Download Eye Infections: Neonatal - Women and Newborn Health Service

WOMEN AND NEWBORN HEALTH SERVICE
King Edward Memorial Hospital
CLINICAL GUIDELINES
WOMEN AND NEWBORN
HEALTH
OBSTETRICS
ANDSERVICE
MIDWIFERY
NEONATAL CARE
King Edward Memorial Hospital
NEONATAL COMPLICATIONS: NEONATAL SEPSIS
EYE INFECTIONS: NEONATAL
Key words: neonatal infection, eye infection, conjunctivitis, ophthalmia neonatorum, puffy eyes, sticky
eyes, nasal lacrimal duct obstruction, moist eyes, neonatal eye care, eye toilet, eye care
AIM
The identification and appropriate management of eye infections in the neonate.
BACKGROUND INFORMATION
Conjunctivitis is the most common neonatal infection, and bacterial infection is the most likely cause if
it occurs within 2-5 days of birth. Purulent discharge is more common with bacterial infections.
Infection from Chlamydia trachomatis (usually seen 5-14 days post birth) may initially present as watery
discharge and later become purulent, and if blood-stained is highly specific for Chlamydia. Herpes
simplex conjunctivitis may present 5 - 14 days post birth and usually causes a nonpurulant and
serosanguineous discharge. A greenish discharge is more characteristic of Pseudomonas aeruginosa
infection, while gonorrhoea infection causes the neonate to have red, swollen eyes with purulent
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discharge.
Other causes that may mimic conjunctivitis such as foreign bodies, lacrimal duct obstruction, trauma
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and glaucoma should be excluded.
DEFINITIONS AND MANAGEMENT
‘PUFFY EYES’
Both upper and lower eyelids are oedematous so that the conjunctives are not visible. There are no
extra secretions. This is usually bilateral and no treatment is required.
‘MOIST EYES’
The eyelids may be oedematous and moist but there is no stickiness and no crusting of the lids. This
is usually bilateral and simple sterile eye toilets should be given to these neonates.
NASAL LACRIMAL DUCT OBSTRUCTION
Nasolacrimal duct obstruction is caused by an imperforate membrane at the end of the nasolacrimal
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duct, and is found in 2 – 6% of all newborns. Persistent tearing, crusting or matting of the eyelids, and
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spilling of tears without conjunctivitis may indicate nasal lacrimal duct obstruction,
which is usually
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unilateral. Mucopurulent material discharge may occur and indicate need for ophthalmic antibiotics.
Conservative management is recommended in the first year of life as the majority of cases will resolve
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spontaneously or with massage.
‘STICKY EYES’
Mild eye infections are referred to as ‘sticky eyes’. Frequent eye cleansing with sterile cotton wool
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moistened with normal saline may be all that is required.
Note: If there are any doubts about eye discharge / infection with ? purulent discharge, inform
the paediatric team immediately.
PURULENT EYE INFECTION (CONJUNCTIVITIS)
Purulent discharge from eyes may result from congenital or acquired infection.
Perform eye toilet and inform the paediatrician/paediatric registrar or RMO.
Note: if there are any doubts about eye discharge / infection with? purulent discharge inform
the paediatric team immediately.
DPMS
Ref: 5329
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 1 of 3
Conduct a history, physical examination, and document eye discharge including:
the age of the infant – timing of the eye infection may indicate risk from different causative
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bacteria
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determination if the infection is unilateral or bilateral
the characteristics of the discharge
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maternal history of sexually transmitted diseases, and confirmation of normal pathology
results for sexually transmitted infections if done during the pregnancy
exclusion of other causes e.g. eye trauma, lacrimal duct obstruction, foreign bodies, glaucoma
physical examination to exclude respiratory or systemic infection
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EYE TOILET
EQUIPMENT
Sterile cotton balls
Sterile sodium chloride 0.9%
PROCEDURE
1. Explain the procedure to the mother/parents
2. Open the cotton wool balls and pour the sodium chloride over them
3. Perform hand hygiene
4. Clean the least effected eye first
5. Gently wipe across eyelids starting at the inner canthus and moving laterally to the outer
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canthus. Discard the swab after one sweep. Continue until the eyelids appear clean.
6. Perform hand hygiene
7. Document
SPECIMEN COLLECTION
Refer to Neonatal Clinical Care Unit Guidelines, Section 8 Infection, Septic Screening and
Management for instruction regarding collection of bacterial / viral eye swabs.
Specimens are collected from each eye
Perform an eye toilet after collection of the swabs
TREATMENT OF EYE INFECTIONS
Refer to Neonatal Clinical Care Unit Guidelines, Section 8 Infection, septic screening and management
Also see Clinical Guidelines Neonatal Drug Protocols A-Z for individual antibiotic treatments
1. Ensure written instructions are clearly documented on the ‘MR811 Neonatal Inpatient
Medication Chart’.
2. Label all eye medications with the neonate’s identification sticker, the date of opening and the
eye the medication is to be used in e.g. left or right eye. Discard the medication according to
the expiry date following manufacturer’s instructions.
3. The medication must be checked against the written order and the neonate’s identification
bands by two nursing /midwifery staff.
4. Perform hand hygiene, and then complete an eye toilet.
5. Instil eye medication.
6. Perform hand hygiene. Document.
7. Provide verbal instructions to the mother about the technique of instilling eye medication, the
expiry date of the medication, storage, and hygiene measures prior to discharge if the
treatment has not been completed.
Eye Infections in the Neonate
Clinical Guidelines: Obstetrics & Midwifery
DPMS
Ref: 5329
King Edward Memorial Hospital
Perth Western Australia
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 2 of 3
REFERENCES / STANDARDS
1.
2.
Gomella TL, Cunningham MD, Eyal FG. Eye Discharge (Conjunctivitis). In: Gomella TL, Cunningham FG, Eyal FG,
Tuttle D, editors. Neonatology Management, Procedures, On-Call Problems, Diseases, and Drugs. 6th ed.
Sydney: The McGraw-Hill Companies; 2009. p. 277-81.
Gomella TL, Cunningham MD, Eyal FG. Eye Disorders of the Newborn and Retinopathy of Prematurity. In: Gomella
TL, Cunningham FG, Eyal FG, Tuttle D, editors. Neonatology Management, Procedures, On-Call Problems,
Diseases, and Drugs. 6th ed. Sydney: The McGraw-Hill Companies; 2009. p. 454-62.
3.
Takahashi Y, Kakizaki H, Chan WO, Delva D. Management of congenital nasolacrimal duct obstruction. Acta
Ophthalmologica. 2010(88):506-13.
4.
Siderov J. The newborn eye: visual function and screening for ocular disorders. Examination of the Newborn and
Neonatal Health A Multidimensional Approach. Philadelphia: Churchill Livingstone; 2008. p. 183-95.
5.
Bates C. Infection. In: Macdonald S, Magill-Cuerden J, editors. Mayes' Midwifery. 14th ed. Sydney: Bailliere Tindall;
2011. p. 689-98.
National Standards – 1- Care Provided by the Clinical Workforce is Guided by Current Best Practice
Legislation Related Policies Other related documents – KEMH Clinical Guidelines:
NCCU: Section 8 Infection, Septic Screening and Management
NCCU: Neonatal Drug Protocols A-Z for Individual Antibiotic Treatments
RESPONSIBILITY
Policy Sponsor
Initial Endorsement
Last Reviewed
Last Amended
Review date
Nursing & Midwifery Director OGCCU
September 2001
October 2013
February 2015
October 2016
Do not keep printed versions of guidelines as currency of information cannot be guaranteed.
Access the current version from the WNHS website.
Eye Infections in the Neonate
Clinical Guidelines: Obstetrics & Midwifery
DPMS
Ref: 5329
King Edward Memorial Hospital
Perth Western Australia
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 3 of 3