eMedicine Specialties > Ophthalmology > Conjunctiva

Conjunctivitis, Neonatal: Differential Diagnoses & Workup

Author: Kalpana K Jatla, MD, Private Practice, Clarity Eye Center
Coauthor(s): Robert William Enzenauer, MD, MPH, Professor, Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center; Feng Zhao, MD, PhD, Staff Physician, Department of Ophthalmology, Emory Cartersville Medical Center
Contributor Information and Disclosures

Updated: Nov 17, 2008

Differential Diagnoses

Cellulitis, Orbital
Keratitis, Bacterial
Cellulitis, Preseptal
Keratitis, Fungal
Dacryocystitis
Keratitis, Herpes Simplex
Glaucoma, Primary Congenital
Nasolacrimal Duct, Obstruction
Glaucoma, Secondary Congenital

Other Problems to Be Considered

Congenital dacryostenosis

Workup

Laboratory Studies

  • Laboratory studies for neonatal conjunctivitis should include the following:
    • Conjunctival scraping Gram stain and either Giemsa or calcofluor white stains
    • Culture on chocolate agar and/or Thayer-Martin for N gonorrhoeae
    • Culture on blood agar for other bacteria
  • Rule out chlamydial infection with a conjunctival scraping Giemsa stain for intracytoplasmic inclusion bodies or, preferably, a direct immunofluorescent antibody assay.
  • A culture for HSV is indicated if a corneal epithelial defect is present or if vesicles are present on the eyelids or other parts of the body, and if the diagnosis cannot be made on ocular examination.

Histologic Findings

Chemical conjunctivitis - Neutrophils, occasional lymphocytes on Gram stain

Bacterial conjunctivitis - Bacteria, neutrophils on Gram stain

Chlamydial conjunctivitis - Neutrophils, lymphocytes, plasma cells on Gram stain; basophilic intracytoplasmic inclusions in epithelial cells on Giemsa stain

Herpetic conjunctivitis - Lymphocytes, plasma cells, multinucleate giant cells on Gram stain; eosinophilic intranuclear inclusions in epithelial cells on Papanicolaou smear

More on Conjunctivitis, Neonatal

Overview: Conjunctivitis, Neonatal
Differential Diagnoses & Workup: Conjunctivitis, Neonatal
Treatment & Medication: Conjunctivitis, Neonatal
Follow-up: Conjunctivitis, Neonatal
Multimedia: Conjunctivitis, Neonatal
References
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References

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Further Reading

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Keywords

neonatal conjunctivitis, ophthalmia neonatorum, infectious conjunctivitis, conjunctiva

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Contributor Information and Disclosures

Author

Kalpana K Jatla, MD, Private Practice, Clarity Eye Center
Kalpana K Jatla, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Robert William Enzenauer, MD, MPH, Professor, Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center
Robert William Enzenauer, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Hamilton County Medical Society Salary Consulting

Feng Zhao, MD, PhD, Staff Physician, Department of Ophthalmology, Emory Cartersville Medical Center
Feng Zhao, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Gerhard W Cibis, MD, Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas, Kansas City
Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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