Conjunctivitis is inflammation of the conjunctiva, the membrane that lines the eyelid and covers the white of the eye.
Conjunctivitis is caused by bacteria, viruses, or a reaction to chemicals.
Symptoms vary but may include inflammation of and a discharge from the eyes.
The diagnosis is typically based on the appearance of the eyes and sometimes on the results of testing the discharge from the eyes.
Antibiotic and antiviral medications and ointments are given to treat the infection.
The infection may be prevented by drops or ointments that are put in the newborn's eyes after birth and by screening and treatment of pregnant people during pregnancy.
An Inside Look at the Eye
(See also Overview of Infections in Newborns and Infectious Conjunctivitis.)
Causes of Conjunctivitis in Newborns
Conjunctivitis in newborns is most often caused by an infection. An infection can be caused by bacteria or viruses.
If certain bacteria are present in a woman's vagina, they can be passed to the newborn during labor and delivery. Such bacteria include Chlamydia, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria gonorrhoeae, and others.
If a pregnant person has a herpes simplex virus (HSV) infection, it can be passed to the newborn during labor and delivery (see also HSV Infection in Newborns).
Conjunctivitis in newborns also can be caused by a reaction to the eye drops or ointment that newborns receive to prevent infection. This reaction is called chemical conjunctivitis.
Symptoms of Conjunctivitis in Newborns
Symptoms of conjunctivitis may vary depending on the cause of the infection.
Conjunctivitis caused by Chlamydia bacteria usually begins 5 to 14 days after delivery. Newborns have swollen eyelids and a watery discharge from the eyes that contains increasing amounts of pus. The infection can sometimes be severe.
Conjunctivitis caused by Neisseria gonorrhoeae bacteria usually begins 2 to 5 days after delivery. Newborns have severe inflammation of the eyelids and discharge of pus from the eyes. Without treatment, sores may develop on the corneas and blindness may occur.
Conjunctivitis caused by other bacteria begins from 4 days up to several weeks after delivery.
Conjunctivitis caused by herpes simplex virus is rare but potentially very serious.
Conjunctivitis caused by chemicals, usually begins within 6 to 8 hours after the eye drops are put in and goes away by itself within 2 to 4 days.
Diagnosis of Conjunctivitis in Newborns
Testing of the eye discharge
Doctors evaluate the newborn's symptoms and appearance of the eyes.
Samples of eye discharge are sent to a laboratory to identify the infecting organism.
Treatment of Conjunctivitis in Newborns
Antibiotics or antivirals
For conjunctivitis caused by Chlamydia, the antibiotic erythromycin or azithromycin is given by mouth.the antibiotic erythromycin or azithromycin is given by mouth.
For conjunctivitis caused by Neisseria gonorrhoeae, newborns stay in the hospital and are given the antibiotic ceftriaxone or cefotaxime by vein or injection into a muscle. Doctors monitor them to see whether infection develops in other parts of their body.newborns stay in the hospital and are given the antibiotic ceftriaxone or cefotaxime by vein or injection into a muscle. Doctors monitor them to see whether infection develops in other parts of their body.
For conjunctivitis caused by other bacteria, ointments containing polymyxin plus bacitracin, ointments containing polymyxin plus bacitracin,erythromycin, or tetracycline are applied., or tetracycline are applied.
For conjunctivitis caused by herpes simplex virus, newborns are given the antiviral acyclovir by mouth and eye drops that contain another antiviral medication called trifluridine or an eye gel that contains another antiviral medication called ganciclovir.newborns are given the antiviral acyclovir by mouth and eye drops that contain another antiviral medication called trifluridine or an eye gel that contains another antiviral medication called ganciclovir.
Prevention of Conjunctivitis in Newborns
In the United States, erythromycin ointment is routinely applied to each of the newborn's eyes after delivery to prevent conjunctivitis caused by In the United States, erythromycin ointment is routinely applied to each of the newborn's eyes after delivery to prevent conjunctivitis caused byNeisseria gonorrhoeae. In some other countries, silver nitrate eye drops, tetracycline eye drops or ointment, or povidone iodine eye drops may be used. . In some other countries, silver nitrate eye drops, tetracycline eye drops or ointment, or povidone iodine eye drops may be used.
Povidone iodine eye drops also may prevent conjunctivitis caused by Chlamydia.
Newborns of women who have untreated gonorrhea should receive a single injection of the antibiotic ceftriaxone even if they are not yet ill. In contrast, newborns of women with chlamydia are typically monitored by doctors and treated with antibiotics only if they develop symptoms.Newborns of women who have untreated gonorrhea should receive a single injection of the antibiotic ceftriaxone even if they are not yet ill. In contrast, newborns of women with chlamydia are typically monitored by doctors and treated with antibiotics only if they develop symptoms.
Pregnant people who at the time of labor have an active episode of genital herpes simplex virus infection (visible sores or blisters) or who have symptoms indicating an episode is going to start (such tingling or burning on the genitals) can undergo a cesarean delivery (c-section) to prevent spreading the virus to their newborn.
Pregnant people who have had a genital herpes infection before may be given antivirals starting at 36 weeks of pregnancy to prevent spreading the virus to their newborn.
Screening and treatment of pregnant people
Screening and treating pregnant people for gonorrhea and chlamydia are the most effective ways to prevent conjunctivitis in the newborn caused by these bacteria. All pregnant people are screened at their first prenatal visit and again during the third trimester if they are at high risk of developing one of these infections. (See also Screening for Chlamydia and Screening for Gonorrhea.)
Pregnant people are given appropriate antibiotics if an infection is diagnosed.
