Conjunctivitis is a potentially blinding condition with associated systemic manifestations
RECOGNITION AND ASSESSMENT 
Conjunctival redness
Swelling of conjunctiva and eyelids
Purulent or mucopurulent discharge
Differential diagnosis
Sticky eye with blocked tear duct
Congenital glaucoma
ETIOLOGY
Bacterial Staphylococcus aureus Haemophilus influenzae
Streptococcus pneumoniae
Serratia spp, E. Coli, Pseudomonas spp
Neisseria gonorrhoeae
typical onset aged 0–5 days
mild inflammation with sero-sanguineous discharge to thick, purulent discharge with tense oedema of eyelids
Chlamydia trachomatis
typical onset aged 5–14 days
mild-to-severe swelling with purulent discharge (may be blood-stained)
Viral Herpes simplex virus (HSV)
MANAGEMENT
Sticky eye/blocked tear duct
4–6 hrly eye toilet using sodium chloride 0.9%
cooled, boiled tap water acceptable for home use
Swab all for: Gram stain and bacterial culture and sensitivities
if other suspicions of HSV (e.g. vesicles etc.), swab in viral transport media for HSV PCR
Treat both eyes with:
frequent eye toilet as necessary
chloramphenicol 0.5% eye drops
fusidic acid 1% eye drops for staphylococcus
Presentation ≤24 hr of birth suggests gonococcal infection – inform consultant paediatrician
SUBSEQUENT MANAGEMENT
In severe non-resolving cases
*⃣Take throat and eye swabs for viral PCR *⃣If herpes suspected, look for other signs of herpetic infection
*⃣Treat suspected herpes with aciclovir IV and topical for 14 days
*⃣Refer to ophthalmology
Neisseria gonorrhoeae suspected
Request urgent Gram stain and culture Swab in viral transport media for PCR Assess baby for septicaemia
Neisseria gonorrhoeae confirmed
Give single dose cefotaxime 100 mg/kg IV stat
For severe cases, frequent sodium chloride 0.9% irrigation of the eyes and continue treatment with cefotaxime IV for up to 5 days
Refer to ophthalmology
If due to Neisseria gonorrhoea or chlamydia discuss referral to the genitourinary medicine services
Chlamydia result positive
Treat with erythromycin 12.5 mg/kg oral 6-hrly for 14 days
Gonococcal or chlamydia infection detected Refer mother and partner to genitourinary medicine for immediate treatment