Which cause of neonatal conjunctivitis is considered the most destructive?

Gonococcal conjunctivitis is considered the most destructive cause of neonatal conjunctivitis due to the severe complications it can cause if not promptly recognized and treated. Neisseria gonorrhoeae can lead to rapid and significant corneal damage and even blindness in infants. The bacteria can traverse the corneal epithelium, leading to severe purulent discharge, inflammation, and rapid progression of keratitis.

This condition typically presents within the first few days of life, often within 24 to 48 hours after birth, which underscores the urgency for immediate medical intervention. The potential for severe complications such as corneal perforation emphasizes the destructive nature of gonococcal infection in neonates.

Other types of conjunctivitis seen in neonates, such as chlamydial conjunctivitis and viral conjunctivitis, can also cause significant eye problems, but they generally have a less rapid onset and potentially less severe outcomes compared to gonococcal conjunctivitis. Chemical conjunctivitis, commonly resulting from exposure to silver nitrate or other irritants applied at birth, typically resolves quickly without long-term damage.