Newborn Eye Infections

Why Are Your Baby's Eyes Red?

A newborn's eyes
Audrey Lendormy/EyeEm/Getty Images

You're home from the hospital and notice that your new infant's eyes are red and crusty. Could it be pink eye? We don’t usually think of newborn babies when we think of eye infections or pink eye. However, health care providers who work with newborns are all too familiar with neonatal conjunctivitis. Conjunctivitis is an inflammation or infection of the conjunctiva, the clear lining of the eye and eyelid.

It is likely that your infant received eye drops in the delivery room right after birth, which helps to prevent many infections. (Most states have laws requiring the instillation of eye drops for newborn babies immediately after birth. These regulations were put in place to reduce the chance of serious eye infection. For viral infections, if the mother has an active outbreak during delivery, a c-section can be performed to totally avoid any potential infection.)

However, your newborn baby may still develop an infection. The following eye inflammations or infections can occur right at birth or shortly after.

  • Blocked Tear Duct: The most common cause of a red, crusty eye in a newborn is nasolacrimal obstruction, commonly known as blocked tear duct. This type of infection usually develops a couple weeks after birth. Blocked tear duct occurs in up to 20% of newborns. Tears normally drain through small holes located in the corners of the upper and lower eyelids. A blocked tear duct occurs when this drainage system is blocked or has not opened properly. In infants, the drainage system may not be completely mature at the time of birth, causing the duct to be more narrow than usual. If the drainage system is disrupted, tears have nowhere to drain and the eyes become flooded. Tears often spill over onto the eyelid, eyelashes and down the cheek. Crusting may appear on the eyelashes, especially after sleeping. If an infection develops, the eyelids may appear red and swollen, and a greenish-yellow mucus may appear.
  • Bacterial Conjunctivitis: Bacterial conjunctivitis can be caused by bacteria that is present in a woman’s vagina that is not necessarily transmitted sexually. These bacteria may simply be different than what the baby is used to and, as the baby goes through the birth canal, the eyes become infected. A few other types of bacteria are sexually transmitted that can cause more serious infections and potentially blindness in a newborn. These are Chlamydia Trachomatis and Neisseria Gonorrhoeae, both of which can be passed to the baby during childhood.
  • Chemical Conjunctivitis: Sometimes the application of eye drops or eye ointments to newborn babies to help prevent bacterial infections can irritate their eyes. This irritation can cause the eye to become very inflamed and is known as chemical or toxic conjunctivitis.
  • Viral Conjunctivitis: Although much less common, some viruses can cause neonatal conjunctivitis. The virus that causes genital and oral herpes can occasionally cause infections and serious eye damage to newborns. Treatment exists for these types of eye infections. However, if an obstetrician is concerned about the possibility of transmitting herpes from the mother to the baby during a vaginal delivery, a cesarean section surgery will be scheduled instead.

What You Need to Know

Infants that develop neonatal conjunctivitis will typically develop swelling of the eyelids. Their eyes may also become red and tender. Most will also develop a watery or mucus discharge or drainage from the eyes and the eyelids may stick together. Neonatal conjunctivitis symptoms should definitely be taken seriously. If your infant continues to have the symptoms described above, consult a doctor immediately. Sometimes, additional medication may need to be prescribed.

Depending on the infection, some babies may even need to be put on IV antibiotics. An eye that appears slightly enlarged and one that is profusely tearing should also be taken seriously as this could also be a sign of infantile glaucoma. Infantile glaucoma can cause disfigurement and blindness. If your doctor determines that your child has a blocked tear duct, he or she may prescribe antibiotics and instruct you to perform gentle massaging to open the blocked tear duct.

A Word From Verywell

If the white part of your baby's eye and the lower eyelid looks red, an eye infection may be to blame. As your baby's body tries to fight the infection, his eyes may tear excessively or become gooey and crusty. It's important to have your baby's eyes checked by a pediatrician to prevent possible complications of an infection. 

View Article Sources
  • Medline Plus. Kaneshiro, Neil K, MD, MHA. Neonatal Conjunctivitis." 19 Nov 2015.
  • Catania, Louis J. "Primary Care of the Anterior Segment." Second Edition, 1995.