It is routine procedure in hospitals to administer a prophylactic eye ointment to all newborns as a preventative measure against Gonorrheal and Chlamydia infections of the eye. The standard of care is to use silver nitrate 1% or Erythromycin .5% applied directly to the infants eye. Erythromycin is a broad spectrum antibiotic and is the most common choice as it does not produce as much eye irritation as silver nitrate while still being effective. Both silver nitrate and erythromycin do produce inflammation, redness and irritation of the eyes as well as blurred vision for 12-48 hours following administration.
Chlamydia: Two-12% of the general female population is infected with Chlamydia trachomatis with rates as high as 20% among high risk populations. 85% of cases of Chlamydia are asymptotic. Depending on the test method chosen, tests for Chlamydia range from 80-100% accurate.
A baby born to an infected, untreated mother has a 30-50% chance of becoming infected during a vaginal birth via contact with an infected cervix. Symptoms of infant eye infection occur 5-12 days after birth and include discharge, swelling and inflammation. Most cases clear on their own. Blindness resulting from Chlamydia eye infection is rare however scarring and vascularization of the eye may occur. If infection develops oral erythromycin is recommended to clear the infection.
Gonorrhea: Babies born to mothers infected with Gonorrhea are also at risk for develop an eye infection. 33% of babies born to infected mothers will also be infected or colonized with Gonorrhea. Symptoms of a Gonorrhea eye infection appear 2-5 days after birth (more immediately if the baby was infected in utero) and include severe swelling of the eyelids followed by copious discharge. If treatment is delayed severe complications such as ulcerations, deep inflammation and blindness may result.
Because Gonorrhea infections are so frequently asymptotic (80%), and compliance among high risk populations is low, it has become the standard of care to administer prophylactic eye treatment. It should be noted that sometimes a Gonorrhea infection is present in a cyst within the vagina or cervix which makes it undetectable by standard testing procedures. However, during birth these cysts can burst resulting in an infection which can be passed to your baby.
Choices in newborn eye care:
-Do nothing. If you and your partner have recently tested negative for Chalmydia and Gonorrhea you have the option of forgoing prophylactic eye treatment, washing the eyes with sterile water immediately following birth and observing for any signs of infection. Should an infection develop appropriate antibiotic treatment should follow immediately.
-Another option would be to wash the eyes gently with an Echinacea infusion followed by maternal intake of Echinacea tincture to pass through her breastmilk to her baby.
-Follow the American Academy of Pediatrics recommendation to administer prophylactic eye ointment within 1-3 hours of birth.
State law in Massachusetts requires physicians to administer prophylactic eye ointment to all newborns. Therefore, if you choose to forgo treatment, you will be asked to sign a waiver stating that you understand the risks involved with not treating and have made an informed decision.