Ophthalmia neonatorum (Neonatal ophthalmia)
Ophthalmia neonatorum (Neonatal ophthalmia)
Definition Any form of coniunctivitis occurnng in the first month of life One of the most severe forms of ophthalmia neonatorum is the purulent type, caused by gonococci.
Etiology
1. Infectious ophthalmia neonatorum:
Bacterial: Gonococci (Gonococcal Pumlent" ophthalmia neonatorum), Staph., Strept. & Pneumococci.
Viral: Herpes simplex & Adenoviruses.
Chlamydia.
2. Non-infectious ophthalmia neonatorum (Chemical): Due to prolonged postpartum instillation of drops or ointment as a prophylaxis against infectious ophthalmia neonatorum.
Diagnosis
Any discharge from the eyes of a newborn has to be seriously examined as tears are not secreted at this early time. The condition should be also differentiated from congenital dacryocystitis (Usually unilateral with regurge of pus).
Diagnosis of ophthalmia neonatorum is carried out mainly by the clinical picture, however any of the following may be helpful:
a. Conjunctival smears: Demonstrate bacteria, inclusion bodies in chlamydial cases & Lipschutz inclusions in herpetic cases.
b. Immunofluorescent tests: In cases of Chlamydia.
c. Herpes culture.
Management
1. Prevention:
Treatment of the mother from herpetic cervicitis before delivery.
Washing of the baby's face & body from above downwards.
Penicillin or any other broad spectrum antibiotic eye drops:
Used after birth and up to a week. Prolonged use should be
avoided to prevent chemical ophthalmia neonatorum.
2. Curative treatment:
Frequent wash & removal of the discharge.
Local antibiotic eye drops (Frequent use).
Local antibiotic eye ointment (As frequent as possible).
Systemic antibiotics in severe cases.
Local atropine in cases with corneal affection.
Purulent conjunctivitis
Causative organism
a. Gonococci: 60-80% of cases.
b. Staph., Strept. & mixed infection.
Route of infection: 1Flies, 2dust, 3contaminated towels, 4through genitals & 5through the birth canal during delivery.
Classification
1. Ophthalmia neonatorum. 2. Adult type.
Clinical picture & stages
1. Incubation period: Few hours to 3 days.
2. Stage of infiltration:
a. Eyelids: edema & tenderness.
b. Conjunctiva: Marked chemosis & hyperaemia.
c. Discharge: Watery or mucoid.
d. May be: Enlarged tender preauricular lymph nodes.
3. Stage of discharge:
a. U lid edema, however tense & may be painful.
b. U conjunctival edema.
c. Hyperemia & papillae formation.
d. Profuse purulent discharge.
Fate & complications
1. Spontaneous cure or after treatment.
2. Chronicity.
3. Comeal ulcers: Central, marginal or ring ulcers.
4. Iridocyclitis.
Management
1. Prevention:
Good personal hygiene & healthy sexual habits.
Protect the fellow eye.
Protect contacts: by using separate towels which should be boiled.
Prevention of purulent ophthalmia neonatorum.
2. Curative:
Sterile water or boric acid 4%: Frequent washing, to remove the discharge.
Local antibiotic eye drops (Broad spectrum): The frequency of application depends on the severity, but it may be applied:
o Every 5 minutes for an hour, then
o Every hour for 48 hours, then
o 4 times! day for the following 10 days.
Antibiotic ointment at night.
Systemic antibiotics: In gonococcal cases, give single 11VI
injection of cefotriaxone.
Local atropine: In conical involvement &/or iritis.
Dark glasses: To relieve photophobia.
Bandage is contraindicated.
Source: http://ophthalmologynotes.blogspot.com/
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