Neonatal conjunctivitis and its prevention
- Topic
A red, discharging eye in the first month can be gonorrhoea or chlamydia caught at birth. Every newborn gets prophylaxis; an infected one, systemic treatment.
What it is
Neonatal conjunctivitis (ophthalmia neonatorum) is conjunctivitis in the first 28 days of life. It is usually acquired during birth from the mother's genital tract. Gonococcal infection is the most dangerous because it can perforate the cornea within days; chlamydia is the commonest infectious cause and can also cause pneumonia. Prophylaxis at birth and treatment of maternal infection prevent most cases.
Key facts
- Chemical (from prophylaxis drops): first 24 hours, mild, resolves alone.
- Gonococcal: 2 to 5 days, hyperacute, very purulent, swollen lids; risk of corneal perforation.
- Chlamydial: 5 to 14 days, watery to purulent, sometimes with pneumonia later.
- Herpes simplex: 1 to 2 weeks, with vesicles; risk of disseminated disease.
In clinical practice
- Colombian guideline: eye prophylaxis for every newborn as soon as possible after birth, without interrupting skin-to-skin contact; povidone-iodine 2.5%, one drop in each eye, is the first option (educational, not a clinical indication).
- Topical treatment alone is not enough for gonococcal or chlamydial conjunctivitis: both need systemic antibiotics.
- The mother and her partners need testing and treatment for sexually transmitted infections.
Next step / Initial management
- Any conjunctivitis in the first month: Gram stain, culture and chlamydia testing of the discharge, and paediatric assessment the same day.
- Suspected gonococcal infection: admission, systemic antibiotic (ceftriaxone), frequent saline irrigation, ophthalmology for the cornea, and screening for disseminated infection.
- Chlamydial infection: systemic macrolide antibiotic, and watch for pneumonia.
- Herpes simplex: systemic aciclovir and full evaluation for disseminated or central nervous system disease.
Test yourself
Think of the answer, then tap the question to see it.
Which cause of neonatal conjunctivitis starts at 2 to 5 days and threatens the cornea?
Gonococcal conjunctivitis.
Why is topical treatment not enough for chlamydial neonatal conjunctivitis?
Because the infection can also involve the nasopharynx and lungs; systemic antibiotics are needed.
What eye prophylaxis does the Colombian newborn guideline recommend as first option?
Povidone-iodine eye drops for every newborn soon after birth, without interrupting skin-to-skin contact.
Connections
In Pharmacology3
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Guía de práctica clínica del recién nacido sano (Guía No. 02) (Ministerio de Salud y Protección Social de Colombia, 2013); Ophthalmia Neonatorum (Neonatal Conjunctivitis) (StatPearls Publishing (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.