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Info Sheet: Eye Prophylaxis, aka Eye Ointment

Posted on July 23, 2013 at 8:14 AM Comments comments (173)
Image from http://www.rxzone.us/images/products/big/313437.jpg Definition
Eye Prophylaxis: ointment or eye drops containing an antibiotic medication that are placed in a newborn's eyes.
Why was it developed?  What was it supposed to treat?  
“The use of erythromycin eye ointment in newborns has its roots in the late 1800s. During that time period, approximately 10% of newborns born in maternity hospitals across Europe developed ophthalmia neonatorum (ON). ON is a type of pink eye that caused blindness in 3% of infants who were affected (Schaller and Klauss 2001). This means that during the late 1800s, before antibiotics were discovered, 0.3% of infants (3 out of 1,000) were blinded from ON.
In 1881, a physician named Carl Crede realized that infants were catching ON during vaginal delivery, and that the infections were caused by gonorrhea—a sexually transmitted infection. Dr. Crede found that by putting silver nitrate in the eyes of newborn babies, he could prevent ON.
Has it been effective: has the incidence decreased because of the intervention/procedure/test?
“The number of newborn ON infections in Dr. Crede’s hospital went from 30-35 cases per year to 1 case in the first six months he started using silver nitrate.
Today, more than 130 years after Dr. Crede made his discovery, quite a few things have changed though. First, the development of antibiotics has made it possible to treat an infant who contracts ON—thus making blindness highly unlikely. Also, silver nitrate is no longer used in most developed countries, because it is highly irritating to the eye and can cause severe pain, chemical pink eye, and temporary vision impairment. Silver nitrate is also not effective with infections caused by Chlamydia, the most common cause of ON today. Furthermore, silver nitrate and tetracycline eye ointment (another antibiotic that has been used in the past to prevent ON) are no longer available in the U.S.  For these reasons, 0.5% erythromycin ophthalmic ointment is used in the U.S. and Canada to prevent ON infection.”

Image from http://doulaswithgrace.com/eye-ointment/ 

  • Erythromycin can reduce the risk of Chlamydia and Gonorrheal ON (Darling and McDonald 2010)
  • Erythromycin prophylaxis may be helpful if the mother was not screened for Chlamydia/Gonorrhea, screening results were not correct, or if there is a sexual partner who may be re-infecting her (Medves 2002)
  • Erythromycin prophylaxis may be especially helpful in geographic regions where rates of Chlamydia and gonorrhea are very high (Medves 2002)
  • Erythromycin ointment is inexpensive (Darling and McDonald 2010)


  • Prenatal detection and treatment of maternal Chlamydia and Gonorrhea is ideal, and may also prevent other adverse outcomes for mother and newborn.
  • Evidence suggests that current North American laws mandating universal neonatal eye prophylaxis have limited benefit
  • Universal prophylaxis will not prevent all cases of ON, and early identification and treatment of newborns infected with either GON or CON will also be necessary to prevent adverse outcomes caused by these infections.
  • Systemic rather than topical antibiotic therapy is recommended for treatment of GON and CON.

Source: Arizona Department of Health Services
Links to continue your research and draw your own conclusion about what is best for your family:

Randomized Trial Results published in the American Journal of Pediatrics, 1993 
Comparison of silver nitrate, tetracycline, erythromycin and no prophylaxisThe bacterial etiology of conjunctivitis in early infancy. Eye Prophylaxis Study Group.Failure of erythromycin ointment for postnatal ocular prophylaxis of chlamydial conjunctivitis.A meta-analysis of the efficacy of ocular prophylactic agents used for the prevention of gonococcal and chlamydial ophthalmia neonatorum.
Is Mandatory Neonatal Eye Prophylaxis Ethically Justified? A Case Study
from Canada
Eye Prophylaxis in the Newborn Infant
Prophylaxis for Gonococcal and Chlamydial Ophthalmia Neonatorum 

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