Table of Contents
Signs/Symptoms
Causes
Diagnosis
Treatment
Neonatal Conjunctivitis
Signs/Symptoms
Gonococcal conjunctivitis- hyperacute onset (first 3 days up to 3 weeks of life) with copious, purulent conjunctival discharge
marked eyelid edema
chemosis
Corneal involvement in 33% with corneal ulceration and possible perforation
Chlamydial conjunctivitis- subacute onset (5 days to several weeks postpartum) with follicles on everted lower eyelid
blood-stained discharge in 33%
eyelid edema
concurrent lung, nasopharynx, genital infection >50%
genital tract involvement is often present but may be asymptomatic
Causes
Bacteria (36%)
Staphylococcus aureus 16%
Moxarella catarrhalis 9%
Streptococcus pneumoniae 3%
Pseudomonus aeruginosa- rare
Nisseria gonorrhoeae (0.4 per 100,000)
Chlamydia trachomatis (<40%)
Viral (5%)
Rhinovirus 2.4%
Adenovirus 1.8%
Bocavirus 0.6%
Herpes simplex, rare
Diagnosis
Suspect chlamydial ophthalmia
obtain specimin from everted eyelid using Dacron-tipped swab or other specific swab
specimin must contain conjunctival cells
Direct fluorescent antibody (DFA) is the only FDA-cleared non-culture test.
Nucleic acid amplification test (PCR) may be used by CLIA approved labs
Culture
Suspect gonococcal ophthalmia
Gram stain of conjunctival exudate looking for gram-negative intracellular diplococci
Culture
Dual testing for both of the above is recommended
Treatment
Chlamydial ophthalmia neonatorum
erythromycin base or ethyl succinate 50 mg/kg/day divided QID x 14 days
in infants <6 weeks, watch for infantile hypertropic pyloric stenosis as a side effect
Gonococcal ophthalmia neonatorum
ceftriaxone 25-50 mg/kg IV or IM x 1 dose (not to exceed 250 mg)
consider substitute in neonates with hyuperbilirubinemia
do not give if receiving IV calcium
substitute: cefotaxime 100 mg/kg IV or IM x 1 dose
Coinfection with the above two is common so combined treatment should be considered
Other bacteria: consider moxifloxicin TID or QID x 10 days guided by culture with close follow-up
Viral- consider
antiviral treatment
for suspected HSV infection.