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Are eye drops really needed?

December 7, 2016   ·   0 Comments

Dear Editor,

Are eye drops really needed?

On arriving home from the hospital with our new daughter, the first call on our answering machine was not offering congratulations. It was from Public Health summoning me to explain why I am not unfit to care for her.

Their concern was that she had left hospital without having drops of the antibiotic erythromycin applied to her eyes.

In my view, that treatment is not sensible.

Ontario has required eye drops in newborns for over 100 years. A small number of pregnant women have always been infected with gonorrhea or chlamydia, which if left untreated can get into their babies’ eyes during birth. Back in the 19th Century, STDs were hard to detect and treat, so newborns would go blind. Nowadays we have tests for them and pregnant women are routinely screened. But bizarrely the Province still requires that all babies be given erythromycin drops in their eyes.

The law is set out in Chapter H7 of the Health Protection and Promotion Act 1990. Clause 33(1) says healthcare providers must give the drops to newborns, while 33(2) says there is no right to withhold consent to this procedure.

Pause to reflect on that for a second. Ontario allows parents to opt out of life-saving vaccines for their children, but not eye drops. Some parents can legally withhold consent to chemotherapy even when that almost guarantees their children will die, but eye drops are sacrosanct. Many hospitals do not even seek consent but apply the drops to babies’ eyes while their mothers are distracted.

The absurdity here is that, while powerful antibiotics can treat STD-related eye problems, many experts seriously doubt that the erythromycin drops used on all newborns will work (the evidence is summarised by Darling and McDonald in the 2010 Journal of Midwifery and Women’s Health). Bacteria are increasingly resistant to the small doses used. The Canadian Paediatric Society recently condemned mandatory eye drops because the evidence that they help children is too weak to justify requiring them

Many countries no longer use these drops, and Ontario might be the only place in the world where low-risk parents are never allowed to refuse them. Britain stopped using drops, far less forcing them on patients, in the 1950s and STD-related blindness in children remains incredibly rare.

There are many obvious alternatives to using antibiotic drops on every baby in Ontario. We could focus resources on children who are at serious risk of infection based their mothers’ histories. Obviously, treating pregnant women who are sick is also a good idea. While I cannot speak from personal experience, I hear gonorrhea is fairly unpleasant for infected adults too. Infant eye drops will not cure the mother’s infection. More powerful antibiotics are available for the tiny numbers of children unlucky enough to be infected, and those definitely work.

Right now, we are forcing everyone to accept a treatment which may not work for diseases which are both rare and easy to detect. Clinicians are being forced to choose between forcibly treating children whose parents strongly object and putting their careers at risk, when they should be building trusting relationships with their patients. Experts in public health are being ordered to police an archaic law when they should be focused on their important work that makes all our lives better. New parents are writing to editors when we should be dodging projectile vomit and hallucinating about giant talking Wubbanubs.

I welcome anyone to correct me if these facts are incorrect. Otherwise, why is Clause 33 still on the books?

Iain Wilson,

Lakeview Court, Orangeville

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