Paeds Vivas · ophthalmology
Ophthalmia neonatorum — branching viva
Branching viva from a three-day-old with profuse purulent discharge and lid oedema, through the recognition of gonococcal ophthalmia neonatorum, the emergency systemic treatment and the ceftriaxone-versus-cefotaxime decision, with a pivot to a ten-day-old with mucopurulent discharge and a staccato cough testing chlamydial ophthalmia, its pneumonia and systemic erythromycin, and a final probe on neonatal HSV keratoconjunctivitis and birth prophylaxis.
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Opening — the three-day-old with a profuse purulent eye
Examiner: A three-day-old term infant is referred from the postnatal ward with profuse thick yellow-green discharge from the right eye and marked bilateral lid oedema. He was born vaginally to a mother with no documented sexually-transmitted-infection screening. Talk me through your immediate thoughts and actions. [12]
Candidate should cover: the diagnosis of gonococcal ophthalmia neonatorum based on the day 2 to 5 onset window, the profuse purulent discharge and lid oedema; recognition that it is sight-threatening because Neisseria gonorrhoeae can ulcerate and perforate the cornea within hours; and immediate management — admit, swab, begin frequent saline irrigation and give single-dose ceftriaxone before culture returns. [1]
References9ShowHide
- [1]Castro Ochoa KJ; Gurnani B Ophthalmia Neonatorum (Neonatal Conjunctivitis). StatPearls, 2026.PMID 31855399
- [3]Moore DL; MacDonald NE; Canadian Paediatric Society Preventing ophthalmia neonatorum. Paediatr Child Health, 2015.PMID 25838784
- [4]Curry SJ; Krist AH; Owens DK; et al Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA, 2019.PMID 30694327
- [5]Zikic A; Schunemann H; Wi T; et al Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis. J Pediatric Infect Dis Soc, 2018.PMID 30007329
- [6]Zar HJ Neonatal chlamydial infections: prevention and treatment. Paediatr Drugs, 2005.PMID 15871630
- [7]Pinninti SG; Kimberlin DW Neonatal herpes simplex virus infections. Semin Perinatol, 2018.PMID 29544668
- [9]Isenberg SJ; Apt L; Yoshimori R; et al Povidone-iodine for ophthalmia neonatorum prophylaxis. Am J Ophthalmol, 1994.PMID 7977595
- [11]Belagal P Current alternative therapies for treating drug-resistant Neisseria gonorrhoeae causing ophthalmia neonatorum. Future Microbiol, 2024.PMID 38512111
- [12]Tan AK Ophthalmia Neonatorum. N Engl J Med, 2019.PMID 30625059