Ophthalmia neonatorum is a conjunctivitis of the eyes in babies. It is also known as neonatal conjunctivitis.
What is ophthalmia neonatorum?
With ophthalmia neonatorum, conjunctivitis (conjunctivitis) of the eye occurs in the first few weeks of life of a newborn child. In most cases, both eyes are affected. Conjunctivitis can be caused by various pathogens, the main ones being bacteria. The incubation period for ophthalmia neonatorum is between two days and two weeks. Symptoms and course of neonatal conjunctivitis depend on their cause. See usvsukenglish for What does the abbreviation ATFP stand for.
The ophthalmia neonatorum appears in the first 28 days of the baby’s life. The classic cause of conjunctivitis are gonococci such as Neisseria gonorrhoeae. However, in the last few decades there has been a significant reduction in gonococcal infections, so that other germs are now responsible for neonatal conjunctivitis. This is mainly chlamydia.
These gram-negative bacteria are the cause of around 73 percent of all conjunctivitis in babies. Other possible causes are staphylococci, streptococci, pseudomonas or viruses such as herpes viruses. However, different environmental influences can also cause conjunctivitis in babies.
Medicine fundamentally differentiates between contagious and non-contagious neonatal conjunctivitis. While infectious ophthalmia neonatorum is caused by bacteria and viruses, the non-infectious form is caused by reactions to pollen, house dust, cosmetic products or hay fever. Other possible causes of the eye disease are chemicals, foreign bodies and excessive exposure to the sun’s rays.
The contagious form can in turn be associated with a cold. It is not uncommon for the germs to be transmitted during the birth process by pressing themselves into the eyelids. Also conceivable is a smear infection after birth from one baby to another. Another circumstance that can lead to the development of neonatal conjunctivitis is the incomplete functioning of the lacrimal ducts. This leads to a build-up of excess tear fluid, which cannot drain properly.
Symptoms, Ailments & Signs
The symptoms of ophthalmia neonatorum can take a different course depending on the pathogen. In the case of an infection by gonococci, doctors speak of gonoblenorrhea. It is characterized by a profuse accumulation of pus. Also, the baby’s eyelids swell, causing pus to spill out when the eyes are opened.
Because gonoblenorrhea causes ulcers on the cornea, it is considered a particularly dangerous form of ophthalmia neonatorum. This shows the formation of holes. In the worst case there is even a risk of blindness. In the case of chlamydial blenorrhea, the baby’s eyes swell and mucous pus builds up.
Characteristic so-called inclusion bodies can be seen in the conjunctival cells. In medicine, the 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, blisters filled with fluid form on the eyelid. Conjunctivitis caused by viruses is considered to be particularly contagious.
Diagnosis & course of disease
If there is a suspicion of conjunctivitis in a baby, a doctor should be consulted. For his examination, the doctor uses a special slit lamp, with the help of which he can examine the different eye structures in magnified form. To examine the inner eyelids, they are folded down.
In order to be able to determine the pathogen, a swab is usually taken. Inclusion bodies in the scraped-off cells of the conjunctiva are an indication of a chlamydial infection. If an allergy is considered a possible trigger of ophthalmia neonatorum, different allergy tests can be carried out.
If the ophthalmia neonatorum undergoes professional treatment and there are no complications, the eye inflammation usually takes a favorable course. The symptoms are then over after about 14 days. However, the healing process can be delayed by the influence of dust, sunlight or cigarette smoke.
In the case of ophthalmia neonatorum, those affected primarily suffer from conjunctivitis. Since this already occurs in the baby, in the worst case it can lead to the blindness of the patient and thus to a significantly delayed development of the child. It can also cause serious problems in adulthood. There is an accumulation of pus in the eye.
The eyes themselves are swollen and sufferers suffer from various visual problems. In many cases, the children cry excessively due to the ophthalmia neonatorum, since they also suffer from eye pain. Ulcers can also form on the cornea itself. If the inflammation of the conjunctiva was caused by viruses, it can also be transmitted to other people.
The treatment of ophthalmia neonatorum is carried out with the help of medication. Taking antibiotics usually leads to a positive course of the disease without complications relatively quickly. The symptoms can be alleviated relatively well, especially with early diagnosis and treatment of the disease. The life expectancy of the patient is not affected by the ophthalmia neonatorum.
When should you go to the doctor?
Since ophthalmia neonatorum, which is associated with pus formation, only occurs in newborns, in most cases the doctor is on the spot immediately. The infectious conjunctivitis that often occurs on both sides of the eyes of newborns usually occurs in the first 14 days of life. With luck, the mother of the child will still be in the maternity hospital. Otherwise, she should immediately consult a pediatrician.
Immediate visit to the doctor is necessary because ophthalmia neonatorum is usually triggered by chlamydia, gonococci, herpes viruses, staphyllococci or streptococci and pseudomonas. 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 can be involved in the purulent infection of the eyes. Fast action is necessary because some pathogens can cause blindness. The newborn patient should be treated promptly. So far, there has only been a prophylactic measure against gonococcal infection. The other infections cannot be treated preventively so far.
In some cases, the infected mother has caused a smear infection at birth. In this case, the mother must also undergo medical treatment. If infected with Chlamydia, even both parents should be treated. Gonoblenorrhea is considered to be a particularly dangerous trigger of ophthalmia neonatorum.
Treatment & Therapy
The treatment of ophthalmia neonatorum depends on the trigger of the eye disease. In the case of gonoblenorrhoea, a special Crede prophylaxis is carried out, which is considered to be very effective against gonococci. In this method, the doctor puts a solution of silver nitrate in the baby’s eyes.
In this way, not only an infection with gonococci is counteracted, but also other pathogens. If a chlamydial infection is responsible for the neonatal conjunctivitis, the doctor usually gives the baby antibiotics. In addition, the baby can be given an eye ointment or eye drops to be placed in the conjunctival sac.
It is not uncommon for the child’s eyes to stick together with tear secretion. This can be washed off with a soft washcloth and warm water. In addition, homeopathic treatment is also possible, but this should be discussed with the doctor. A proven homeopathic remedy is eyebright (Euphrasia), 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 in the eyes can be relieved by applying cool compresses. This is especially important because the baby must not rub his eyes. In addition, the child should not be exposed to bright light and sunshine for a few days.
Instilling a honey solution is a helpful home remedy for conjunctivitis in babies, as it has anti-inflammatory properties. For this purpose, two tablespoon portions of honey are dissolved in half a liter of boiled water.
Outlook & Forecast
Neonatal conjunctivitis (ophthalmia neonatorum) is an inflammation of the conjunctiva in newborns that requires treatment. The prognosis is positive with rapid treatment with antibiotics, provided the pathogen or trigger can be identified.
The symptomatic treatment is related to the cause. The prognosis can also be influenced by the cause of the ophthalmia neonatorum. If the eye is infected by chlamydia, a full recovery of the affected eye can be guaranteed in 80 percent of affected babies. However, it may be that further therapy measures are necessary because chlamydia is persistent. In 20 percent of affected babies, the prognosis for a complete cure is less good.
In the case of bacterial infections of the child’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. Untreated ophthalmia neonatorum infections can lead to permanent eye damage in the newborn – and sometimes even to the death of the child. The reason lies in the lack of a trained immune system.
The prognosis is worse for people with ophthalmia neonatorum who have a virus-related eye infection. Eyesight can be permanently damaged. The systemic consequences can also be fatal. Conjunctivitis caused by chemical irritation resolves within 24 or 36 hours after exposure has ended.
Preventing ophthalmia neonatorum is difficult. The responsible pathogens are often transmitted at birth.
After the treatment of ophthalmia neonatorum, follow-up care for the newborn is urgently required. Because the babies have been treated with antibiotics, there are potential complications from the medication. For this reason, parents must take their children to regular follow-up examinations for up to six weeks.
If it is determined that the newborns have survived the treatment well, no further treatments are necessary after the six weeks. If, on the other hand, it is determined that the antibiotics have caused side effects such as fever or breathing difficulties, these must be treated accordingly with other drugs in order not to endanger the well-being of the child.
However, the follow-up examination is also necessary for the parents and family members who have come into contact with the sick child. Since smear infection can lead to the transmission of pathogens, every person is at risk of unknowingly contracting the newborn. To be on the safe side, family members are usually prescribed antibiotics, which they have to take at the same time as the child.
If, after successful treatment of ophthalmia neonatorum, it is determined that there are no residues of pathogens left in the newborn or family members, no further follow-up steps are necessary. The toddler can grow up normally without the risk of permanent damage or long-term effects.
You can do that yourself
Intensive treatment is usually not required or necessary for ophthalmia neonatorum, as 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 can be used to clear the infection.
An irritating conjunctivitis will go away once the cause is eliminated. 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 carried out by a dermatologist. It is best to relieve the symptoms for the time being. Any sticky or crusty coating on the eyelids or lashes can be cleaned off with cotton and water.
Washing hands regularly and not sharing pillows or towels with the infant will help prevent the spread. The family doctor can check if there is a more serious underlying cause for the symptoms. This should be checked at least in the case of a longer-lasting illness.