It is important to realise that in the early part of this century, a large proportion of the inmates of blind institutions had suffered from ophthalmia neonatorum. The disease affects primarily the conjunctiva and cornea and is the result of infection by organisms resident in the maternal birth passage. The gonococcus was the most serious cause of blindness but a number of other bacteria have been incriminated, including staphylococci, streptococci and pneumococci. It has also been shown that chlamydial infection of the genital tract can lead to the same problem, as can infection by the herpes simplex virus. The blindness that resulted from this condition was so serious that any excessive discharge from the eyes has been a notifiable disease in this country since 1914. Ophthalmia neonatorum is caused by unhygienic conditions at birth and its relative rarity nowadays is because of the fact that midwives are trained to screen for the condition. Bacterial conjunctivitis usually occurs between the second and fifth day after birth, whereas chlamydial infection tends to occur a little later, between the sixth and tenth day. Purulent or mucopurulent discharge is evident and the eyelids can become tense and swollen so that it is difficult to open them and carry out the all-
important examination of the cornea. When the disease is suspected, the infant should be admitted to hospital and treated with penicillin drops every hour. Diagnosis is achieved by taking a conjunctival culture before treatment is started and by looking for the inclusion bodies of the chlamydial virus in a smear. The history of infection in the parents needs to be explored and managed by a genitourinary specialist.
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