Carl Credes silver nitrate prophylaxis represented a tremendous step forward in the prevention of ophthalmia neonatorum (ON) in newborns in the 19th century. However this original prophylaxis is mainly effective against gonococcal ophthalmia and chlamydial ON is now more widespread in the contemporary world. Silver nitrate has also been noted to cause chemical conjunctivitis. In industrialized countries where ON is no longer a public health problem and different strategies for prevention are available prophylaxis at birth has been stopped opting instead for early treatment. But growing populations urbanization and increasing promiscuity have caused a rising incidence of ON in these countries. Preventing infection of the neonate through routine prophylaxis with topical antibiotics may be feasible but it carries the risk of resistance especially in patients with ON due to gonococcal infection. Povidone-iodine as a topical anti-infective appears to be an effective and cheap alternative. Further epidemiological research and monitoring of the incidence of ON and the prevalence of the various agents in different parts of the world are needed so that prevention and treatment can be adjusted accordingly and experience with new options can be analyzed for wide use.