Consultation withthe Specialist

Abstract

Routine eye prophylaxis for newborn infants against gonococcal ophthalmia is a standard procedure in perinatal centers around the world. Gonococcal ophthalmia is a purulent eye disease that has its usual onset between the second and fifth days of life. Prior to the introduction of routine eye prophylaxis, it was a common cause of blindness in infancy. The use of 1% silver nitrate drops as prophylaxis against gonococcal ophthalmia soon after birth has reduced its incidence in the United States to less than 0.03% of infants. The success of 1% silver nitrate prophylaxis depends somewhat on the use of proper technique. Each eyelid is wiped gently with sterile cotton prior to administration of the agent. Two drops of the solution are introduced into each conjunctival sac and not rinsed out; rinsing has been shown to reduce effectiveness. Because of the successful introduction of silver nitrate prophylaxis, Neisseria gonorrheae is no longer the most common infectious cause of conjunctivitis in newborn infants. Although silver nitrate prophylaxis is a highly effective preventive measure, it has its drawbacks—primarily in the form of chemical conjunctivitis. Chemical conjunctivitis is a nonpurulent inflammation of the eye, with 1) swelling and a watery discharge occurring within several hours of instilling 1% silver nitrate, 2) a maximum inflammatory response around 48 hours, and 3) clearing by the fourth day in the absence of secondary infection.