The incidence of gonococcal ophthalmia neonatorum (GON) in the area served by the Peninsula Maternity and Neonatal Services in Cape Town is 273/100,000 live births. Two prophylactic agents, 1% silver nitrate ophthalmic solution and 0.5% erythromycin ophthalmic ointment, were introduced in routine eye care of the newborn in the main academic obstetric units. These agents resulted in a significant decrease in the incidence of GON to 34/100,000 live births. The alternative forms of prophylaxis against GON are discussed and the need for reinstitution of prophylaxis is emphasised.