HOW TO TAKE CARE OF A NEWBORN WITH EYE DISCHARGE

I had a short consultation with a new mom and the encounter left me to ponder again and again the word of our Lord Jesus Christ as contained in John 9:1-3. It reads, “As He passed by, He saw a man blind from birth. And His disciples asked Him, ‘Rabbi, who sinned, this man or his parents, that he would be born blind?’” Jesus answered, “It was neither that this man sinned, nor his parents.”

The encounter goes thus…

Patient: Good morning doctor

Doctor: Good morning ma, how may I help you?

Patient: My newborn is seven days old, and his eye leaks out yellowish discharge, it dries up when he sleeps and then he can’t open his eye when he wakes up. It gives me concern.

Doctor: Have you administered any medicine or substance in the eyes?

Patient: I have been advised to put breast milk in his eyes, but I just put a little, the eyes are not just opening. I have tried putting eye drops but could not because the eyes refuse to open.

Doctor: Is that all ma? Have you used any herbal concoction?

Patient: Not at all, but I have been putting the local eye pencil to remove the impurities from my baby’s eyes.

Doctor: How was your delivery? Where did you deliver your baby?

Patient: Delivery was uneventful; I delivered at a Primary Health Care centre.

Doctor: Has your baby been immunised?

Patient: No, I will have him immunised and circumcised after the eighth day. Doctor, my baby is okay; all I want from you is to help open my baby’s eyes.

Doctor: I will need to admit your baby for proper care, treatment and investigations. The eye discharge can lead to blindness, meaning your baby may not be able to see for life. We need to take immediate action.

Patient: No way, my baby will see once the eyes are open. Tomorrow is the naming ceremony. Kindly help open the eyes. We will be back tomorrow for the admission after the naming ceremony.

The baby was received from the mother and an infusion (drip) called ‘normal saline’ was used to irrigate the eyes. The eyes opened and the mother was ecstatic. She paid her bill for the treatment and investigations but never came back for the investigations.

She was called on phone a day after the naming ceremony. She thanked us for opening her baby‘s eyes and said her baby was now very okay.

If this child turns blind and the question of who sinned is thrown open to the public, it is clear that our answers will be the mother, since many of her acts and actions were not just right.

Ophthalmia neonatorum

Neonatal conjunctivitis or ophthalmia neonatorum is a form of conjunctivitis contracted by newborns during delivery. The baby’s eyes are contaminated during passage through the birth canal from a mother infected with Neisseria gonorrhoeae , Chlamydia trachomatis or Herpes simplex virus.

If left untreated, it can rapidly progress to blindness and should be considered an ophthalmic emergency. Early referral to an ophthalmologist is essential.

Purulent discharge, watery discharge and blood-stained discharge are highly specific for Chlamydia. Herpes simplex conjunctivitis usually causes a non-purulent and serosanguineous discharge. A greenish discharge is more characteristic of pseudomonas aeruginosa infection, while gonorrhoea infection causes the neonate to have red, swollen eyes with purulent discharge.

Early treatment and urgent referral to a specialist centre are essential. Ensure that mother is tested for gonorrhoea, treated and contact traced. Ophthalmic ointment containing 0.5 per cent erythromycin is typically applied to the newborn’s eyes within an hour of birth as prophylaxis against gonococcal ophthalmia.

Sticky eyes: Sticky eyes occur when the extremely fine tear duct that leads from the inner corner of the baby’s eyes (near the nose) is blocked by fluid and debris (such as amniotic fluid). Newborns have difficulty flushing their own eye out, as they do not produce tears in the early weeks.

The sticky eye(s) should be bathed frequently with sterile salt water and clean cotton balls. Some parents will use cooled boiled water in the absence of sterile salt water. The tear duct (lying under the skin between the inner eye and nose) can also be gently massaged towards the baby’s nose, to help clear the duct. If sticky eyes are not bathed regularly, the stagnant, sticky secretions can occasionally lead to an infection of the tear duct or conjunctivitis.

Puffy eyes: Both upper and lower eyelids are oedematous (swollen) so that the conjunctivas are not visible. There are no extra secretions. This is usually bilateral and no treatment is required.

The eyelids may be oedematous and moist, but there is no stickiness and no crusting of the lids. This is usually bilateral and simple sterile eye irrigation with saline infusion is required.

Nasolacrimal duct obstruction: Nasolacrimal duct obstruction is caused by an imperforate membrane at the end of the nasolacrimal duct. It causes persistent tearing, crusting or matting of the eyelids, and spilling of tears without conjunctivitis. It may indicate nasolacrimal duct obstruction, which is usually unilateral.

Mucopurulent material discharge may occur and indicate need for ophthalmic antibiotics.

Conservative management is recommended in the first year of life, as the majority of cases will resolve spontaneously or with massage.

Prevention

Parents or care providers should wash their hands frequently to prevent transmission of neonatal conjunctivitis. Some years ago, all new born eyes are routinely bathed with silver nitrate solution to prevent this infection, but it was found that it causes chemical conjunctivitis. The eye drops that may be used routinely now is erythromycin eye ointment