Neonatal conjunctivitis

  • Definition
    • Conjunctivitis is swelling or infection of the membrane that lines the eyelids and covers the white part of the eye.

      Conjunctivitis may occur in a newborn child.

  • Alternative Names
    • Newborn conjunctivitis; Conjunctivitis of the newborn; Ophthalmia neonatorum; Eye infection - neonatal conjunctivitis

  • Causes
    • Swollen or inflamed eyes are most commonly caused by:

      • A blocked tear duct
      • Eye drops with antibiotics, given right after birth
      • Infection by bacteria or viruses

      Bacteria that normally live in a woman's vagina may be passed to the baby during childbirth. More serious eye damage may be caused by:

      • Gonorrhea and chlamydia: These are infections spread from sexual contact.
      • The viruses that cause genital and oral herpes: These 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. She still may carry bacteria or viruses that can cause this problem.

  • 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 exam to look for damage to the surface of the eyeball
  • Treatment
    • Eye swelling 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 most often tried before starting antibiotics. Surgery may be needed if a blocked tear duct has not cleared up by the time the baby is 1 year old.

      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)
    • Quick diagnosis and treatment usually leads to good outcomes.

  • Possible Complications
    • Complications may include:

      • 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 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. An example would be having an unsupervised birth at home. This is very important if you have or are at risk for any sexually transmitted disease.

  • Prevention
    • Pregnant women should get treatment for diseases spread through sexual contact to prevent newborn conjunctivitis caused by these infections.

      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 (C-section) is recommended to prevent serious illness in the baby.

  • References
    • Olitsky SE, Hug D, Plummer LS, et al. Disorders of the conjunctiva. In: Kliegman RM, Stanton BF, St Geme JW III, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 626.

      Rubenstein JB, Tannan A. Conjunctivitis: infectious and noninfectious. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. St. Louis, MO: Elsevier Saunders; 2014:chap 4.6.