Child less than 8 weeks of age

The 2009 Red Book estimates that the major pathogens associated with ophthalmia neonatorium include 'other bacterial microbes' (30-50%) and Chlamydia trachomatis  (2-40%,) with minor pathogens including Neisseria gonorrhoeae (less than 1%) and Herpes simplex virus (less than 1%) (Pickering 2009).

Cases of opthalmia neonatorium secondary to Chlamydia trachomatis and Neisseria gonorrhoeae have the potential for the most significant clinical outcomes and still account for the leading cause of blindness worldwide. Newborn risk and incidence are affected by the prevalence of maternal infections. In untreated mothers with Chlamydia trachomatis infections, the overall risk of disease to the newborn is estimated at 50-75%, with a risk of conjunctivitis estimated at 20-50% (Rours, Hammerschlag et al. 2008). Countries with higher rates of maternal Chlamydiatrachomatis infection estimate as many as 15-18 cases per 1000 live births (Iroha, Kesah et al. 1998; Di Bartolomeo, Mirta et al. 2001) while countries with less prevalent disease estimate as low as 4 cases per 1000 live births (Yip, Chan et al. 2007). US estimates identify 8.2 cases per 1000 live births (O'Hara 1993).

Incidence of gonococcal ophthalmia neonatorium is also associated with prevalence of maternal disease. In Belgium, the overall prevalence is very low at 0.04 cases per 1000 live births compared to the US at 0.3 cases per 1000 (MacDonald, Mailman et al. 2008).

Non-infectious etiologies such as nasolacrimal duct obstruction are a more common finding, estimated to effect up to 20% of infants by six months of age with 6% of infants developing symptoms. (O'Hara 1993; Paul and Shepherd 1994; Lin, Nar et al. 2006). Less common entities such as dacrocystoceles do not occur frequently enough to provide prevalence data.

Child greater than 8 weeks of age

Older children, specifically greater than one year of age, with signs of conjunctivitis are more likely to have disease secondary to other infectious agents (Streptococcus pneumoniae, Moraxella catarrhalis and nontypable Haemophilus influenzae) compared to opthalmia neonatorium. The incidence of true bacterial conjunctivitis in pediatric patients varies based on identification method used. Reports of an incidence of 135.5 per 10,000 (Granet, Dorfman et al. 2008) with more than 5 million outpatient or emergency department visits are based on diagnosed cases treated with antibiotics. Other studies have shown that physicians prescribe antibiotic for nearly 80-95% of patients presenting for conjunctivitis while estimates of bacterial conjunctivitis varying from 50-80% of cases. (Meltzer, Kunkov et al. 2010)

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.

Copyright © 1996-2014 The Children's Mercy Hospital