What is eye-care in newborns: Ophthalmia Neonatorum Management?

Picture showing discharge from the eye of a  new-bon baby.
Visual cues comprise of 98 per cent of all environmental cues effectively utilised by a newborn.

Neonatal vision and visual functions are different from those of adults in many respects. A newborn has an aversion to light for a few days after birth
and will open his eyes in diffuse and dimly lit surroundings. Secondly it is to be noted that a new-born child lacks any ocular secretions during the first
week of life, as tears are not formed during this time, and hence any discharge of whatever kind during this period of life must be viewed with utmost
suspicion.

The visual milestones of a newborn child up to six weeks of age are as follows:
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• Stares at surroundings when awake 
• Momentarily holds gaze on bright light or 
• Blinks at camera flash· Eyes and head move together 
• One eye may seem turned in at times. (This may be a false appearance due to a flat nasal bridge of the newborn.) 
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Ophthalmia Neonatorum is the name given to conjunctivitis affecting both the eyes of an infant under one month of age.

What are the source and mode of this infection?
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• Before birth: It is very rare through ascending infection by vaginal route. 
• During birth: It is the most common mode of infection and occurs as a result of infected birth canal especially when child is born in a face presentation
or an instrumental deliver (forceps) is carried out. 
• After birth: It may result after the first bath of the baby with unclean water or from soiled clothes or dirty fingers. 
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What are the signs and symptoms?
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• Ocular discharge: watery whitish or purulent. 
• Swollen eyelids. 
• Redness of eyes. 
• Inconsolably crying infant. 
• Complications: 
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• Corneal ulceration leading to vision loss. 
• Corneal opacity leading to vision loss. 
• Corneal perforation. 
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How is it treated?
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• Saline lavage till the discharge is eliminated. 
• Topical antibiotics and atropine instilled into the eyes of newborns. 
• Systemic antibiotics (depending on the infecting organism) in cases of severe infections. 
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Are there any precautionary measures?
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• Before birth: Thorough care of mother and treatment of genital infections when suspected 
• During birth: 
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• Deliveries to be conducted under hygienic conditions undertaking all aseptic measures. 
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• Clean surface. 
• Clean hands. 
• Clean blade. 
• Clean cord tie. 
• No application on the cord. 
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• Delivery may be conducted by Caesarean section in women with active genital tract infections. 
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• After birth: 
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• The newborn baby’s eye-lids must be thoroughly cleaned with the sterile saline soaked gauze pieces. 
• Antibiotics are usually prescribed by an Ophthalmologist. But for this, an urgent consultation with an Ophthalmologist is essential.
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