Ophthalmia neonatorum — formative SAQs

SAQ 1 — The three-day-old with a profuse purulent eye (10 marks, 15 minutes)

A three-day-old term boy is referred from the postnatal ward with a 12-hour history of profuse, thick, yellow-green discharge from the right eye that reaccumulates within minutes of cleaning. Both eyelids are swollen and chemotic and the eye is intensely red. He was born by spontaneous vaginal delivery after an unbooked pregnancy with no documented antenatal sexually-transmitted-infection screening. ^[12]

a) What is the most likely diagnosis, and which feature makes it a sight-threatening emergency? State the onset window that supports it. (2 marks) ^[1]

b) Outline your immediate emergency management, including the specific drug, dose, route and the bedside measure that protects the cornea, before any culture result. (3 marks) ^[1]

c) The infant is clinically jaundiced. How does this change your drug choice, and why? Name the alternative agent. (2 marks) ^[1]

d) List the conjunctival swab investigations you would send, and explain why you would not delay treatment while awaiting them. (3 marks) ^{[4] [11]}