Our today's topic is neonatal conjunctivitis, inflammation of the conjunctiva in neonates, this is a very high yield topic, so let's get started.
First of all, what the flip is the conjunctiva? The conjunctiva is a mucous membrane that lines the inner surface of your eyelid and the outer surface of your eyeball. It covers the sclera, but it does not cover the cornea. It stops at the limbus.
Inflammation of this membrane is called conjunctivitis, and this will give you a red eye or a pink eye. Since the conjunctiva does not cover the cornea, and it does not interfere with light rays entering into your eye, conjunctivitis, for the most part, does not affect your visual acuity. Your eye is going to hurt, but you will continue to see.
After the lovely baby is delivered, doctors usually give topical erythromycin ointment or topical tetracycline ointment or silver nitrate drops. This varies from country to country.
Why do doctors do this? This is because they want to prevent ophthalmia neonatorum aka neonatal conjunctivitis, especially the one that's caused by gonorrhea.
When did the conjunctivitis happen can give you a clue regarding the cause of the conjunctivitis. If it happens on day one, it's usually chemical conjunctivitis caused by the ointment or the drops that you just gave the baby. If it happens on day two or after, it's usually bacterial.
If it happens after 14 days or after 21 days, every textbook is different, this is probably viral conjunctivitis. Don't forget CBV, chemical conjunctivitis, followed by bacterial conjunctivitis, then you have viral conjunctivitis. Chemical, bacterial, viral.
However, the bacteria is divided into two groups. First, Neisseria gonorrhea, usually between day two and day seven. And then Chlamydia trachomatis, some textbooks will say between day 5 and 14, others will say between 7 and 21.
Lastly, we have viral, this is HSV, herpes simplex virus. Is it HSV1 or HSV2? Since this is neonatal conjunctivitis, the baby got the virus in his or her eye from the vaginal canal. And as you know, generally speaking, HSV1 is above the waist, HSV2 is below the waist. Since the vaginal canal is below the waist, this is herpes simplex virus 2. So mommy has HSV2 in the vaginal canal.
Mommy's is going to transmit herpes simplex virus 2 to the baby, this is called vertical transmission. And now the baby has HSV2 in his or her eye, this is herpes simplex conjunctivitis. And that's why if mommy has herpes, do not perform vaginal delivery.
You should do a C-section to prevent HSV conjunctivitis. Because as you know, once the baby has HSV, it's not going away. The symptoms will come and go, but the virus is there to stay.
It remains dormant in the ganglia for decades and decades and decades.
Symptoms of Conjunctivitis
Now let's talk about the symptoms of conjunctivitis. If it's chemical, it's a very, very mild conjunctival injection.
What if it's nocirogonarrhea? That's terrible. Profuse purulent ocular discharge. What does purulent mean? Purulent is the same as pyogenic, is the same as suppurative, is the same as pus.
There is tons of pus in the eye, with significant ocular swelling, gonorrhea is horrible. If it's chlamydia, it can be watery discharge, not purulent, or it could be mucoperulent.
But there is no question that nocirogonarrhea is way more purulent than chlamydia, generally speaking. Also there is some ocular swelling. Who makes pus? Neutrophils.
What's the function of neutrophils? To protect your body against bacteria. Okay, do neutrophils protect my body against viruses? Shut up, they do not. And that's why if you have a virus, you have a non-purulent discharge with no pus, because pus is made by neutrophils, and neutrophils only defend your body against bacteria, not viruses.
So you have non-purulent ocular discharge, corneal ulceration, and the nasty infamous periocular vesicles. Whenever you have HSV, you can have vesicles. Vesicles, HSV, HSV, vesicles.
Do you remember shingles? Yeah, shingles was caused by herpes zoster virus in the same family, and shingles also has vesicles across a dermatome unilaterally.
Prevention and treatment
First of all, chemical irritation or chemical conjunctivitis is caused by the ointment. It's not an allergy by the way, and the treatment is just to irrigate the eye with saline.
How about Neisseria gonorrhoeae? For prophylaxis, the topical erythromycin ointment, or topical tetracycline ointment, etc. For treatment, ceftriaxone, which is a third generation cephalosporin.
For chlamydia, you cannot prevent it with ointment, it's not very effective against chlamydia. Treatment, oral, not topical, oral erythromycin or oral azithromycin. These are macrolides, because macrolides are erythromycin, azithromycin, clarithromycin.
For herpes simplex, the treatment is a systemic medication and a local medication. So for the systemic, that's acyclovir. For the topical, this is videribine.
If the baby has chlamydia trachomatis conjunctivitis. You should treat that and you should give medications to the mother and any sick contact for prophylaxis.
So for the baby, you'll give oral erythromycin or azithromycin, either one is a macrolide. For the prophylaxis, for the mother or sick contact, close contacts, you give oral erythromycin, the same, or amoxicillin, not azithromycin, amoxicillin for one week.
Closing Thought
If you want to learn more about antibacterials, antivirals, antifungals, and antiparasitic medications, follow this blog and stay tuned as we will be releasing post on this topics gradually
Thank you for reading, hope you have learned something.
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