Neonatal conjunctivitis is the inflammation of the conjunctiva during the first four weeks of a baby’s life. The causes can be split into two categories. Non-infectious neonatal conjunctivitis is caused by chemical irritants. Infectious conjunctivitis is caused by bacteria. Viral conjunctivitis is caused by the Herpes simplex virus (HSV).
The symptoms and signs of neonatal conjunctivitis depend on the causative agents. Chemical conjunctivitis usually presents with mild conjunctival infection and watering and is usually seen in the first 24 hours after birth. Conjunctivitis due to Chlamydia trachomatis usually appears as early as three days or within two weeks of birth. Mild redness and minimal discharge are the usual symptoms but some may even develop eyelid swelling, and pseudo-membrane formation.
Neisseria gonorrhea conjunctivitis is usually seen in both eyes and is associated with swelling of the conjunctiva, severe lid oedema, and discharge containing mucus and pus within 3-5 days of birth. Herpes simplex virus conjunctivitis presents in the first two weeks with lid oedema, minimal conjunctival redness, and watering. The presence of vesicles (fluid-filled cysts) on the skin around the eye is a clue to HSV conjunctivitis.
Major risk factors are unhygienic birth canal and inadequate hygiene during delivery. Hence deliveries ought to be carried in a sterile and hygienic environment while taking proper care of the baby’s eyes. The baby’s eyelids and surrounding areas must be cleaned and kept free of secretions.
If the problem is due to chemicals, it requires no treatment as it resolves spontaneously in 2-4 days. Chlamydial conjunctivitis requires the use of antibiotic drops. Sometimes, oral antibiotic syrup is given for 2-3 weeks. Gonococcal conjunctivitis requires the discharge to be cleared, necessitating the use of various antibiotic ointments.
On the other hand, viral neonatal conjunctivitis or HSV keratoconjunctivitis entails the use of anti-viral ointments and intravenous antiviral medications depending on whether the central nervous system is involved or not. If left untreated it can cause blindness. Therefore, it is important that parents respond to the baby’s symptoms at the earliest.
