Alternate Names: Newborn conjunctivitis; Conjunctivitis of the newborn; Ophthalmia neonatorum

Causes and Risks: Many organisms can cause infection in the eyes of newborn infants, but the most common birth-related bacterial infections with the potential to cause eye damaging are gonorrhea (Neisseria gonorrhea) and Chlamydia (Chlamydia trachomatis). Herpes is a virus that can cause neonatal conjunctivitis (eye infection) and severe eye damage. It may also be acquired during passage through the birth canal, however the incidence of herpes conjunctivitis is less than the others.

These organisms are generally picked up by the expectant mother as a sexually-transmitted disease (STD). Chlamydia may be the most common STD in the United States today (Note: gonorrhea is the most common reported bacterial infection) and Chlamydial conjunctivitis in the newborn is seen 10 times as frequently as gonorrheal conjunctivitis.

The mother may be without symptoms (asymptomatic) at the time of delivery, yet still harbor bacteria or virus capable of causing conjunctivitis in the newborn. Infected newborn infants develop drainage from the eyes within 1 day to 2 weeks after birth. The eyelids become puffy, red, and tender. Gonorrhea may cause perforation of the cornea and very significant destruction of the deeper eye structures. Chlamydia is somewhat less destructive.

Because of the significance of neonatal conjunctivitis, all hospitals (most required by State law) routinely use silver nitrate or antibiotic drops such as erythromycin in the newborn’s eyes to prevent disease. Silver nitrate is no longer commonly used and has been mostly replaced by antibiotic eye drops.

Prevention: Treatment of the pregnant mother for sexually-transmitted diseases will prevent conjunctivitis in the neonate. If the mother’s infection has not been recognized, keep in mind that prophylactic eye drops put in the infant’s eyes immediately after birth prevents infection, and these drops are used routinely for all births. Antibiotics, given intravenously, may be given to infants delivered of mothers with untreated gonorrhea. Antibiotic eye drops may not prevent Chlamydial conjunctivitis.

Symptoms:

• maternal history of any STD
• watery, bloody (serosanguineous) drainage from the infant’s eyes
• thick pus-like (purulent) drainage from the infant’s eyes
• swollen, red eyelids
• tensely swollen eyelids

Signs and Tests:

• standard ophthalmologic examination
• slit lamp examination to look for corneal ulceration, perforation, or other changes (called iridocyclitis and inclusion blennorrhea)
• culture of the drainage from the eye to look for Neisseria gonorrhea and Chlamydia trachomatis

Treatment: Topical antibiotic eye drops and ointments, oral antibiotics, and intravenous antibiotics are all used depending on the severity of the infection and the organism. Occasionally topical and oral (or topical and intravenous) routes may be used simultaneously. Irrigation of the eye with normal saline is done to remove the purulent drainage that accumulates.

Prognosis: Early recognition of infectious mothers and good hospital preventive practices have reduced conjunctivitis of the newborn to very low levels. Infants who do develop conjunctivitis and are quickly treated generally have good outcomes.

Complications:

• perforation of the cornea
• iritis (inflammation of the iris)
• corneal scarring
• blindness
• Chlamydial pneumonia

Talk to your health care provider if you have given birth (or expect to give birth) to a baby in a setting where antibiotic or silver nitrate drops are not routinely placed in the infant’s eyes (for example, an unsupervised birth at home). This is especially important if you have had, or are at risk for, any sexually-transmitted disease.