GCMHS DEPARTMENT OF

PEDIATRICS AND CHILD

HEALTH
Dr. Yohanes
Hailu(Pediatrician)
OPHTHALMIA NEONATORUM

09/24/2020
 Occurs in infants younger than 4 wk of age.
 Etiology :

Hailu(MD)
Yirgalem medical college. Pby Yohanes
 Neisseria
gonorrhea
 Pseudomonas.
 Chlamydia trachomatis

 Risk factors:
 Maternal infections,
 Prophylactic measures,
 Circumstances during labor and delivery, and
 Post delivery exposure to microorganisms.
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EPIDEMIOLOGY

09/24/2020
 Acquired during vaginal delivery and reflects the
sexually transmitted infections prevalent in the

Hailu(MD)
Yirgalem medical college. Pby Yohanes
community.
Clinical Manifestations
 Rednessand chemosis (swelling) of the
conjunctiva, edema of the eyelids, and discharge,
which may be purulent.

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CONT…

09/24/2020
 The usual incubation period for conjunctivitis
due to N. gonorrhea is 2-5 days, and for C.

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Yirgalem medical college. Pby Yohanes
trachomatis is 5-14 days.
 Gonococcal infection may be present at birth or
be delayed beyond 5 days of life owing to partial
suppression by ocular prophylaxis.

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CONT…

09/24/2020
 Gonococcal conjunctivitis
 begins with mild inflammation and a serosanguineous

Hailu(MD)
Yirgalem medical college. Pby Yohanes
discharge. Within 24 hr, the discharge becomes thick
and purulent, and tense edema of the eyelids with
marked chemosis occurs.
 If proper treatment is delayed, the infection may
spread to involve the deeper layers of the
conjunctivae and the cornea.
 Complications include corneal ulceration and
perforation, iridocyclitis, anterior synechiae, and
rarely panophthalmitis.
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CONT….

09/24/2020
 C. trachomatis conjunctivitis (inclusion
blennorrhea)

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Yirgalem medical college. Pby Yohanes
 vary from mild inflammation to severe swelling of
the eyelids with copious purulent discharge.
 mainly involves the tarsal conjunctivae; the corneas
are rarely affected.
 Conjunctivitisdue to Staphylococcus aureus or
other organisms is similar to that produced by C.
trachomatis.
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CONT…

09/24/2020
 Conjunctivitis due to Pseudomonas aeruginosa
 acquired in the nursery, and a potentially serious

GCMHS . Pby Yohanes Hailu(MD)

process.
 characterized by the appearance on days 5-18 of
edema, erythema of the lids, purulent discharge,
pannus formation, endophthalmitis, sepsis,
shock, and death.

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DIAGNOSIS

09/24/2020
 N. gonorrhea
 Gram stain of the purulent discharge and culture.

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Yirgalem medical college. Pby Yohanes
 Chlamydial conjunctivitis
 Giemsa-stained epithelial cells scraped from the tarsal
conjunctivae for the characteristic intracytoplasmic
inclusions
 Culture
 Immunofluorescent staining of conjunctival scrapings
for chlamydial inclusions, or
 By tests for chlamydial antigen or DNA.
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TREATMENT

09/24/2020
 N. gonorrhea
 Ceftriaxone 50 mg/kg/24 hr for 1 dose, not to exceed

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Yirgalem medical college. Pby Yohanes
125 mg.
 saline irrigation every 10-30 min, gradually
increasing to 2-hr intervals until the purulent
discharge has cleared.
 Cefotaxime (100 mg/kg/24 hr given IV or IM every
12 hr for 7 days or 100 mg/kg as a single dose) is an
alternative.
 Treatment is extended if sepsis or other extraocular
sites are involved (meningitis, arthritis).
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CONT…

09/24/2020
 Chlamydial neonatal conjunctivitis
 oralerythromycin (50 mg/kg/24 hr in 4 divided

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Yirgalem medical college. Pby Yohanes
doses) for 2 wk
 Pseudomonas neonatal conjunctivitis
 Treated with systemic antibiotics plus local saline
irrigation and gentamicin ophthalmic ointment.
 Staphylococcalconjunctivitis is treated with
parenteral methicillin and local saline irrigation.

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PROGNOSIS AND PREVENTION

09/24/2020
 Drops of 0.5% erythromycin, tetracycline or 1%
silver nitrate are instilled directly into the open

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Yirgalem medical college. Pby Yohanes
eyes at birth.
 Identification of maternal gonococcal infection
and appropriate treatment.
 An infant born to a woman who has untreated
gonococcal infection should receive a single
dose of ceftriaxone, 50 mg/kg (maximum
125 mg) IV or IM, in addition to topical
prophylaxis. 11
 Yirgalem medical college. Pby Yohanes
09/24/2020
Hailu(MD)
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