Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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A red neonatal eye needs immediate assessment
Profuse pus, corneal haze or ulceration, vesicles, poor feeding or an unwell baby may indicate gonococcal infection, neonatal herpes or disseminated disease.
Action: Contact on-call ophthalmology immediately and involve acute paediatrics or neonatology. Stabilise a sick infant, obtain urgent specimens without delaying indicated systemic treatment, and arrange hospital care.
Synopsis
Recognise neonatal conjunctivitis, protect the cornea and identify babies who need immediate systemic treatment and assessment for infection beyond the eye.
Ophthalmia neonatorum means conjunctival inflammation in the neonatal period, usually defined as the first 28 days.
Simple stickiness without conjunctival redness or other infection signs is a different clinical problem.
Onset helps prioritise organisms but cannot safely exclude gonococcus, chlamydia or herpes.
Key red flags
Copious discharge that rapidly returns after cleaning, particularly during the first few days after birth.
Investigation priorities
01
Urgent conjunctival microscopy and bacterial cultureFirst step
Identify a likely gonococcal infection and recover organisms for susceptibility testing.
Management branches
TriageSeparate uncomplicated stickiness from inflammation
A newborn presents with ocular discharge in the community or postnatal setting.
Assess general condition and inspect both conjunctivae and corneas before labelling the problem a blocked duct.
For a well infant with no inflammation or other infection signs, explain gentle cleansing and arrange reassessment if symptoms persist or change.
Key medicines
Cefotaxime for isolated gonococcal ophthalmiaNeonatal regimen, not an adult dose: the cited GGC pathway specifies 100 mg/kg intravenously as a single dose for ophthalmia without systemic disease. This is specialist off-label use relative to the cited product's neonatal indications and divided-dose schedules.
Erythromycin oral suspension for neonatal chlamydiaNeonatal GGC and BASHH regimen: 12.5 mg/kg per dose orally four times daily for 14 days, equivalent to 50 mg/kg per day. The cited erythromycin suspension includes eye infections and weight-based dosing up to this daily amount in children under two years; the neonatal course is specified by the clinical guidance.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.
NHS GGC: eye infections in the neonatePublic neonatal pathway, reviewed January 2023, accessed September 2026; source-labelled IV cefotaxime and oral macrolide regimens, specimen collection and follow-up. Its scheduled review date has passed, so doses are cross-checked against BASHH children's guidance and current product information.
College of Optometrists: ophthalmia neonatorumPublic summary supports immediate referral to on-call ophthalmology and the risk of corneal complications; member-only recommendations were not used.
Erythromycin 125 mg/5 mL oral suspension SmPCCurrent product indications, paediatric weight-based dosing, QT contraindications, interactions, excipients and pyloric stenosis warning.
Zithromax 200 mg/5 mL oral suspension SmPCJuly 2026 product information confirms licensed paediatric age limits and neonatal off-label status, as well as pyloric stenosis, QT and hepatic precautions.
Cefotaxime 1 g injection or infusion SmPCProduct-specific neonatal schedules, renal and allergy precautions, administration rate and lidocaine restrictions; the neonatal ocular single-dose regimen comes from clinical guidance.
Ceftriaxone 2 g injection SmPCExact neonatal contraindications concerning prematurity, bilirubin binding and intravenous calcium.
Aciclovir 25 mg/mL infusion SmPCLicensed neonatal 20 mg/kg eight-hourly IV regimen, 14- or 21-day course, renal adjustment, hydration and minimum one-hour infusion.