Ophthalmia neonatorum

• ANATOMY OR SYSTEM AFFECTED: Eyes, vision
• ALSO KNOWN AS: Neonatal conjunctivitis, newborn conjunctivitis

Definition

Ophthalmia neonatorum is conjunctivitis that occurs in the newborn. Conjunctivitis is inflammation of the surface or covering of the eye from infectious or noninfectious causes. Any eye infection that occurs in the first month of a baby’s life can be classified as ophthalmia neonatorum. An infection has the potential to damage the delicate eye of an infant, but there are many ways these infections can be prevented. If an infection does occur, effective treatment is available for infants who develop an eye infection.

Causes

The cause of conjunctivitis may be simply an irritation in the eye or a blocked tear duct (dacryocystitis). However, bacteria can also cause an infection in the eye. The most common types of bacteria that cause infection in an infant’s eye come from the mother’s birth canal and are passed to the infant during delivery. These infections can include sexually transmitted diseases (STDs). The most common bacteria passed to infants during delivery are those from STDs that infect the birth canal. If untreated, many of these infections can cause serious damage to the infant’s eye. The STDs that can cause eye damage include chlamydia and gonorrhea; the virus that causes oral and genital herpes; skin bacteria such as Staphylococcus aureus; and bacteria from the woman’s gastrointestinal tract, such as Pseudomonas.

Risk Factors

The biggest risk factor for developing ophthalmia neonatorum is a maternal infection, or STD, at the time of delivery. With some infections, however, the woman may not have any symptoms during delivery and may still be able to transmit the infection. If pregnant, one should discuss any STD infections, past or present, with a doctor.

Symptoms

The most common symptom is redness and swelling of the conjunctiva in the newborn. If the baby has this or any of the following symptoms, one should consult the baby’s pediatrician. Other symptoms of ophthalmia neonatorum include drainage and discharge from the eye (which may be watery or thick and puslike) and swollen eyelids.

Screening and Diagnosis

If the baby’s pediatrician suspects ophthalmia neonatorum, they will order an eye examination to check for eye irritants and eye damage. The doctor also may look at the baby’s tear ducts to see if they are blocked and may also take a sample of any discharge to determine what type of bacteria or virus is causing the infection.

Treatment and Therapy

Because the potential for serious eye damage to the infant is so great, it is standard treatment in hospitals in the United States to give infants antibiotic eye drops or ointment immediately following their delivery. The eye drops help prevent the development of an eye infection, even if the mother shows no symptoms of infection.

In cases where conjunctivitis does develop, the treatment of ophthalmia neonatorum depends on the cause. If caused by a blocked tear duct, the treatment may include warm compresses and gentle massage to the area to help unclog the duct. If caused by bacterial irritation, the treatment includes antibiotics after delivery. These antibiotics may be given as topical drops or ointments, orally, or as an injection. In addition, the eye may be irrigated to remove the discharge. Silver nitrate, which was often used in the past to prevent eye infection, can cause irritation in the baby’s eye, so hospitals now use other types of antibiotics to avoid this irritation.

Because hospitals have such effective prevention measures, bacterial cases of ophthalmia neonatorum are rare, and when they do occur, they are usually identified quickly. Antibiotic treatment is effective, and, generally, the infection resolves rapidly. If a person suspects that an infant may have an eye infection, they should consult the baby’s doctor to receive prompt treatment.

Prevention and Outcomes

The best prevention of ophthalmia neonatorum is the treatment of any STDs in the pregnant woman before labor and delivery. In most cases, effective treatment before the time of delivery can prevent the transmission of infection to the newborn. For women with active genital herpes lesions at the time of delivery, a cesarean section can prevent neonatal infection.

Bibliography

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Johnson, Gordon J., et al., eds. The Epidemiology of Eye Disease. 2d ed. New York: Oxford University Press, 2003.

Koby, M. “Conjunctivitis.” In Ferri’s Clinical Advisor 2011: Instant Diagnosis and Treatment, edited by Fred F. Ferri. Philadelphia: Mosby/Elsevier, 2011.

The Merck Manuals, Online Medical Library. “Neonatal Infections.” Available at http://www.merck.com/mmhe.

Olitzky, S. E., et al. “Disorders of the Conjunctiva.” In Nelson Textbook of Pediatrics, edited by Richard E. Behrman, Robert M. Kliegman, and Hal B. Jenson. 18th ed. Philadelphia: Saunders/Elsevier, 2007.

Riordan-Eva, Paul, and John P. Whitcher. Vaughan and Asbury’s General Ophthalmology. 17th ed. New York: Lange Medical Books/McGraw-Hill, 2007.

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Sun, Ruiyang, et al. "A Review of Clinical Practice Guidelines for Preventing Chlamydial and Gonococcal Ophthalmia Neonatorum." Interdisciplinary Nursing Research, vol. 2, no. 2, May 2023, pp. 76-82, DOI: 10.1097/NR9.0000000000000021. Accessed 4 Feb. 2025.