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You are seeing a 10 day old ex-full term infant with bilateral watery mucoid eye discharge, mild eyelid edema, and papillary conjunctivitis. You suspect chlamydial conjunctivitis. What is the best management?
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February 1, 2022 at 11:18 pm
C) Oral erythromycin
Neonatal conjunctivitis caused by chlamydia typically presents on days 5-14 of life, whereas gonococcal conjunctivitis presents in the first few days of life. Discharge is watery and may progress to mucoid or even purulent. Conjunctivitis may be unilateral or bilateral, and may be associated with eyelid edema, chemosis, and pseudomembrane formation. Eye discharge may be bloody. Chlamydia is treated by macrolides, but topical is insufficient, therefore oral erythromycin is the treatment of choice. Admission for IV ceftriaxone would be needed if gonococcal conjunctivitis was suspected. Emergency physicians can rule out herpes keratitis by lack of dendritic lesions on fluorescein exam and lack of other signs of herpes infection, such as skin vesicles.