Treatment of Conjunctivitis in Babies
For bacterial conjunctivitis in babies, a 5-7 day course of broad-spectrum topical antibiotic applied 4 times daily is the recommended first-line treatment. 1
Diagnosis and Treatment by Type
Bacterial Conjunctivitis
- Apply erythromycin ophthalmic ointment (approximately 1 cm in length) directly to the infected eye(s) up to six times daily, depending on severity 2
- Most cases can be treated effectively in an outpatient setting without the need for hospitalization 3
- Parents should be advised to return for evaluation if no improvement is seen after 3-4 days of treatment 1
- Strict hand hygiene is essential to prevent transmission to others or to the unaffected eye 1
Special Considerations for Specific Infections
Gonococcal Conjunctivitis
- Requires systemic antibiotic therapy in addition to topical treatment 1
- Daily follow-up is necessary until resolution 1
- Hospitalization may be necessary for severe cases and is mandatory for neonatal conjunctivitis 3
- For prophylaxis of neonatal gonococcal ophthalmia, a ribbon of erythromycin ointment approximately 1 cm in length should be instilled into each lower conjunctival sac 2
- For infants born to mothers with clinically apparent gonorrhea, intravenous or intramuscular injections of aqueous crystalline penicillin G should be given (50,000 units for term infants or 20,000 units for infants of low birth weight) 2
Chlamydial Conjunctivitis
- Systemic antibiotic therapy is indicated as more than 50% of infants with chlamydial conjunctivitis may also be infected at other sites such as the nasopharynx, genital tract, or lungs 3
- There are no data to support the use of topical therapy in addition to systemic therapy 3
- In low-to-middle income countries with limited antibiotic access, povidone-iodine 1.25% ophthalmic solution can be used 3
When to Refer to an Ophthalmologist
Immediate referral to an ophthalmologist is recommended for babies with:
- Visual loss 3
- Moderate or severe pain 3
- Severe purulent discharge 3
- Corneal involvement 3
- Conjunctival scarring 3
- Lack of response to therapy after 3-4 days 1
- Recurrent episodes 3
- History of HSV eye disease 3
- History of immunocompromise 3
Supportive Measures and Prevention
- Avoid sharing towels, pillows, and maintain strict hand hygiene to prevent transmission 1
- For viral conjunctivitis, supportive care options include artificial tears and cold compresses 4
- For allergic conjunctivitis, topical antihistamines with mast cell-stabilizing properties are the treatment of choice 5
Common Pitfalls to Avoid
- Indiscriminate use of topical antibiotics or corticosteroids should be avoided 1
- Failure to consider gonococcal or chlamydial infection in infants, which requires systemic treatment 1
- Delayed referral to an ophthalmologist when there are signs of severe infection or lack of improvement 3
- Not considering the possibility of child abuse in cases of potentially sexually transmitted ocular disease in children 3