ophthalmia neonatorum (chlamydial)

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Ophthalmia neonatorum is literally, an infection of the newborn eye. It is usually a conjunctivitis; rarely a penetrating keratitis

  • Ophthalmia neonatorum, also known as neonatal conjunctivitis, describes conjunctivitis occurring within the first 28 days of life (1)

Causes include:

  • from maternal genital tract:
    • Neiserria gonorrhoeae
    • Chlamydia trachomatis
    • Group B beta-haemolytic streptococci
  • from cross infection:
    • Staphylococcus aureus
    • Coliforms
    • Pseudomonas aeruginosa

  • clinical features
    • all cases of neonatal conjunctivitis present with discharge, conjunctival redness, and lid swelling, but the severity and timing of these features vary according to the aetiology
      • examination of an infant with any of these signs should include visualisation of the lids, cornea, and tarsal and bulbar conjunctiva under direct illumination
      • instillation of fluorescein drops by the primary care practitioner is not necessary
      • if the conjunctiva is red and inflamed, infection can be assumed

    • if the baby is otherwise well then eye swabs should be sent as follows:
      • for bacterial and viral culture. Also microscopy (looking for intracellular gonoccoci) and chlamydia (e.g. via immunofluorescence)
      • clearly, if the baby is otherwise unwell, a full sepsis screen is indicated

  • treatment depends on cause - all cases of neonatal conjunctivitis are investigated for both gonococcal and chlamydia infection

A review suggests (3):

  • consider neonatal conjunctivitis in all infants presenting with eye discharge within the first 4 weeks of life

  • carefully examine the conjunctiva: if red, refer to hospital eye services for same day review
    • NICE recommends urgent referral to ophthalmology for all cases of "sticky eye with redness in a neonate"

  • investigations and treatment for suspected neonatal conjunctivitis in primary care are not necessary and may interfere with subsequent microbiology sampling

  • eye discharge with normal conjunctiva is likely due to congenital nasolacrimal duct obstruction

Notes:

  • not all neonatal eye discharge is due to conjunctivitis, however, with congenital nasolacrimal duct obstruction being a common and benign cause of sticky eyes in newborns
    • distinguishing these conditions when babies present to primary care services helps avoid unnecessary referrals to secondary care and undue distress for new parents

Reference:

Last edited 03/2022 and last reviewed 04/2022

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