**5. Prevention of conjunctivitis**

**4.6. Management of neonatal conjunctivitis**

38 Common Eye Infections

ervative artificial tears have been used in some cases.

sults become available then specific therapy can be instituted.

[45].

12 hours for 7 days [47].

**4.7. Complications of neonatal conjunctivitis**

Prophylaxis- In 1881 for the first time silver nitrate was used as prophylactic treatment to reduce the incidence of ophthalmia neonatorum. Silver nitrate is specifically more effective against gonorrhoeal conjunctivitis. It inactivates gonococci by agglutination. It is not effec‐ tive against Chlamydial conjunctivitis. However silver nitrate use also led to mild conjuncti‐ val inflammation, tearing and redness which typically resolved within 48 hours. Chemical conjunctivitis is a self-limiting condition, therefore no treatment is required. However pres‐

In recent times povidone-iodine drops are used as prophylaxis instead of silver nitrate [41]. These are shown to be more effective against *gonococcal* and *chlamydial* conjunctivitis and al‐ so less toxic. In US, erythromycin is being used as alternative to silver nitrate and povidoneiodine [42]. This is also well tolerated and effective against TRIC and gonococci agents.

Treatment -Treatment of neonatal conjunctivitis should initially be based on the history, clinical presentation and results of smears. This can later be adjusted when laboratory re‐

The risk of transmission of chlamydial, gonococcal, herpetic, and streptococcal pathogens to the foetus during the birth process should be considered. If necessary, cervical cultures should be performed and managed appropriately. To confirm the presence of a sexually transmitted disease in the neonate, examine and treat the mother and her sexual partner. If necessary, therapy can be modified when the results of culture and sensitivity are known. Bacterial conjunctivitis- Chlamydial conjunctivitis is treated with fourteen day course of twice daily oral erythromycin(50 mg/kg/d divided qid) [43, 44]. Systemic therapy is impor‐ tant in Chlamydia conjunctivitis, due to the high incidence of extra-ocular infection in neo‐ nates. It has shown to eliminate Chlamydial infection in 80-100% of patients. Topical erythromycin can be used as adjunct with the oral therapy. If there is failure to respond to this course the fourteen day course can be repeated before seeking alternative antibiotics

Gonococcal conjunctivitis may be treated with intramascular or intravenous ceftriaxone 50 mg/kg/day or as a single dose treatment of 125mg [46]. Alternatively, cefotaxime 100mg can be given intramuscularly or 25 mg/kg given either intramuscularly or intravenously every

Neonates with conjunctivitis caused by herpetic simplex virus should be treated with sys‐ temic acyclovir to reduce the chance of a systemic infection [48]. An effective dose is 60 mg/kg/day IV divided.The recommended minimal duration is 14 days, but a course as long as 21 days may be required.Infants with neonatal HSV keratitis should receive a topical oph‐

Complications of neonatal conjunctivitis vary. There are two main types of complications, ocular and systemic complications. These can be prevented with prompt diagnosis and

thalmic drug, most commonly 1% trifluridine drops or 3% vidarabine ointment.

Infective conjunctivitis is a condition which affects people of all ages. Its spread is something that can be effectively controlled via good personal hygiene and adequate education. Once an individual is affected, rapid measures must be taken to ensure that the spread is limited.

Good personal hygiene is primarily achieved via effective hand washing and eye care. Where an outbreak of the highly contagious viral conjunctivitis has occurred, stringent measures to control the spread must be undertaken immediately. Simple measures such as removal of possible contaminated materials (hand cloth, towels and face cloths) are very ef‐ fective in reducing spread.

For specialist cases of conjunctivitis, i.e. neonatal conjunctivitis and conjunctivitis in the im‐ munocompromised, immediate action must be undertaken to ensure no long term complica‐ tions and quick recovery. Should there be any delay in treatment, the potential for long term damage, and even blindness, is very high. Prevention of such conditions can be attained by immediate and frequent treatment via hospital admissions, prophylactic medication and good eye hygiene.
