Chemical conjunctivitis

Usually occurs within 24 hours of instillation of eye prophylaxis after birth

Clinical features: mild lid edema with sterile discharge from eyes

Treatment: none needed because condition usually resolves within 48 hours after birth

Gonorrheal conjunctivitis

Usually occurs within 24 to 48 hours after birth

Clinical features: profound lid edema, chemosis, intensely purulent exudates, corneal ulceration

Treatment: for proven penicillin-susceptible organisms, aqueous crystalline penicillin G, 100,000 units per kg per day IV given in four divided doses for 7 days; because of emergence of resistant strains of Neisseria gonorrhoeae, recommended therapy is ceftriaxone (Rocephin), 25 to 50 mg per kg IV or IM (not to exceed 125 mg) given once, or cefotaxime (Claforan), 100 mg per kg IV or IM given once; until discharge is eliminated, frequent eye irrigations with saline; gonorrheal treatment for the mother and her sexual partner(s)

Chlamydial conjunctivitis

Usually occurs within 7 to 14 days after birth

Clinical features: watery discharge that later becomes copious and purulent; if untreated, may result in corneal scarring and pannus formation

Treatment: orally administered erythromycin, 50 mg per kg per day in four divided doses for 2 weeks

HSV conjunctivitis

Usually occurs within 2 weeks after birth

Eyes involved in 5% to 20% of HSV-infected infants

Clinical features: infants may present with keratitis, cataracts, chorioretinitis, or optic neuritis; imperative to rule out disseminated herpes

Treatment: both topical and systemic antiviral agents, because HSV-infected neonates do not present with isolated conjunctivitis; systemic therapy—acyclovir (Zovirax), 60 mg per kg per day in three divided doses for 14 days if disease is limited to skin, eyes, and mouth; topical therapy—1% trifluridine (Viroptic) or 3% vidarabine (Vira-A); referral to subspecialist