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CLINICAL MANAGEMENT GUIDELINES
Ophthalmia neonatorum
Aetiology
Ophthalmia Neonatorum (ON) (conjunctivitis of the newborn) occurs
within the first month of life. It is a bacterial, chlamydial or viral infection
acquired during passage through an infected birth canal. Since April
2010 it is no longer a notifiable disease in the UK
Historically, the commonest agent was Neisseria gonorrhoeae (also
known as ‘gonococcus’, and a cause of sexually-transmitted disease).
The use of silver nitrate drops as prophylaxis was introduced in the 19th
century, although abandoned in the UK in the 1950s. Gonococcal ON
develops in approx. 30-50% of newborns exposed during delivery
Nowadays a more usual agent, also sexually acquired by the mother, is
Chlamydia trachomatis. Babies born to women with untreated
chlamydial infection at delivery have a 30-50% chance of developing ON
The incubation period is usually as follows:
 C. trachomatis: 5-14 days
 N. gonorrhoeae: 3-5 days
The prevalence of ON differs in different parts of the world and is
dependent mainly upon socio-economic conditions, level of knowledge
about general health, standard of maternal healthcare as well as the type
of prophylactic programme used. In the UK, the incidence in 2003 was:
 C. trachomatis: 6.9 per 100,000 live births
 N. gonorrhoeae: 3.7 per 100,000 live births
In developing countries, very much higher incidences have been
reported
Other bacteria that cause ON include Haemophilus, Streptococcus,
Staphylococcus and Pseudomonas species
Viral infections (less common) can be caused by herpes simplex virus,
adenovirus or enterovirus
Predisposing factors
Symptoms
Signs
The neonatal conjunctiva is particularly vulnerable to infection because
of the lack of immunity and the absence of local lymphoid tissue at birth
Infection of the maternal birth canal as the result of sexually-transmitted
disease
This infection may be asymptomatic, especially in the case of C.
trachomatis
(Usually described by mother):
 redness
 discharge (may be profuse in gonococcal infection)
 swelling of lids (may be severe)
 symptoms usually bilateral
Lids
 oedema (may impede examination of ocular surfaces)
Conjunctival features
 mucopurulent conjunctivitis – discharge may be profuse in C.
trachomatis infection. Danger of infection of clinician when
prising open lids
 NB: in neonatal C. trachomatis infection there are no follicles as
in adults, because of the neonate’s lack of lymphoid tissue
 conjunctival oedema (‘chemosis’)
 conjunctival membrane in severe cases
Ophthalmia neonatorum
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Date of search 17.02.16; Date of revision 13.06.16; Date of publication 17.10.16; Date for review 16.02.18
© College of Optometrists
CLINICAL MANAGEMENT GUIDELINES
Ophthalmia neonatorum
Corneal features
 cornea can be involved, especially in N. gonorrhoeae infection.
This organism can pass through intact corneal epithelium.
Perforation may result
 signs usually bilateral; may be asymmetrical
Differential diagnosis
 By definition, conjunctivitis occurring within the first month of life
is ON
 Congenital obstruction of the nasolacrimal duct(s) is often
associated with epiphora, discharge and recurrent conjunctivitis
(see Clinical Management Guideline on Nasolacrimal Duct
Obstruction)
Management by Optometrist
Practitioners should recognise their limitations and where necessary seek further advice or refer
the patient elsewhere
Non pharmacological
None
Pharmacological
None
Management Category A1: emergency (same day) referral to ophthalmologist; no intervention
ON may result in a severe and progressive conjunctivitis with corneal
complications and be associated with potentially serious systemic
infection
Possible management by Ophthalmologist
Diagnosis
 conjunctival cultures for bacteria (N. gonorrhoeae requires
special media)
 conjunctival scraping for Gram stain (bacteria) and Giemsa stain
(for C. trachomatis)
 Polymerase Chain Reaction (PCR) studies
Treatment
Bacterial conjunctivitis
 systemic penicillin G or a cephalosporin for N. gonorrhoeae
 topical erythromycin sometimes given in addition
 other topical antibiotics, including azithromycin or
chloramphenicol
 frequent irrigation until discharge ceases
Chlamydial conjunctivitis
 systemic erythromycin
 topical azithromycin
Herpetic conjunctivitis
 systemic and topical antiviral, e.g. aciclovir
Evidence base
*GRADE: Grading of Recommendations Assessment, Development and
Evaluation (see http://gradeworkinggroup.org/toolbox/index.htm)
Sources of evidence
Darling EK, McDonald H. A meta-analysis of the efficacy of ocular
prophylactic agents used for the prevention of gonococcal and
chlamydial ophthalmia neonatorum. J Midwifery Womens Health
2010;55:319-27
McAnena L, Knowles SJ2, Curry A, Cassidy L. Prevalence of gonococcal
conjunctivitis in adults and neonates. Eye (Lond). 2015;29(7):875-80
Ophthalmia neonatorum
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Date of search 17.02.16; Date of revision 13.06.16; Date of publication 17.10.16; Date for review 16.02.18
© College of Optometrists
CLINICAL MANAGEMENT GUIDELINES
Ophthalmia neonatorum
Moore DL, MacDonald NE; Canadian Paediatric Society, Infectious
Diseases and Immunization Committee. Preventing ophthalmia
neonatorum. Can J Infect Dis Med Microbiol. 2015;26(3):122-5
LAY SUMMARY
The definition of Ophthalmia Neonatorum (conjunctivitis of the newborn) is an eye infection that
occurs within the first 30 days of life. It is caught during birth by contact with the mother’s birth
canal if it is infected with a sexually-transmitted disease. The infection may be caused by any one
of a number of germs, such as bacteria, (including chlamydia) or viruses. Historically, gonorrhoea
was the usual cause, but chlamydial infection is now more common. Globally, the prevalence of
this infection varies widely according to prevailing socio-economic conditions, health education and
maternal healthcare.
The baby’s eyes are red, the eyelids and the whites of the eyes are swollen and there is watering or
a discharge. Usually both eyes are affected, but one may be worse than the other. One of the
dangers of gonorrhoeal eye infection is that it may affect the cornea (the clear window of the eye).
Early diagnosis is important and for this reason, the optometrist is advised to refer all cases
immediately to the on-call ophthalmologist. Swabs will be taken to aid diagnosis and treatment will
be started without delay, using antibiotics given by mouth or by injection or into a vein, and in eye
drop form.
Ophthalmia neonatorum
Version 9, Page 3 of 3
Date of search 17.02.16; Date of revision 13.06.16; Date of publication 17.10.16; Date for review 16.02.18
© College of Optometrists