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Erythromycin Eye Ointment

When a baby is born in the hospital, an eye ointment is almost immediately placed in his or her eyes. Many parents wonder about this strange “goop” and why it’s given to their baby, especially so soon after birth. It is referred to as erythromycin eye ointment, and it has quite an interesting history!

In the 1800’s, about 10% of newborns in hospitals across Europe contracted Ophthalmia neonatorum (ON) —  also known as neonatal conjunctivitis — resulting in some infants becoming blind as a result of the condition. In 1879, a German physician named Albert Neisser discovered that this was due to exposure of gonorrhea — a sexually transmitted disease — in the birth canal. He then realized that this could be prevented by administering silver nitrate in the eyes of all newborns instead of waiting for symptoms to develop. This was a great success that has carried over today (Dekker, 2017).

With the discovery of antibiotics, it is now possible to treat pregnant moms with sexually transmitted diseases before delivery, which significantly decreases the risk of neonatal conjunctivitis. Silver nitrate is also no longer used, and instead, a 0.5% erythromycin solution is used at birth to prevent neonatal conjunctivitis (Dekker, 2017).

What Causes ON?

There are several causes of ON, including from viruses, bacteria, chemicals, or clogged tear ducts. The most common cause today is from chlamydia, a sexually transmitted infection — gonorrhea is now a much less common cause than in the past. ON is still a leading cause of blindness in less developed nations (Dekker, 2017).

If a baby is born via cesarean, it is much less likely that the infant will develop ON. The American Academy of Pediatrics still recommends erythromycin ointment for those born by cesarean, however, because infection can still occur via ascending infection. This means that the bacteria were able to infect the baby before he or she passed through the birth canal (Dekker, 2017).

What are the Benefits for Erythromycin Eye Ointment at Birth?

    • Science proves the ointment helps reduce the risk of ON, and studies also show that erythromycin has been effective in reducing gonorrheal ON as well as the risk of blindness from infections, and possibly chlamydial ON. There is also some evidence that shows erythromycin could be effective in reducing bacteria in the eye and preventing ON from non-sexully transmitted bacteria, such as staph (Dekker, 2017).
    • It’s an added layer of protection. Some mothers and partners do not receive adequate screening or treatment for sexually transmitted infections during pregnancy, and sufficient testing during labor isn’t possible. It could also help protect the newborn if the mother was infected even after a negative screening result. In areas where there are low rates of prenatal care, erythromycin prophylaxis can be especially helpful (Dekker, 2017).

What are the Risks of Erythromycin Eye Ointment at Birth?

  • Eye irritation and chemical pink eye. This could lead to antibiotic treatment when waiting for culture results (Dekker, 2017).
  • Blurred vision. This could potentially interfere with bonding by disrupting the early eye contact and gazing that occurs between a mom and her new baby (Dekker, 2017).
  • It’s not 100% effective. In past years, erythromycin had a 20% failure rate and could be less effective due to increased antibiotic resistance. It also might not be effective at preventing chlamydial ON or ON from non-gonorrheal bacteria (Dekker, 2017).

Should You Opt for Erythromycin Eye Ointment?

The most common cause of ON is chlamydia, with a less common but more serious cause being gonorrhea. Past studies have shown that erythromycin eye ointment is approximately 80% effective against ON from gonorrhea, but also offers some protection against ON from chlamydia. There is also growing evidence of antibacterial resistance, meaning that erythromycin might be less effective today than it used to be. ON can also have other originators, such as clogged tear ducts or staph bacteria. In fact, some studies show that drops of breast milk or colostrum have been shown to reduce ON from non-gonorrheal and non-chlamydial bacteria, as well as inhibit the growth of those bacteria (Dekker, 2017).

Another thing to keep in mind is that ON is treatable as long as antibiotics are started immediately. To prevent ON, make sure to opt for prenatal screening of sexually transmitted infections. In many states, eye ointment can be declined in a hospital setting (and isn’t often used in a home birth or birth center setting) as long as both partners are negative for gonorrhea and chlamydia and are in a monogamous relationship with an uninfected partner. It’s also very unlikely that babies born by cesarean will contract ON if the mother’s water did not break before the surgery.

Whether or not you decide to pursue erythromycin eye ointment for your newborn should be a decision between you, your partner, and your provider. Discuss the pros and cons and how they fit into your lifestyle. Address the benefits and the risks and see what will work best for you and your family, and make a decision together with your clinician.

Jessica Rockowitz is a former OB/GYN Health Educator. She obtained her undergraduate degree in Biotechnology with a minor in Marketing from Endicott College. Upon graduation, Jessica worked in stem cell research at Harvard University and simultaneously volunteered with teen parents and disadvantaged women. Being a former teen parent herself, she has always been passionate about serving young moms and helping empower them to achieve their goals. Itching to pursue a field with more patient interaction, Jessica left the research field and attended a second degree nursing program at The University of Pennsylvania. She then worked in the field of OB/GYN Health Education at a women’s health clinic in downtown Philadelphia. Jessica is also a mother of three and has experienced both a traditional hospital birth with an epidural, followed by two unmedicated birth center births. She likes to think of herself as the perfect balance between holistic and pro-science. When Jessica’s second child was a little over a year, she turned her passion for serving others into a marketing and photography career in Austin, TX where she lives with her husband, three children, and rescue fur baby.