This is an =acute purulent conjunctivitis= in the new-born. Neonatorum
comes from a junction of the Greek word Neos—new, to the Latin word
natus—born; new-born. This disease is the bugbear to the obstetrician.
He must always be on the lookout for it and act promptly in order to
save sight. Every general practician should make a careful study of
this disease if he expects to treat children.
Sixty to seventy percent of conjunctivitis neonatorum is due to the
infection with the gonococcus of Neisser. It usually comes from a
gonorrheal discharge from the genitals of the mother. The nurse or
anyone who handles the baby might be the agent in the transmission of
the infection.
The disease is not always of gonorrheal origin. Some cases are due
to the pneumococcus, streptococcus, diplobacillus or one variety of
staphylococci.
Thus there are two varieties or types of ophthalmia neonatorum; a
severe type which is =gonorrheal= or specific and a mild type which is
non-specific.
In some states there is a law which requires the use of silver nitrate
in the eyes of all babies at birth. Every baby’s eyes should be
thoroughly washed at birth, with boric acid and where there is the
least suspicion of gonorrhea silver nitrate 1% or argyrol 25% should be
used. A routine use of one of the silver salts would be good practice.
=Symptoms.=—Gonorrheal cases begin usually the third day after birth,
non-gonorrheal, on the fifth or sixth day. Both eyes are usually
involved, one worse than the other. The lids swell much. There is
chemosis of the conjunctiva which may put the cornea in a pit. The
discharge is abundant. It is yellow or greenish yellow.
The disease gradually declines and the discharge ceases in six to eight
weeks. The conjunctiva is thickened and looks granular. May be some
cicatricial changes.
The chief danger is to the cornea, more so if it becomes hazy the first
two days. Corneal lesions seldom occur in non-specific forms.
If the cornea is involved perforation is likely, with a general
inflammation of the eyeball (panophthalmitis) followed by atrophy
(phthisis bulbi).
Complications such as rhinitis, meningitis, endocarditis and general
septicemia may occur.
=Diagnosis= is made from the onset, character, symptoms and course with
the use of the microscope.
=Prognosis.=—Delayed or improper treatment in these cases will likely
be fatal to sight as sloughing of the cornea will occur. With prompt
and proper care the prognosis is favorable.
=Treatment.=—Mild cases (non-specific) are treated in the same manner
as simple conjunctivitis. In severe cases (specific) clean the eye
carefully and apply cold compresses of gauze 15 to 20 minutes at a
time every hour or two. Keep the gauze on a block of ice and change
every few minutes. If the cornea is involved heat may prove more
satisfactory. There must be constant removal of the discharge. Wipe
away the excess and irrigate freely with boric acid at least every hour
day and night and more often if necessary. After each washing use a
solution of argyrol 25%. Once a day silver nitrate 1% solution may be
used and washed out with a salt solution.
If the cornea should ulcerate the treatment need not be altered.
The attendants should be carefully instructed as to the importance of
the care and the contagious nature of the pus.
Antisepsis and cleanliness here is more essential, effective and
exclusive than in any other disease of the eye. Wisdom in the use of
antiseptics is a strong point in the armamentarium of every progressive
osteopath.