Ophthalmia Neonatorum

Definition

Ophthalmia neonatorum is acute conjunctivitis occurring in newborns within the first 28 days of life, typically caused by bacterial or viral pathogens acquired during delivery. It can lead to serious ocular complications if untreated.

Epidemiology

• Incidence varies globally, higher in areas with limited prenatal screening and prophylaxis
• Typically presents within the first 2–14 days of life depending on pathogen
• Bacterial causes predominate in developing countries; viral causes more common in some settings
• Higher risk in infants born to mothers with untreated sexually transmitted infections
• Routine prophylaxis with topical antimicrobials has reduced incidence in many countries

Etiology

• Bacterial: Neisseria gonorrhoeae, Chlamydia trachomatis, Staphylococcus aureus, Streptococcus species, Haemophilus influenzae
• Viral: Herpes simplex virus (HSV) type 1 or 2
• Chemical conjunctivitis: reaction to prophylactic eye drops (rare)
• Transmission primarily via vertical passage through infected birth canal

Pathophysiology

• Pathogen inoculation occurs during passage through birth canal
• Adhesion and invasion of conjunctival epithelial cells trigger inflammation
• Neutrophilic response leads to purulent discharge in bacterial infections
• HSV infection can cause epithelial necrosis and vesicular lesions
• Inflammation may spread to cornea, leading to keratitis or corneal ulceration
• Delayed or untreated infections risk permanent ocular damage