pediatrics
Neonatal Conjunctivitis
Symptoms and Signs of Neonatal Conjunctivitis
Because they overlap in both manifestation and onset, causes of neonatal conjunctivitis are difficult to distinguish clinically. Conjunctivae are injected, and discharge (watery or purulent) is present. Chemical conjunctivitissecondary to topical prophylaxis usually appears within 6 to 8 hours after instillation and disappears spontaneously within 48 to 96 hours. Chlamydial ophthalmiausually occurs 5 to 14 days after birth. It may range from mild conjunctivitis with minimal mucopurulent discharge to severe eyelid edema with copious drainage and pseudomembrane formation. Follicles are not present in the conjunctiva, as they are in older children and adults. Gonococcal ophthalmiacauses an acute purulent conjunctivitis that appears 2 to 5 days after birth or earlier with premature rupture of membranes. The neonate has severe eyelid edema followed by chemosis and a profuse purulent exudate that may be under pressure. If untreated, corneal ulcerations and blindness may occur. Conjunctivitis caused by other bacteriahas a variable onset, ranging from 4 days to several weeks after birth. Herpetic keratoconjunctivitiscan occur as an isolated infection or with disseminated or central nervous system infection. It can be mistaken for bacterial or chemical conjunctivitis, but the presence of dendritic keratitis is pathognomonic. 