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Ophthalmia%20neonatorum Diagnosis
Diagnosis
- Laboratory diagnosis is important in identifying the causative agent & appropriate treatment
Classification
- Identifying the specific cause & clinical presentation of ophthalmia neonatorum is essential in deciding the treatment to be given to the infant
- Usually connotes to chemical conjunctivitis
- Classically secondary to silver nitrate instillation for ocular infection prophylaxis
- Time of onset: 1-36 hrs postpartum
- Usually disappears w/ withdrawal of offending agent or spontaneously in 2-4 days
- Clinical presentation:
- Mild, transient conjunctival injection w/ tearing
- Lid swelling associated w/ redness of the eyes
- Rarely, lacrimal stenosis
- Bacterial, chlamydial or viral infection acquired during passage through an infected birth canal
- Due to the lack of immunity & absence of local lymphoid tissue at birth, the neonatal conjunctiva is particulalry vulnerable to infection
- Genital serovars type D-K of Chlamydia trachomatis is the most frequent cause of neonatal conjunctivitis
- Also called inclusion conjunctivitis
- Time of onset: 5-14 days postpartum
- Colonization of the eye w/ C. trachomatis after birth does not always result in infection
- Clinical presentation:
- Eyelid edema
- Bulbar conjunctival injection
- Initially the discharge is watery then becomes mucopurulent discharge
- No follicles
- Pseudomembrane formation
- Severe cases may result in conjunctival scarring & peripheral corneal pannus w/ corneal scarring
- Hemorrhagic eye discharge is a highly specific sign of neonatal chlamydial conjunctivitis
- Infantile pneumonia may occur if it is left untreated
- Untreated cases may persist for 3-12 months
- Other extraocular involvement: Nasopharyngeal, rectal & vaginal colonization
- Usual cause is the gram-negative diplococcus Neisseria gonorrhoeae that can penetrate an intact epithelium causing epithelial edema & corneal ulceration
- More severe than chlamydial neonatal conjunctivitis as it can progress to corneal perforation, endophthalmitis & blindness if unrecognized & untreated
- Incubation period: 2-5 days
- Time of onset: 24-48 hours postpartum
- Can present later (> 7 days) if a topical antibiotic was used
- Can occur earlier in cases of premature rupture of membranes
- Clinical presentation:
- Severe hyperacute purulent discharge
- Marked eyelid edema
- Marked chemosis
- Marked builbar conjunctival injection
- Pre-auricular lymphadenopathy
- Other extraocular involvement: Stomatitis, arthritis, rhinitis, septicemia, meningitis & anorectal infection
Laboratory Tests
Cultures
- Indicated in all cases of suspected neonatal conjunctiviits
- Chlamydia trachomatis culture specimens should contain conjunctival cells & not exudate only
- Obtained from the everted eyelid using a dacron-tipped swab
- Neisseria gonorrhea cultures is best done using blood agar, chocolate agar &/or Thayer-Martin media
- Viral cultures are not routinely used to establish a diagnosis
- Smears for cytology & special stains are recommended in cases of suspected infectious neonatal conjunctivitis
- Conjunctival scrapings for gram stain & giemsa stains should be obtained from the palpebral conjunctiva of all infants w/ neonatal conjunctivitis
- Gonococcal neonatal conjunctivitis has gram negative intracellular kidney bean-shaped diplococci in conjunctival smears
- Chlamydial neonatal conjunctivitis shows intracytoplasmic inclusion bodies in Giemsa stain
- Herpetic conjunctivitis has eosinophilic intranuclear inclusions
- Highly sensitive & specific for diagnosing chlamydial cause of neonatal conjunctivitis w/ results obtained w/in several hours
- Gold standard for diagnosing chlamydial infections
- Shows the presence of an impressively large number of punctate, fluorescing chlamydial elementary bodies, resembling “star-spangled sky at night”
- For detection of Chlamydia trachomatis immunoglobulin (IgG) & immunoglobulin (IgM) antibodies
