Merck Manual

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Conjunctivitis in Newborns

(Neonatal Conjunctivitis; Ophthalmia Neonatorum)

By

Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Last full review/revision Jul 2020| Content last modified Jul 2020
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Topic Resources

Conjunctivitis is inflammation of the conjunctiva, the membrane that lines the eyelid and covers the white of the eye.

  • Conjunctivitis is caused by bacteria, viruses, or a reaction to chemicals.

  • Symptoms vary but may include inflammation of and a discharge from the eyes.

  • The diagnosis is typically based on the appearance of the eyes.

  • The infection may be prevented by drops or ointments that are put in the eyes after birth.

  • Antibiotics and antibiotic ointments are given to treat the infection.

An Inside Look at the Eye

An Inside Look at the Eye

Causes

Conjunctivitis in newborns can be caused by an infection or by a reaction to chemicals put into the eyes (called chemical conjunctivitis). An infection can be caused by bacteria or viruses.

If certain bacteria are present in the mother's vagina, they can be passed to the newborn during delivery. Such bacteria include Chlamydia, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria gonorrhoeae, and others.

Chemical conjunctivitis is a reaction to the eye drops that newborns receive to prevent infection.

Symptoms

Symptoms of conjunctivitis may vary depending on the cause of the infection.

Conjunctivitis caused by chlamydia usually begins 5 to 14 days after delivery but sometimes as late as 6 weeks after. Newborns have swollen eyelids and a watery discharge from the eyes that contains increasing amounts of pus. The infection can sometimes be severe.

Conjunctivitis caused by gonorrhea usually begins 2 to 5 days after delivery. Newborns have severe inflammation of the eyelids and discharge of pus from the eyes. Without treatment, blindness may occur.

Conjunctivitis caused by chemicals, such as eye drops, usually begins within 6 to 8 hours after the drops are put in and goes away by itself within 2 to 4 days.

Conjunctivitis caused by other bacteria begins from 4 days up to several weeks after delivery.

Diagnosis

  • Testing of the eye discharge

Doctors evaluate the newborn's symptoms and appearance of the eyes.

Samples of eye discharge are sent to a laboratory to identify the infecting organism.

Prevention

In the United States, erythromycin ointment or drops are routinely put into each of the newborn's eyes after delivery to prevent conjunctivitis caused by Neisseria gonorrhoeae. In other countries, silver nitrate, tetracycline, or povidone iodine also may be used. Except for povidone iodine, these drugs do not prevent conjunctivitis caused by Chlamydia.

Newborns of women who have untreated gonorrhea should receive a single injection of the antibiotic ceftriaxone even if they are not yet ill.

Treatment

  • Antibiotics

For conjunctivitis caused by Chlamydia, the antibiotic erythromycin or azithromycin is given by mouth.

For conjunctivitis caused by Neisseria gonorrhoeae, newborns are hospitalized and given the antibiotic ceftriaxone or cefotaxime by vein or injection.

For conjunctivitis caused by other bacteria, ointments containing polymyxin plus bacitracin, erythromycin, or tetracycline are applied.

Drugs Mentioned In This Article

Generic Name Select Brand Names
No US brand name
ZITHROMAX
ACHROMYCIN V
ERY-TAB, ERYTHROCIN
ROCEPHIN
CLAFORAN
BACIIM
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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