Herpes simplex ophthalmia neonatorum: a sight-threatening diagnosis

I appreciate the useful article from Maqsood and Mahmood on the identification and diagnosis of herpes simplex ophthalmia neonatorum.¹ As McKechnie and Snelson suggest in their response, a key differential for ‘sticky eye’ in the neonate is congenital nasolacrimal duct obstruction.²

A large cohort study of all children in Olmsted County, Minnesota found that the prevalence of congenital nasolacrimal duct obstruction was 11.3%. Of these cases, over 90% were identified in primary care.³

Ophthalmia neonatorum however is comparatively rare. A survey sent to members of the American Association of Paediatric Ophthalmology and Strabismus, found that most ophthalmologists encountered fewer than five cases per year. Of these cases, the most common causative organism was Chlamydia trachomatis.⁴

The diagnostic challenge for the general practitioner is clear. While they will see numerous cases of congenital nasolacrimal duct obstruction, they will rarely encounter ophthalmia neonatorum. From the literature it appears that herpes simplex ophthalmia neonatorum is relatively uncommon even for specialists working in a more selected population.

Given this difficulty, the pragmatic approach of referral of all cases suspicious for infection, as suggested by McKechnie and Snelson, is prudent. Prompt secondary care assessment would then allow timely and effective treatment to prevent sight threatening complications.

References
1. Maqsood N, Mahmood U. Herpes simplex ophthalmia neonatorum: a sight-threatening diagnosis. Br J Gen Pract 2020, DOI: https://doi.org/10.3399/bjgp20X712973.
2. McKechnie DG, Snelson E. Ophthalmia neonatorum and the role of primary care. Br J Gen Pract 2020, DOI: https://doi.org/10.3399/bjgp20X713621
3. Sathiamoorthi S, Frank RD, Mohney BG. Incidence and clinical characteristics of congenital nasolacrimal duct obstruction. Br J Ophthalmol 2019;103(4):527–9.
4. Zloto O, Gharaibeh A, Mezer E, Stankovic B, Isenberg S, Wygnanski-Jaffe T. Ophthalmia neonatorum treatment and prophylaxis: IPOSC global study. Graefes Arch Clin Exp Ophthalmol 2016; 254(3):577–82.