Neonatal conjunctivitis

Causes

Neonatal conjunctivitis is most commonly caused by:

• A blocked tear duct
• Infection by bacteria or viruses, or irritation from antibiotic eyedrops containing silver nitrate (these are rarely used anymore)

Bacteria that normally live in a woman's vagina may cause a milder form of neonatal conjunctivitis. However, an infection with other bacteria or viruses can be very serious.

• The most common bacteria that can cause serious eye damage are gonorrhea and chlamydia, which can be passed from mother to child during birth.
• The viruses that cause genital and oral herpes may also be passed to the baby during childbirth, and may lead to severe eye damage. Herpes eye infections are less common than those caused by gonorrhea and chlamydia.

The mother may not have symptoms at the time of delivery. Yet she still may carry bacteria or viruses that can cause conjunctivitis in the newborn.

Symptoms

Infected newborn infants develop drainage from the eyes within 1 day to 2 weeks after birth.

The eyelids become puffy, red, and tender.

There may be watery, bloody, or thick pus-like drainage from the infant's eyes.

Exams and Tests

The health care provider will perform an eye exam on the baby. If the eye does not appear normal, the following tests may be done:

• Culture of the drainage from the eye to look for bacteria or viruses
• Slit-lamp examination to look for damage to the surface of the eyeball

Treatment

Eye irritation that is caused by the eye drops given at birth should go away on its own.

For a blocked tear duct, gentle warm massage between the eye and nasal area may help. This is usually tried before starting antibiotics. If a blocked tear duct has not cleared up by the time the baby is a year old, surgery may be needed.

Antibiotics are often needed for eye infections caused by bacteria. Eye drops and ointments may also be used. Salt water eye drops may be used to remove sticky yellow drainage.

Special antiviral eye drops or ointments are used for herpes infections of the eye.

Outlook (Prognosis)

Early diagnosis of infected mothers and good preventive practices at hospitals have made this problem much less common in newborns. Quick diagnosis and treatment usually leads to good outcomes.

Possible Complications

• Blindness
• Inflammation of the iris
• Scar or hole in the cornea--the clear structure that is over the colored part of the eye (the iris)

When to Contact a Medical Professional

Talk to your health care provider if you have given birth (or expect to give birth) in a place where antibiotic or silver nitrate drops are not routinely placed in the infant's eyes -- for example, if you are having an unsupervised birth at home. This is especially important if you have had, or are at risk for, any sexually transmitted disease.

Prevention

Treating a pregnant woman for sexually transmitted diseases will prevent conjunctivitis caused by these infections in her newborn.

Putting eye drops into all infants' eyes in the delivery room right after birth can help prevent many infections. (Most states have laws requiring this treatment.)

When a mother has active herpes sores at the time of delivery, a cesarean section is recommended to prevent serious illness in the baby.

Alternative Names

Newborn conjunctivitis; Conjunctivitis of the newborn; Ophthalmia neonatorum

References

Rubenstein JB, Virasch V. Conjunctivitis: infectious and noninfectious. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 4.6.

Update Date: 11/14/2011

Updated by: Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review Provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.