at the time of birth .

📌Contents:
- Definition
- Etiology
- Clinical features
- Prophylaxis
- Investigations
- Treatment

1. OPHTHALMIA NEONATORUM

2. Ophthalmia neonatorum Also called as Neonatal conjunctivitis Bilateral inflammation of conjunctiva in infants <30 days old . Preventable disease As a matter of fact any discharge or even of watering from eyes should arouse suspicion of ophthalmia neonatorum ,as tears are not formed till then .

3. Etiology The infection may occur in 3 ways 🔹 Before birth – through infected liquor amnii in mothers with ruptured membranes . 🔹 During birth - transmission from infected birth canal 🔹 After birth – may occur during first bath of newborn or from soiled clothes or fingers with infected lochia .

4. 🔹Causative agents : Silver nitrate and antibiotics used for prophylaxis.— 🔸Chemical neonatal conjunctivitis Neisseria gonorrhoea — 🔸Gonococcal ophthalmia neonatorum Chlamydia Trachomatis ( Serotypes D to K ) — 🔸Neonatal Inclusion Conjunctivitis

5. Herpes Simples Virus (HSV II) – 🔸 Herpes simplex ophthalmia neonatorum Other bacterial infections include : 🔸Staphylococcus aureus 🔸Streptococcus pneumoniae 🔸Streptococcus haemolyticus 🔸 haemophilus species

6. Clinical features 🔹 Incubation period : 🔸chemical – 6hours 🔸Gonococcal —2-5 days 🔸neonatal inclusion conjunctivitis – 5-14days 🔸herpes simplex – 6-15 days 🔸other bacterial —5-8days

7. Clinical features 🔹signs and symptoms Pain and tenderness Lids edematous Conjunctivital discharge : 🔸 mucopurulent - gonococcal 🔸purulent –chlamydial infection 🔸bloody - HSV

8. Conjunctiva – hyperaemia and chemosis . Corneal involvement — superficial punctuate keratitis

9. Herpes simplex ophthalmia neonatorum

10. Complications Corneal ulceration and perforation Anterior synechiae Opacification Staphyloma Panophthalmitis Anterior capsular cataract Adherent leucoma

11. Prophylaxis ♦️Antenatal measures : — care of the mother —Rx of mother - suspected genital infections —Surveillance of woman during third trimester of pregnancy. ♦️Natal measures : —deliveries conducted under hygienic conditions —the newborn baby’s closed lids should be thoroughly cleansed & dried .

12. ♦️Postnatal measures : — Povidone iodine 2.5% solution —1% tetracycline ointment or 0.5% erythromycin ointment —single injection of ceftriaxone 50mg /kgIM or IV

13. Investigations🔬 Gonococci — 🔸 gram stain: gram negative diplococci 🔸culture: chocolate agar , Thayer Martin agar

14. Chlamydia trachomatis — 🔸 Giemsa Stain : inclusion bodies 🔸direct immunofluorescence assay.

15. HSV — 🔸 Tzanck smear : multinucleated giant cells 🔸Pap smear : eosinophilic intranuclear inclusion bodies

16. 💊 Treatment