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130

Jennifer A. Dunbar

Kimberly M. Chan

Ophthalmic Specimen

Collection

24

Neonatal conjunctivitis is considered an ocular emergency

(1,2). Conjunctivitis may be the presenting sign of coexisting life-threatening systemic infection. Signs include diffuse

conjunctival injection with mucoid, purulent, or watery

ophthalmic discharge. Both bacterial and viral pathogens

cause corneal ulceration and opacity, which may lead to

blindness. Neisseria gonorrhea or Pseudomonas species may

rapidly perforate the globe.

A. Indications

To obtain specimen for testing to determine the cause of

conjunctivitis (Table 24.1)

1. The most common cause of neonatal conjunctivitis

is chemical conjunctivitis, which presents in the first

24 hours of life as a reaction to prophylaxis and usually

resolves within 48 hours.

2. Infectious neonatal conjunctivitis may be bacterial

or viral, and it is often associated with exposure in

the birth canal or through spontaneous rupture of

membranes. The causes include Chlamydia,

Streptococcus spp., Staphylococcus spp., Escherichia

coli, Haemophilus spp., Neisseria gonorrhea, and herpes

simplex (3).

3. In addition to the classic causes of neonatal conjunctivitis

above, methicillin-resistant Staphylococcus aureus, group B

Streptococcus and Neisseria meningitides have been

described in neonates (4,5).

4. Hospital-acquired conjunctivitis affects 6% to 18% of

infants in neonatal intensive care units (NICUs) and

may occur in epidemics (6–8).

a. The eye may be contaminated by respiratory

secretions, with coagulase-negative Staphylococcus,

S. aureus, and Klebsiella sp. reported as the most

common pathogens.

b. Epidemics of conjunctivitis have been associated

with routine ophthalmic screening in the NICU.

Serratia marcescens, Klebsiella sp., Acinetobacter

baumannii, and adenovirus epidemics have been

described (8–11).

B. Relative Contraindications

Corneal epithelial defect

If fluorescein staining of the cornea reveals an epithelial

staining defect, then corneal ulceration may be present. This

requires referral to an ophthalmologist.

C. Special Considerations for

Ophthalmic Specimen Management

1. Conjunctival scrapings are the specimen of choice

because many pathogens are intraepithelial (1).

2. The ocular specimen size is small; therefore, special

care is given to specimen handling.

3. Direct placement of the conjunctival scrapings on

slides for staining and direct plating onto culture

medium at the bedside will maximize the yield.

4. Communication with laboratory personnel regarding

specimen handling improves culture results (12).

D. Materials

1. Equipment for staining the cornea to rule out epithelial

defect