Ophthalmia neonatorum refers to conjunctivitis of the eye in babies. It is also known as neonatal conjunctivitis.
What is ophthalmia neonatorum?
In ophthalmia neonatorum, conjunctivitis (inflammation of the conjunctiva) of the eye occurs during the first few weeks of a newborn baby’s life. In most cases, both eyes are affected. Conjunctivitis can be caused by various pathogens, which primarily include bacteria. The incubation period of ophthalmia neonatorum is between two days and two weeks. The symptoms and course of neonatal conjunctivitis depend on its causative agent.
Causes
Ophthalmia neonatorum presents in the first 28 days of the baby’s life. Gonococci such as Neisseria gonorrhoeae are considered the classic cause of conjunctivitis. However, in recent decades there has been a significant reduction in gonococcal infections, so that in modern times other germs are responsible for neonatal conjunctivitis. These are primarily chlamydia. These gram-negative bacteria are the cause of about 73 percent of all conjunctivitis in babies. Other possible causes are staphylococci, streptococci, pseudomonads or viruses such as herpes viruses. However, different environmental influences can also cause conjunctivitis in babies. Medicine basically differentiates between infectious and noninfectious neonatal conjunctivitis. While infectious ophthalmia neonatorum is triggered by bacteria and viruses, the non-infectious form is caused by reactions to pollen, house dust, cosmetic products or hay fever. Other possible originators of the eye disease are chemicals, foreign bodies, and excessive exposure to sunlight. The contagious form, in turn, may be associated with a cold. It is not uncommon for the germs to be transmitted during the birthing process by being pressed into the eyelids. Smear infection after birth from one baby to another is also conceivable. Another circumstance that can lead to the development of neonatal conjunctivitis is the incomplete functioning of the lacrimal ducts. This causes a buildup of excess tear fluid that cannot drain properly.
Symptoms, complaints, and signs
Symptoms of ophthalmia neonatorum can vary depending on the pathogen. In the case of infection by gonococci, doctors speak of gonoblennorrhea. It is characterized by a strong accumulation of pus. In addition, the baby’s eyelids swell, causing pus to come out when the eyes are opened. Because gonoblennorrhea causes ulcers on the cornea, it is considered a particularly dangerous form of ophthalmia neonatorum. This is how the development of holes is manifested. In the worst case, there is even a threat of blindness. In case of chlamydial blennorrhea, the baby’s eyes swell and mucous pus is formed. Characteristic so-called inclusion bodies can be seen in the conjunctival cells. In medicine, this form of the disease is therefore also called inclusion body conjunctivitis. If herpes viruses trigger ophthalmia neonatorum, this is noticeable by a swollen and reddened conjunctiva. In addition, vesicles filled with fluid form on the eyelid. Conjunctivitis caused by viruses is considered particularly contagious.
Diagnosis and course of the disease
If conjunctivitis is suspected in a baby, a doctor should definitely be consulted. For his examination, the doctor uses a special slit lamp, with the help of which he can magnify the different eye structures. To examine the inner eyelids, they are folded down. In order to determine the pathogens, a smear is usually taken. An indication of a chlamydia infection are the inclusion bodies in the scraped cells of the conjunctiva. If an allergy is considered a possible trigger of ophthalmia neonatorum, different allergy tests can be performed. If ophthalmia neonatorum is treated professionally and there are no complications, the eye inflammation usually takes a favorable course. The symptoms are then over again after about 14 days. However, the healing process can be delayed by the influence of dust, sunlight or cigarette smoke.
Complications
In ophthalmia neonatorum, those affected suffer primarily from conjunctivitis. Since this occurs in this case already in the baby, it can lead in the worst case to blindness of the patient and thus to a significantly delayed development of the child. It can also cause considerable discomfort in adulthood. There is an accumulation of pus at the eye. The eyes themselves are swollen and those affected suffer from various visual complaints. In many cases, children cry excessively due to ophthalmia neonatorum, as they also suffer from eye pain. Furthermore, ulcers may also form on the cornea itself. If the inflammation of the conjunctiva is caused by viruses, it can also spread to other people. The treatment of ophthalmia neonatorum is carried out with the help of medications. Taking antibiotics usually leads to a positive course of the disease relatively quickly without complications. Especially if the disease is diagnosed and treated at an early stage, the symptoms can be alleviated relatively well. The patient’s life expectancy is not affected by ophthalmia neonatorum.
When should you see a doctor?
Because ophthalmia neonatorum associated with pus formation occurs only in newborns, the physician is on the scene immediately in most cases. Often bilateral, infectious conjunctivitis in the eyes of newborns usually occurs in the first 14 days of life. With luck, the child’s mother will still be at the maternity hospital at that time. Otherwise, she should immediately consult a pediatrician. The immediate visit to the doctor is necessary because ophthalmia neonatorum is usually triggered by chlamydia, gonococci, herpes viruses, staphyllococci or streptococci, and pseudomonads. Depending on the trigger, the first symptoms of the infection appear within a few hours or only after several days. It is also possible that two of the triggers may be involved in the purulent eye infection. Quick action is necessary because some pathogens can cause blindness. The newborn patient should be treated promptly. Only against gonococcal infection there is a prophylactic measure so far. The other infections cannot be treated prophylactically so far. In some cases, a smear infection has occurred during birth due to the infected mother. In this case, the mother must also undergo medical treatment. In the case of infection with chlamydia, even both parents should be treated. Gonoblenorrhea is considered a particularly dangerous trigger of ophthalmia neonatorum.
Treatment and therapy
Treatment of ophthalmia neonatorum depends on the particular trigger of the eye disease. In the case of gonoblenorrhea, special crede prophylaxis is given, which is considered very effective against gonococci. In this method, the doctor drips a silver nitrate solution into the baby’s eyes. In this way, not only is infection with gonococci counteracted, but also other pathogens. If a chlamydia infection is responsible for the neonatal conjunctivitis, the doctor usually gives the baby antibiotics. In addition, the baby may receive an eye ointment or eye drops to be placed in the conjunctival sac. It is not uncommon for the baby’s eye to become stuck with lacrimal secretions. This can be washed out with a soft washcloth and warm water. In addition, homeopathic treatment is also possible, but this should be discussed with the doctor. Eyebright (Euphrasia) is considered a proven homeopathic remedy, which can be taken either in the form of globules or tablets. Eyebright is also available in the form of eye drops. Itching and burning of the eye can be relieved by applying cool compresses. This is especially important because the baby should not rub his eyes. Also, the child should not be exposed to bright light and sunshine for a few days. A helpful home remedy for conjunctivitis in the baby is considered to be the instillation of a honey solution, as it has anti-inflammatory properties. For this purpose, dissolving two tablespoon portions of honey in half a liter of boiled water.
Outlook and prognosis
Neonatal conjunctivitis (ophthalmia neonatorum) is an inflammation of the conjunctiva in the eye of newborns that requires treatment.The prognosis is positive with rapid treatment with antibiotics, provided that the causative agent or trigger can be identified. Symptomatic treatment is cause-related. The prognosis may also be influenced by which causative agent is present for ophthalmia neonatorum. If the eye is infected by chlamydia, complete recovery of the affected eye can be ensured in 80 percent of affected babies. However, further treatment may be necessary because chlamydia is persistent. In 20 percent of affected babies, the prognosis for complete recovery is less good. In bacterial infections of the baby’s eye, the prognosis is positive. The causative bacteria almost always respond to treatment. However, this must be done promptly and with appropriate therapeutic agents. Ophthalmia neonatorum infections that remain untreated can lead to permanent damage to the newborn’s eye – and sometimes to the death of the child. The reason is the lack of a developed immune system. The prognosis is worse for ophtalmia neonatorum sufferers who have a virus-related eye infection. Vision may suffer permanent damage. The systemic consequences can also be fatal. Conjunctivitis triggered by chemical irritation resolves within 24 or 36 hours after exposure ends.
Prevention
Preventing ophthalmia neonatorum is difficult. For example, the responsible pathogens are often transmitted at birth.
Aftercare
After treatment for ophthalmia neonatorum, follow-up care for the newborns is urgently needed. Because the babies have been treated with antibiotics, any complications may arise from the medications. For this reason, parents need to take the babies for regular follow-ups for up to six weeks. If it is determined that the newborns have survived the treatment well, no further treatments are needed after the six weeks. If, on the other hand, it is found that the antibiotics have caused side effects such as fever or breathing difficulties, these must be treated accordingly with other medications so as not to endanger the child’s well-being. However, follow-up is also necessary for parents and family members who have come into contact with the sick child. Because smear infection can result in the transmission of pathogens, there is a risk that any person may have unknowingly contracted the disease from the newborn. To be on the safe side, family members are also usually prescribed antibiotics, which they must take at the same time as the child. If, after successful treatment of ophthalmia neonatorum, it is determined that no residual pathogens remain in the newborn or family members, no further follow-up steps are necessary. The infant can grow up normally without risk of permanent damage or late effects.
Here’s what you can do yourself
Ophthalmia neonatorum usually does not require or need intensive treatment because symptoms often improve within a few weeks. If treatment is needed, the type of treatment depends on the cause. In severe cases, antibiotic eye drops may be used to clear the infection. Irritant conjunctivitis will disappear once the cause is removed. Allergic conjunctivitis can usually be treated with anti-allergy medications such as antihistamines. If possible, the substance that caused the allergy should be avoided. If it is not known which substances trigger these symptoms, then an allergy test should be performed at the dermatologist. It is best to relieve the symptoms for the time being. Any sticky or crusty coating on the eyelids or eyelashes can be cleaned with absorbent cotton and water. Washing hands regularly and not sharing pillows or towels with the infant will prevent spread. The primary care physician can check to see if there is a more serious underlying cause for the symptoms. This should be checked at least in case of a prolonged illness.
