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
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.
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
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.