Evidence Library · Newborn procedures

The eye ointment

A grade A recommendation, for one infection, with a common misunderstanding.

Antibiotic ointment is placed in the newborn's eyes to prevent gonococcal eye infection, which can cause blindness. The US Preventive Services Task Force gives this a grade A recommendation, its strongest, and most states require it by law.

The condition it prevents is now rare, occurring in roughly 0.4 to 1.6 cases per 100,000 live births in recent US data.

The common misunderstanding is that it also protects against chlamydia. It does not. In a study of 12,431 newborns comparing silver nitrate, erythromycin and tetracycline, chlamydial conjunctivitis occurred in 20%, 14% and 11% of exposed infants respectively, with no significant difference between agents. Chlamydia in a newborn is treated with oral antibiotics, not prevented by ointment.

Timing is negotiable even where the ointment is notAsk for it to be delayed until after the first hour of skin-to-skin contact. It blurs the baby's vision briefly, and there is no reason it has to happen in the first minutes.

Where this comes from:

243. US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, et al. Ocular prophylaxis for gonococcal ophthalmia neonatorum: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2019;321(4):394-398.

244. Hammerschlag MR, Cummings C, Roblin PM, Williams TH, Delke I. Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis. N Engl J Med. 1989;320(12):769-772.

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