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Neonatal conjunctivitis

Definition

Neonatal conjunctivitis is swelling (inflammation) or infection of the tissue lining the eyelids in a newborn.

Alternative Names

Newborn conjunctivitis; Conjunctivitis of the newborn; Ophthalmia neonatorum; Herpetic neonatal conjunctivitis

Causes, incidence, and risk factors

Neonatal conjunctivitis is most commonly caused by:

• A blocked tear duct
• Infection by bacteria or viruses, or irritation from antibiotic eyedrops called silver nitrate (these are rarely used anymore)

Neonatal conjunctivitis that is caused by an infection with bacteria or viruses can be very serious. The most common bacterial infections that can cause serious eye damage are gonorrhea (Neisseria gonorrhea) and chlamydia (Chlamydia trachomatis), which can be passed from mother to child during birth.

Bacteria that normally live in a woman's vagina also cause neonatal conjunctivitis.

The viruses that cause genital and oral herpes may also be passed to the baby during childbirth, leading to neonatal conjunctivitis and severe eye damage. However, herpes conjunctivitis is less common than conjunctivitis caused by gonorrhea and chlamydia.

The mother may be without symptoms (asymptomatic) at the time of delivery, yet still carry bacteria or viruses that can cause conjunctivitis in the newborn.

Symptoms

Infected newborn infants develop drainage from the eyes within 1 day to 2 weeks after birth.

The eyelids become puffy, red, and tender.

There may be watery, bloody, or thick pus-like drainage from the infant's eyes.

Signs and tests

The health care provider will perform an eye exam on the baby. If the eye does not appear normal, the following tests may be done:

• Culture of the drainage from the eye to look for bacteria or viruses
• Slit-lamp examination to look for damage to the surface of the eyeball

Treatment

Eye irritation that is caused by the eye drops given at birth should go away on its own.

For a blocked tear duct, gentle warm massage between the eye and nasal area may help. This is usually tried before starting antibiotics. If a blocked tear duct has not cleared up by the time the baby is 1 year old, surgery may be needed.

Antibiotics are usually needed for eye infections caused by bacteria. Eye drops and ointments may also be used. Salt water eye drops may be used to remove sticky yellow drainage.

Special antiviral eye drops or ointments are used for herpes infections of the eye.

Support Groups

Expectations (prognosis)

Early diagnosis of infected mothers and good preventive practices at hospitals have reduced the incidence of infectious conjunctivitis of the newborn. Infants who do develop conjunctivitis and are quickly treated generally have good outcomes.

Complications

• Blindness
• Corneal scarring
• Inflammation of the iris
• Perforation of the cornea
• Pneumonia

Calling your health care provider

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, if you are having an unsupervised birth at home. This is especially important if you have had, or are at risk for, any sexually transmitted disease.

Prevention

Treating a pregnant woman for sexually transmitted diseases will prevent conjunctivitis caused by these infections in her newborn. Depending on the infection, the mother may receive antibiotics through a vein (IV).

Even if the mother's infection has not been recognized, eye drops put into the infant's eyes immediately after birth can help prevent many infections. These drops are used routinely for all hospital births. (Most states have laws requiring this treatment.)

When a mother has active herpes sores at the time of delivery, a cesarean section is recommended to prevent serious illness in the baby.

References

Rubenstein JB, Virasch V. Conjunctivitis: infectious and noninfectious. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 4.6.