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Conjunctivitis is an inflammation of the membranes that line the inside of the eyelid and the lining of the eyeball. When the condition occurs in babies younger than 4 weeks old, it is called neonatal conjunctivitis.

What is going on in the body?

The conjunctiva is a mucous membrane that forms the outermost layer of the eye. Any type of irritation to the eye can cause the blood vessels in the conjunctiva to enlarge. This makes the eye appear red. Irritation also causes the eye to produce more tears. When the eye is infected, white blood cells and mucus are seen on the conjunctiva. This appears as a thick, yellow-green discharge from the eye.

What are the signs and symptoms of the disease?

Neonatal conjunctivitis is often caused by bacteria. The symptoms may include:

• discharge from the eye that may contain pus
• redness and swelling of the conjunctiva
• swelling of the eyelid

If the infection progresses deeper into the eye, the following symptoms may occur:

• clouding of the cornea, which is the normally clear covering of the eye
• fever
• marked redness of the eye
• severe eye pain

What are the causes and risks of the disease?

Conjunctivitis in newborns is often caused by bacteria acquired during birth. The baby gets the bacteria from the mother's vagina during delivery. These bacteria may come from an infection that the mother contracted sexually. Conjunctivitis caused by gonorrhea used to be the leading cause of blindness. It shows up at birth or within the first week afterward.

Chlamydia, another sexually transmitted infection (STI), also causes conjunctivitis in newborns. About half of infants born to infected mothers get the eye infection. Symptoms from this type of the disease show up several days to weeks after birth.

Newborns today are routinely treated with antibiotic eye drops to prevent gonorrheal and chlamydial conjunctivitis.

An infant can also be infected if his or her eyes are touched by contaminated hands or objects.

A rare cause of conjunctivitis is the Pseudomonas aeruginosa bacterium. Since it is generally found in hospital settings, newborns and hospitalized people are more at risk. The bacteria can get into the infant's bloodstream and travel throughout the body. The result can be shock and death.

Staphylococcus and other bacteria can sometimes cause neonatal conjunctivitis. These infections are similar to those caused by chlamydia.

What can be done to prevent the disease?

Many cases of neonatal conjunctivitis can be prevented by screening and treating pregnant women for STIs.

Putting antibiotic ointment in newborns' eyes right after birth helps prevent gonococcal conjunctivitis. Silver nitrate eye drops were at one time commonly used for this purpose, but have been found to cause chemical irritation of the infant's eyes. The Centers for Disease Control and Prevention (CDC) now recommend erythromycin or tetracycline eye ointment.

Infants born to mothers who have chlamydia infection should be treated with oral antibiotics.

How is the disease diagnosed?

The healthcare professional can make an initial diagnosis by examining the infant. The provider may order lab tests to confirm the diagnosis.

Gonorrhea organisms can be detected by looking at eye discharge under a microscope. Scrapings of the conjunctiva must be taken to find Chlamydia bacteria. Other bacteria can be found by growing cells from the conjunctiva in the lab. Antibody titer tests can be done to measure antibodies to bacteria in the baby's blood.

What are the long-term effects of the disease?

Untreated gonococcal conjunctivitis can cause permanent scarring and blindness. Infections with pseudomonas can cause similar damage to the eye. This type of infection may also lead to bloodstream infection, shock, and death. Infants infected with chlamydia can develop pneumonia.

What are the risks to others?

Neonatal conjunctivitis can be passed from infant to infant in a nursery. This can happen if caregivers do not use good handwashing techniques.

What are the treatments for the disease?

The treatment depends on the type of infection:

• Babies born to mothers with gonorrhea are given oral antibiotics right after birth.
• Babies born to mothers with chlamydia need to take oral antibiotics, such as erythromycin.
• Newborns with gonococcal conjunctivitis need to be hospitalized and treated with an antibiotic, such as ceftriaxone (i.e., Rocephin).
• Conjunctivitis and pneumonia caused by chlamydia is treated with an oral antibiotic, such as erythromycin.
• Infants with gonococcal or pseudomonas conjunctivitis will be given regular saline eye rinses.
• Infants with conjunctivitis caused by Pseudomonas or Staphylococcus are treated with intravenous (IV) antibiotics.

What are the side effects of the treatments?

Topical antibiotics may cause an allergic reaction. Oral antibiotics may cause stomach upset, rash, or allergic reactions.

What happens after treatment for the disease?

The healthcare professional will evaluate the baby to see how the conjunctivitis is clearing up. If symptoms continue or progress, further treatment may be necessary.

How is the disease monitored?

Babies should be watched to make sure the infection does not return after treatment. Mothers of infants with neonatal conjunctivitis should be tested and treated for sexually transmitted infections when appropriate. Any new or worsening symptoms should be reported to the healthcare professional.