II. Definition
- Conjunctivitis within the first 4 weeks of life
III. Pathophysiology
- Typically vertical transmission via birth canal
IV. Causes
- Chemical Conjunctivitis (most common)
- Typically a reaction to prophylactic Topical Antibiotics applied at birth (less common with Erythromycin than Silver Nitrate)
- Mild palpebral edema and clear, sterile Eye Discharge
- Onset <24-36 hours within eye prophylaxis at birth
- Resolves within 48 hours of birth
-
Gonorrheal Conjunctivitis
- See Gonorrhea
- Onset typically within 2-4 days of life (up to 7 days of life)
- Severe bilateral involvement with lid edema, Chemosis, and purulent exudates
- Risk of Corneal Ulcer and Corneal perforation
-
Chlamydia Conjunctivitis
- Onset within 5-14 days of birth (up to 3-4 weeks)
- Initial mild watery discharge
- Progresses to diffuse swelling and Chemosis with copious and purulent discharge
-
Herpes Simplex Virus
Conjunctivitis (HSV Conjunctivitis)
- Onset within 6-14 days of birth
- Up to 20% of HSV infected infants are affected
- Corneal Herpetic Dendrites on Fluorescein stain
- Risk of disseminated Herpes Simplex Virus
- Risk of Vision Loss as well as Keratitis, Uveitis, Cataracts, chorioretinitis, Optic Neuritis
- Other causes
V. Differenital Diagnosis
-
Dacryostenosis (blocked tear ducts)
- Common in infants, presenting with a build-up of yellow, sticky, non-purulent secretions
- Treated with warm compresses to the eye
VI. Prevention
- Erythromycin ophthalmic ointment in first hour of life
VII. References
- Williams (2017) Crit Dec Emerg Med 31(2): 3-12
- Yanoff (1999) Ophthalmology, Mosby, p. 1.7
- Fuloria (2002) Am Fam Physician 65(1):61-8 [PubMed]