Per Wikipedia:  “Neonatal conjunctivitis, also known as ophthalmia neonatorum, is a form of conjunctivitis and a type of neonatal infection contracted by newborns during delivery. The baby’s eyes are contaminated during passage through the birth canal from a mother infected with either Neisseria gonorrhoeae or Chlamydia trachomatis.

“Antibiotic ointment is typically applied to the newborn’s eyes within 1 hour of birth as prevention gonococcal ophthalmia. This practice is recommended for all newborns and most hospitals in the United States are required by state law to apply eye drops or ointment soon after birth to prevent the disease.

“If left untreated, it can cause blindness.”

If there is one takeaway from this, if there is any chance that the mother has an active, untreated infection of gonorrhea or chlamydia, the child must get antibiotic eye ointment or it risks blindness.  In undiagnosed cases of gonorrhea, the rate of permanent blindness in the infant can be in excess of 70% by day 3.  Blindness from chlamydia is often a slower process, but it is also much easier for chlamydia tests of the mother to return a false negative and for symptoms in the infant to go overlooked until it is too late.

Healthcare providers are trained to inform you that not all cases of neonatal conjunctivitis are from these two sexually transmitted diseases, and they are correct.  The following information can be confirmed with the CDC.  From 30-50% of cases are caused by the following:  Staphylococcus aureus; Streptococcus pneumoniae; Haemophilus influenzae, nontypeable; Group A and B streptococci; Corynebacterium species; Moraxella catarrhalis; Escherichia coli; Klebsiella pneumoniae; and Pseudomonas aeruginosa.  Unlike the two sexually transmitted diseases listed, these will not necessarily be affected by the eye ointment, and do not cause blindness in infants.  A final cause of neonatal conjuncivitis are viral infections, such as herpes, that can be caught by the child if the mother is shedding herpesvirus in her vaginal canal or opening.  Ocular herpes infections are extremely dangerous, and can not be prevented by antibiotics.

The most common adverse effect of most eye ointments is the risk of chemical conjunctivitis in the eyes of the infant.  This is generally irritating to the child, but usually subsides within 24 to 36 hours.  Secondary rare complications include an allergic or sensitivity reaction to the ointment.

It should be noted that prophylactic eye ointment is not used in all countries.  While it is standard practice in countries such as Brazil, Canada, France, Italy, Spain, Turkey, and the US, it isn’t in Australia, Belgium, Denmark, Great Britain, the Netherlands, Norway, or Sweden.  In some of those countries it is used only if the mother has positive screenings for gonorrhea or chlamydia.  In others, such as Great Britain, a “wait and see” approach is used in which the child is treated only after symptoms arise, and the mother is never screened for STIs.

The primary reason that parents refuse eye ointment for their child is to prevent the inevitable side-effects of treatment:  puffy eyes and blurred vision.  Many parents feel that this interferes with initial bonding between parent and child.  Refusal isn’t an option in all states:  in most states it is mandated by law that all children are given eye ointment, and in some such as New York there is no option to opt-out or refuse care.  Attempting to refuse treatment can result in your child being removed from your care by CPS, where they will promptly administer the eye ointment over your objections.

Editor’s Opinion

Eye ointment can be the one treatment standing between your child’s vision and their blindness.  For monogamous couples who screen negative for both STIs, some states allow you to waive treatment based on religious or philosophical objections.  We urge parents to use caution when declining this treatment:  while you may have been monogamous, unless you are with your spouse at all times, can you be sure that they have remained monogamous as well?  People make mistakes on a daily basis, and while this might factor as a big mistake, if such a mistake occurred, would they be willing to admit to it in front of a group of healthcare providers and their partner?  This isn’t a matter of trust.  This isn’t a matter of right or wrong.  A very recent infection may not be advanced enough to be caught during a screening, but still be advanced enough that it could permanently damage your child.  If there is any possibility, however slight, that your partner has strayed, then it is in your child’s best interests to be administered eye ointment.  If this isn’t a possibility, and you’re willing to trust the safety of your child to the good behavior of your partner, then this is a risk that you will have to work out with them if it is an option in your state.  Remember:  this isn’t about either of you or your relationship, it is about the health and safety of your child.

For the record, none of our children have received eye ointment, and the enhanced bonding that afforded was precious beyond measure.  That said, had any of our children been negatively affected by that decision, we could have never forgiven ourselves.