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Ophthalmia Neonatorum

From: Diseases Of The Eye
Creator: George Edmund De Schweinitz (author)
Date: 1893
Publisher: W.B. Saunders, Philadelphia
Source: Yale University, Cushing/Whitney Medical Library
Figures From This Artifact: Figure 1  Figure 2  Figure 3

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Ophthalmia Neonatorum. -- This is an inflammation of the conjunctiva, characterized in its usual form by great swelling of the lids, serous infiltration of the bulbar conjunctiva, and the free secretion of contagious pus.


Causes. -- The affection is caused by the introduction into the eye of the infecting material, from some portion of the genitourinary tract of the mother, at the time of or shortly after birth. The majority of cases, and all severe forms, are associated with a special micro-organism -- the gonococcus of Neisser. Exception ally, inoculation appears to occur in utero, owing, perhaps, to the high degree of penetrating power which has been ascribed to the gonococcus.


Inasmuch as this micro-organism is not invariably present, two forms of the disease have been distinguished -- a severe type, supplied with the micro-organism, with a tendency to increase in severity and invade the cornea; and a milder type, non-specific, with a tendency to recover. Hence a virulent vaginal discharge is not necessary to produce this condition, except in intense degree, and it probably may arise from the contamination of any muco-purulent discharge during birth. Careless bathing of the child after birth, and the use of soiled towels and sponges, are fruitful sources of infection. It is possible that later contact with the lochial discharge may originate the disorder, although in the hands of several observers inoculation with healthy lochia has failed to produce the disease.


The exact time of inoculation has not been determined. Infection is more likely to occur in face presentations and during retarded labors. Boys are attacked more frequently than girls. The disease is said to be more common during summer months in cold climates; in hot countries, during the spring and autumn.


Symptoms. -- Ophthalmia neonatorum usually begins on the third day after birth, but may set in as early as from twelve to forty-eight hours after inoculation, or, when it is the result of a secondary infection from soiled fingers, sponges or clothes, be delayed to a much later date. Almost always both eyes suffer, the one being earlier, and frequently more decidedly affected than its fellow.


Four stages of the disease are common, but, as these vary in different eases, and more or less rapidly shade one into the other, no very sharp lines need be drawn.


A slight redness of the conjunctiva, with a trifling discharge in the corner of the eye, is rapidly succeeded by great, cushion-like swelling of the lids, with intense chemosis and congestion of the conjunctiva, accompanied by severe pain and discharge. The surface of the swollen lid is hot, dusky red, and tense; the upper lid overhangs the lower, and at first can only with difficulty be everted. The discharge, which in the beginning is slightly turbid, soon changes to a yellow or greenish yellow pus, and is secreted in great quantities.


If the lids are everted during the first day or two of the disease, the conjunctiva will be found to be swollen, red, and velvety, and that upon the eyeball intensely injected; upon the surface easily detached flakes of lymph are found; later, the conjunctiva becomes rough and of a dark-red color, spots of ecchymosis appear, or it is succulent and bleeds easily. Marked chemosis and infiltration of the ocular conjunctiva succeed, forming a hard rim; at the bottom of the crater-like pit thus produced, the cornea may be seen. The thick, cream-like discharge increases, and either flows out from beneath the overhanging upper lid on to the cheek, or is packed up in the conjunctival cul-de-sac. (Fig. 81.) The lids now may lose much of their tense character, and can be more easily everted; the conjunctiva is puckered into folds and papilla-like elevations, and the discharge contains an admixture of blood and serum. Gradually the disease declines, and in from six to eight weeks the discharge ceases. The relaxed palpebral conjunctiva is thick and granular, looking like the granulation tissue which surrounds wounds. The ocular conjunctiva is also thickened, and positive cicatricial changes may remain.


The chief risk is destruction of the vitality of the cornea, the danger of which is materially increased if this membrane becomes lustreless, dull, and hazy within the first day or two of the disease. Frequently small, oval ulcers form near the limbus, either transparent or surrounded by an area of cloudy infiltration, which rapidly increase in size; or larger areas of ulceration develop in a more central situation. In many mild cases the cornea escapes without harm. The changes which take place in the cornea are due in part to strangulation of its nutrient vessels by the swollen tissue, but largely to direct infection by the discharge.


After the formation of a corneal ulcer, either its healing and regeneration of the corneal tissue takes place, or else perforation occurs.


The result of perforation will depend upon the amount and character of the destruction of the corneal tissue. When the ulcer is central and perforates, the aqueous humor escapes, the lens is pressed forward against the posterior surface of the cornea, and the opening becomes closed with lymph. This renders the re-collection of the aqueous possible, and, when it occurs, the lens returns to its proper position, carrying with it upon the anterior capsule a little mass of lymph. Thus the formation of a pyramidal cataract results. (See page 395.)

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