OPHTHALMIA NEONATORUM (CONJUNCTIVITIS)
Ophthalmia neonatorum is defined as inflammation of conjunctiva during first month of life.
CAUSES: The common causative agents are:
(i) Chlamydia trachomatis (oculogenitalis);
(ii) Other bacterial causes:
(a) Gonococcus (rare), Staphylococcus, Pseudomonas;
(b) Chemical—silver nitrate;
(c) Viral: herpes simplex (type II)
MODE OF INFECTION: Infection occurs mostly during delivery by contaminated vaginal discharge. It is more likely in face or breech delivery. During neonatal period, there may be direct contamination from other sites of infection or by chemical.
CLINICAL FEATURES: The clinical picture varies and the discharge may be watery, mucopurulent to frank purulent in one or both eyes. The eyelids may be sticky or markedly swollen. Cornea may be involved in severe cases.
PROGNOSIS is favorable to most cases except in neglected cases with rare gonococcal infection. Fortunately, effective methods of prophylaxis and treatment have almost eliminated the risk of blindness.
PREVENTION: Any suspicious vaginal discharge during the antenatal period should be treated and the most meticulous obstetric asepsis is maintained at birth. The newborn baby’s closed lids should be thoroughly cleansed and dried.
Nitric-acid: Gonorrhoeal ophthalmia; lids swollen, hard and painful, great photophobia, copious discharge of yellow pus, corroding and inflaming cheeks.
Argentum nitricum: Ophthalmia neonatorum: profuse, purulent discharge; cornea opaque, ulceration; lids sore, thick, swollen; agglutinated in morning. Acute granular conjunctivitis; scarlet-red, like raw beef; discharge profuse, muco-purulent.
Thuja: ophthalmia neonatorum, sycotic or syphilitic; large granulations, like warts or blisters; > by warmth and covering; in uncovered, feels as if a cold stream of air were blowing out through them. Eyelids: agglutinated at night; dry, scaly on edges.
Syphilinum: Acute ophthalmia neonatorum; lids swollen, adhere during sleep; pain intense at night < from 2 to 5 a. m., pus profuse; > by cold bathing.
Pulsatilla: Thick, profuse, yellow, bland discharges. Itching and burning in eyes. Profuse lachrymation and secretion of mucus. Lids inflamed, agglutinated. Styes. Veins of fundus oculi greatly enlarged.
Calcarea sulph. : Inflammation of the eyes, with discharge of thick, yellow matter. Sees only one-half an object. Cornea smoky. Ophthalmia neonatorum.