Neonatal conjunctivitis – a review

  • Mallika PS
  • Asok T
  • Faisal HA
  • Aziz S
  • AK Tan
  • Intan G
Keywords: Crédés Prophylaxis, Neonatal Conjunctivitis, Ophthalmia Neonatorum, Sexually Transmitted Diseases


Ophthalmia neonatorum remains a significant cause of ocular morbidity, blindness and even death in underdeveloped countries. Theorganisms causing ophthalmia neonatorum are acquired mainly from the mother’s birth canal during delivery and a small percentage ofcases are acquired by other ways. Chlamydia and Neisseria are the most common pathogens responsible for the perinatal infection.Fortunately in most cases, laboratory studies can identify the causative organism and unlike other form of conjunctivitis, this perinatalocular infection has to be treated with systemic antibiotics to prevent systemic colonization of the organism. Routine prophylaxis with 1%silver nitrate solution (crédés method) has been discontinued in many developed nations for the fear of development of chemical conjunctivitis.


Fransen L, Klauss V. Neonatal ophthalmia in the developing world. Epidemiology, etiology, management and control. Int Ophthalmol. 1988;11(3):189-96.

Scott R Lambert, Conjunctivitis of the newborn (Ophthalmia Neonatorum). David Taylor & Creig S Hoyt. Pediatric Ophthalmology and Strabismus, Philadelphia, Elsevers Saunders, 2005, 146-8.

Isenberg S J, Apt L, Wood M. The influence of perinatal infective factors on ophthalmia neonatorum. J Pediatr Ophthalmol Strabismus. 1996;33(3):185-8.

Molgaard TL, Nielsen PB, Kaern J. A study of the incidence of neonatal conjunctivitis and of its bacterial causes including Chlamydia trachomatis. Clinical examination, culture and cytology of tear fluid. Acta Ophthalmol. 1984;62(3):461-71.

Akera C, Ro S. Medical concerns in the neonatal period. Clinics in Family Practice. 2003;5(2):265-92.

Prentice MJ, Hutchinson GR, Taylor-Robinson D. A microbiological study of neonatal conjunctivae and conjunctivitis. Br J Ophthalmol. 1997;61(9):601-7.

Barry WC, Teare EL, Uttley AHC, et al. Chlamydia trachomatis as a cause of neonatal conjunctivitis. Arch Dis Child. 1986;61(8):797-9.

Mohile M, Deorari Ashok K, Satpathy G, et al. Microbiological study of neonatal conjunctivitis with special reference to Chlamydia trachomatis. Indian J Ophthalmol. 2002;50(4):295-9.

Shariat H, Young M, Abedin M. An interesting case presentation: a possible new route for perinatal acquisition of Chlamydia. J Perinatology. 1992;12(3):300-2.

Schaller UC, Klauss V. Is Crede’s prophylaxis for ophthalmia neonatorum still valid? Bull World Health Organ. 2001;79(3):262-6.

Laga M, Plummer FA, Piot P, et al. Prophylaxis of gonococcal and Chlamydia ophthalmia neonatorum. N Eng J Med. 1988;318(11):653-7.

Gururaj AK, Ariffin WA, Vijayakumari S, Reddy TN. Changing trends in the epidemiology and management of gonococcal ophthalmia neonatorum. Singapore Med J. 1992;33(3):279-81.

Lockie P, Leong LK, Louis A. Penicillinase-producing Neisseria gonorrhoea as a cause of neonatal and adult ophthalmia. Aust N Z J Ophthalmol. 1986;14(1):49-53.

Panikabutra K, Ariyarit C, Chitwarakom A. Cefatoxime in the treatment of gonorrhoea caused by PPNG and non-PPNG. J Med Assoc Thai. 1982;65(5):271-6.

Klauss V, Schwartz EC. Other conditions of the outer eye. In: Johnson GJ, Minassian DC, Weale R, eds. The epidemiology of eye disease. London, Chapman & Hall, 1998.

Johnson D, McKenna H. Bacteria in ophthalmia neonatorum. Pathology. 1975;7(3):199-201.

Meheus A, Piot P. Provision of services for sexually transmitted diseases in developing countries. In: Oriel JD, Harris JRW, ed. Recent advances in sexually transmitted diseases. London: Churchill Livingstone, 1986:261-71.

Laga M, Plummer F, Nsanze H, et al. Epidemiology of ophthalmia neonatorum in Kenya. Lancet. 1986;2:1145-8.

Darvielle T. Chlamydia trachomatis infections in neonates and young children. Semin Pediatr Infect Dis. 2005;6(4):235-44.

Chandler JW, Alexander ER, Pfiffer TA, et al. Ophthalmia neonatorum associated with maternal chlamydial infection. Trans Sect Ophthalmo Am Acad Ophthalmol Otolaryngo. 1997;83(2):302-8.

Walsh C, Anderson LA, Irwin K. Journal of Women’s Health & Gender- Based Medicine. 2000;9(4):339-43.

James J. Champoux, Lawrence Corey, Frederick C. Neidhardt, et al. Chlamydia: John C. Sherris. Medical Microbiology.United States of America.Prentice-Hall International Inc 1990, 469-77.

Snowe RJ, Wilfert CM. Epidemic reappearance of Gonococcal ophthalmia neonatorum. Pediatrics. 1973;51(1):110-4.

Yetman R, Coody D. Conjunctivitis: A practice guideline. J Pediatric Health Care. 1997;11(5):238-44.

Goldbloom RB. Prophylaxis for gonococcal and chlamydial ophthalmia neonatorum. In: Canadian Task Force on the Periodic Health Examination. Canadian Guide to Clinical Preventive Health Care. Ottawa: Health Canada 1994; 168-75.

Beem MO, Saxon EM. Respiratory tract colonization and a distinctive pneumonia syndrome in infants infected with chlamydia trachomatis. N Engl J Med. 1997; 296(6):306-10.

Bradford WL, Kelly HW. Gonococci meningitis in a newborn infant, with review of the literature. Am J Dis Child. 1933; 46:543-9.

Nelson LB: Disorders of the conjunctiva. In: Harley’s Pediatric Ophthalmology. WB Saunders Co; 1998:202-14.

Gigliotti, Williams WT, Hayden FG, et al. Etiology of acute conjunctivitis in children. J Pediatr. 1981;98(4):531-6.

Leibowitz HW, Pratt MV, Flagstad IJ, et al. Human conjunctivitis. I. Diagnostic evaluation. Arch Ophthalmol. 1976;94(10):1747-9.

Fransen L, Nsanze H, Klauss V, et al. Ophthalmia neonatorum in Nairobi, Kenya: The roles of Neisseria gonorrhoea and Chlamydia trachomatis. J Infect Dis. 1986;153(5):862-9.

Chlamydial neonatal conjunctivitis and pneumonia 2002. Accessed on 20 May 2007 at docs/infections/ophth_neonat.asp.

Ridway GL, Taylor-Robinson D. Current problems in microbiology chlamydial infections: which laboratory test? J Clin Pathol. 1991;44(1):1-5.

Talley AR, Garcia-Ferrer KF, Laycock KA, et al. Comparative diagnosis of neonatal chlamydial conjunctivitis by polymerase chain reaction and McCoy cell culture. Am J Ophthalmol. 1994;117(1):50-7.

Crédé CSF. Reports from the obstetrical clinic in Leipzig: prevention of the eye inflammation in the newborn. Am J Dis Child. 1971;121(1):3-4.

Nishida H, Resenberg HM. Silver nitrate ophthalmic solution and chemical conjunctivitis. Pediatrics. 1975;56(3):368-73.

Oriel JD. Ophthalmia neonatorum: relative efficacy of current prophylactic practices and treatment. J Antimicrob Chemother. 1984;14(3):209-20.

Bell TA, Grayson JT, Krohn MA, et al. Randomized trial of silver nitrate, erythromycin, and no eye prophylaxis for the prevention of conjunctivitis among newborn not at risk for gonococcal ophthalmitis. Pediatrics. 1993;92(6):755-60.

Guidelines for the management of sexually transmitted infections 2003. Accessed on 15 Aug 2007 at

AAP, AAOP, Red Book: 2003 Report of the committee on Infectious Diseases, 26th ed. ELK Grove Village, IL, 2003.

Haase Da, Nash Ra, Nsanze H, et al. Single-dose ceftriaxone therapy of gonococcal ophthalmia neonatorum. Sex Transm Dis. 1986;13(1):53-55.

Hoosen AA, Kharsany AB, Ison CA. Single low-dose ceftriaxone for the treatment of gonococcal ophthalmia –implications for the national programme for the syndromic management of sexually transmitted diseases. S Afr Med J. 2002;92(3):238-40.

Fransen L, Nsanze H, D’Costa L, et al. Single dose kanamycin therapy of gonococcal ophthalmia neonatorum. Lancet. 1984;2:1234-7.

Whittey R, Arwin A, Prober C, et al. A controlled trial comparing vidarabine with acyclovir in neonatal herpes simplex virus infection. N Engl J Med. 1991;324(7):444-9.

How to Cite
PSM., TA., HAF., SA., TanA., & GI. (2008). Neonatal conjunctivitis – a review. Malaysian Family Physician, 3(2), 5. Retrieved from
Original Articles