II. Definition

  1. Conjunctivitis within the first 4 weeks of life

III. Pathophysiology

  1. Typically vertical transmission via birth canal

IV. Causes

  1. Chemical Conjunctivitis (most common)
    1. Typically a reaction to prophylactic Topical Antibiotics applied at birth (less common with Erythromycin than Silver Nitrate)
    2. Mild palpebral edema and clear, sterile Eye Discharge
    3. Onset <24-36 hours within eye prophylaxis at birth
    4. Resolves within 48 hours of birth
  2. Gonorrheal Conjunctivitis
    1. See Gonorrhea
    2. Onset typically within 2-4 days of life (up to 7 days of life)
    3. Severe bilateral involvement with lid edema, Chemosis, and purulent exudates
    4. Risk of Corneal Ulcer and Corneal perforation
  3. Chlamydia Conjunctivitis
    1. Onset within 5-14 days of birth (up to 3-4 weeks)
    2. Initial mild watery discharge
    3. Progresses to diffuse swelling and Chemosis with copious and purulent discharge
  4. Herpes Simplex Virus Conjunctivitis (HSV Conjunctivitis)
    1. Onset within 6-14 days of birth
    2. Up to 20% of HSV infected infants are affected
    3. Corneal Herpetic Dendrites on Fluorescein stain
    4. Risk of disseminated Herpes Simplex Virus
    5. Risk of Vision Loss as well as Keratitis, Uveitis, Cataracts, chorioretinitis, Optic Neuritis
  5. Other causes
    1. Moraxella catarrhalisConjunctivitis
    2. Adenovirus

V. Differenital Diagnosis

  1. Dacryostenosis (blocked tear ducts)
    1. Common in infants, presenting with a build-up of yellow, sticky, non-purulent secretions
    2. Treated with warm compresses to the eye

VI. Prevention

  1. Erythromycin ophthalmic ointment in first hour of life

VII. References

  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Yanoff (1999) Ophthalmology, Mosby, p. 1.7
  3. Fuloria (2002) Am Fam Physician 65(1):61-8 [PubMed]

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