Ophthalmia Neonatorum

Ophthalmia Neonatorum (ON) is a serious infection of the eye, prevalent among the newborns and is potentially sight threatening. Read and find out all about the symptoms, causes, diagnosis and treatment of this disease.

Ophthalmia Neonatorum Definition

It is a type of bacterial conjunctivitis or infection of the eyelid tissues, occurring among newborns during delivery. The problem arises when the eyes of a newborn get infected while passing through the birth canal of a woman suffering from Chlamydia trachomatis or Neisseria gonorrhoeae.

This form of eye swelling is generally present during the first 28 days of birth and can be septic or aseptic.

This medical condition is also referred to as:

  • Neonatal conjunctivitis
  • Conjunctivitis of the newborn

Ophthalmia Neonatorum ICD9 Code

The ICD9 code for this disorder is 098.40.

Ophthalmia Neonatorum Incidence

This irritation of the eye is quite common among the newborns. Conjunctivitis of the newborn affects 1-2% of the infants in the west and almost 23% in developing nations of US and Europe.

Ophthalmia Neonatorum Types

The condition is differentiated into various types, which includes:

Picture of Ophthalmia Neonatorum

Picture 1 – Ophthalmia Neonatorum

  • Infectious ON
  • Non-Infectious ON

Ophthalmia Neonatorum Causes

The disorder may result due to a number of factors depending on its type. Such form of conjunctivitis can be:

Causes of Infectious ON

Bacterial infections such as Chlamydia and N. gonorrheae present in the birth canal of a woman can give rise to conjunctivitis in the neonate. Conjunctivitis of a newborn occurring due to Neisseria gonorrhoeae is generally characterized by local inflammation and pussy discharge. It is considered to be one of the most fatal and dangerous causes for Neonatal conjunctivitis and can give rise to serious consequences. In contrast, conjunctivitis caused due to Chlamydia trachomatis infection gives rise to conjunctivitis which can be persistent for up to 3 weeks.

It is one of the most common contagious causes of conjunctivitis of the newborn and generally affects infants born to infected mothers. Other agents which can give rise to Neonatal conjunctivitis may include:

  • Staphylococcus aureus
  • Streptococcus pneumonia
  • Herpes simplex virus (HSV 2)
  • Streptococcus haemolyticus

Causes of Non-infectious ON

A few chemical irritants like silver nitrate often give rise to chemical conjunctivitis in newborns, persisting for 2-4 days. Hence, chloramphenicol and neomycin should be put to use instead of silver nitrate. Apparently, silver nitrate facilitates agglutinate gonococci and inactivates them. Silver nitrate is lethal to such form of conjunctivitis. It leads to sterile neonatal conjunctivitis.

Ophthalmia Neonatorum Symptoms

The warning signs of the disorder, which indicate its presence among affected newborns, may include:

  • Conjunctival discharge – mucoid, purulent or mucopurulent
  • Corneal association may arise in herpes simplex ophthalmia neonatorum
  • Tenderness along with pain in the eyeball
  • Swollen eyelids

Ophthalmia Neonatorum Diagnosis

A health care provider initiates the diagnosis of neonatal conjunctivitis by performing a proper examination of the eye of the baby. If the eye of a newborn displays the signs of conjunctivitis, a few diagnostic procedures are recommended including:

Culture of the drainage from the eye

This diagnostic procedure is advised to determine the existence of any virus or bacteria

Sit-lamp Examination

Such tests are recommended to determine any kind of injury on the surface of the eyeball of a newborn.

Ophthalmia Neonatorum Differential Diagnosis

ON is considered to be identical to various other disorders, including:

  • Glaucoma, Secondary Congenital
  • Keratitis, Bacterial
  • Keratitis, Herpes Simplex
  • Nasolacrimal Duct, Obstruction
  • Glaucoma, Primary Congenital
  • Glaucoma, Secondary Congenital
  • Keratitis, Bacterial
  • Cellulitis, Orbital
  • Cellulitis, Preseptal
  • Dacryocystitis
  • Keratitis, Fungal

Ophthalmia Neonatorum Treatment

Neonatal conjunctivitis inflicts potential threat to the eye. Hence, conjunctivitis of the newborns in the US is treated with antibiotic eye drops along with ointments. In rare case, when the disorder is severe patients are recommended with medical surgery following delivery. This prevents the growth of any eye contamination in case a mother shows signs of infection. Treatment for newborns affected with ON depends on the cause which includes:

Irritation

Neonatal conjunctivitis arising due to irritation gets cured on its own. In rare cases, irritation may arise due to the use of antibiotics containing silver nitrate, given during delivery. Hospitals now prefer to use other forms of antibiotics to avoid such irritation.

Blocked Tear Duct

For conjunctivitis of the newborn arising due to blocked tear duct, doctors recommend warm compresses along with regular massage in order to unblock the duct

Bacteria

Neonatal conjunctivitis, arising due to any bacterial infection is recommended with antibiotics. Such antibiotics are used as ointments, topical drops or even as injections to remove the discharge for eyes which are filled with puss.

Ophthalmia Neonatorum Prognosis

Neonatal conjunctivitis reacts to apt treatment and the prognosis is considered to be really good. Use of antibiotics significantly changed the prognosis of the neonatal conjunctivitis which is accompanied with Nesseria Gonorrhoeae infection. Due to the influence of the infecting agent, patients affected with neonatal conjunctivitis often suffer from death.

Ophthalmia Neonatorum Risk Factors

Patients injected with STD during the delivery time are more at risk of getting affected with ON. In rare cases, a pregnant woman might not be suffering from any symptom but may still unknowingly transmit the bacteria in the newborn. Pregnant women are highly recommended to discuss any previous session of STD with their respective healthcare providers in order to prevent the baby from all kinds of infections during delivery.

Ophthalmia Neonatorum Complications

This disorder often gives rise to a number of complications in the body of the patient, including:

Image of Ophthalmia Neonatorum

Picture 2 – Ophthalmia Neonatorum Image

  • Conjunctivits
  • Keratits
  • Superior Corneal Pannus
  • Pseudomonas spp. infection

In few cases, patients experience side effects for the treatment of such bacterial conjunctivitis such as the relation between IHPS (infantile hypertrophic pyloric stenosis) and oral erythromycin.

Ophthalmia Neonatorum Prevention

In order to prevent a newborn from getting affected with the disorder, the pregnant woman should be treated for sexually transmitted diseases. Doctors often suggest eye drops for the newborns right after delivery, in order to prevent many viral infections including conjunctivitis. If a pregnant woman experiences herpes sores during the delivery time, cesarean section is highly recommended to prevent the newborn from any kind of illness.

Ophthalmia Neonatorum is a serious disorder of the eye. If a newborn in the family is experiencing irritation in the eye or having swollen eyelids, consulting a doctor at the earliest is highly recommended. Lack of proper treatment can increase the pain in the eye. Proper detection and accurate treatment can heal the syndrome and provide great relief to the eye.