What to Do About a Newborn Eye Infection

Causes of Neonatal Conjunctivitis ("Pink Eye")

Let's say that you return home from the hospital and notice that your new infant's eyes are red and crusty. Could it be pink eye? While we don’t usually think of this with newborns, pediatricians are all too familiar with the condition, referred to as neonatal conjunctivitis.

Conjunctivitis is the inflammation or infection of the conjunctiva, the clear lining of the eye and eyelid. While most infants receive eye drops right after birth to prevent multiple infections there is still a chance the baby may develop pink eye either in a hospital or at home.

Symptoms

Infants that develop neonatal conjunctivitis will typically develop swelling of the eyelids, usually within 14 days of birth. Their eyes may also become red and tender. Most will also develop a watery or viscous discharge from the eyes, causing the eyelids to stick together.

When to See a Doctor

The cause of neonatal conjunctivitis is often difficult to discern as the symptoms tend to be the same. As such, newborns with pink eye should always be seen by a doctor. When caused by an infection, neonatal conjunctive can be very serious.

Causes

The causes of pink eye in newborns include both physical causes (like a blocked tear duct) and external ones (like irritants and infection). In some cases, there may be multiple causes, each of which may require separate investigation and treatment.

Blocked Tear Duct

The most common cause of a red, crusty eye in a newborn is a nasolacrimal obstruction, commonly known as blocked tear duct. This type of infection usually develops a couple of weeks after birth. Blocked tear duct occurs in up to 20 percent 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 obstructed 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 narrower than usual.

It a tear duct is blocked, tears have nowhere to drain, and the accumulated fluid can quickly become a hotbed for infection.

Blocked tear duct will often be recognized when tears begin to 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 will appear red and swollen. Sometimes a greenish-yellow mucus may appear.

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 inflamed, the reaction of which is referred to as chemical conjunctivitis.

Bacterial Conjunctivitis

Bacterial conjunctivitis may be caused by bacteria in a woman’s vagina that is transmitted to the newborn's eyes as it passes through the birth canal. The bacteria may or may not be sexually transmitted. In some cases, it may be an otherwise harmless bacteria to which your baby has not yet developed an immunity.

Sexually transmitted bacteria are especially concerning since they can cause serious systemic infections or cause ocular infections that lead to blindness. These include Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea), both of which can be in high concentrations in the vagina during an active infection.

Generally speaking, if the baby's eye and the lower eyelid looks red and inflamed, an eye infection is to blame.

Viral Conjunctivitis

While far less common, some viruses can cause neonatal conjunctivitis. Herpes simplex-2 (HSV-2) associated with genital and oral herpes is a usual suspect. Herpes infections in the eyes can be extremely serious, leading to eye damage and vision loss.

If a mother has an active genital herpes infection or is at risk of a flare-up, the obstetrician may recommend a cesarean section instead of a vaginal delivery.

Diagnosis and Treatment

Pink eye can often be diagnosed by a physical examination but may also involve a swab of the eye discharge if an infection is suspected. This is especially true if there other signs of infection including fever, crying, poor feeding, and changes in skin color.

Depending on the confirmed or suspected cause, treatment may involve:

  • A blocked tear duct may be relieved with a gentle, warm massage between the eye and nasal area. If the blocked tear duct does not clear by age 1, surgery may be needed.
  • Eye irritation caused often be relieved with special neonatal eyedrops and eased by placing a warm, moist cloth over the eyes.
  • Bacterial infections are treated with antibiotics. Depend on the severity, the antibiotic may be delivered in an eye drop, eye ointment, oral solution, or through a vein (intravenously). 
  • Herpes simplex usually requires treatment with a single injection of the antiviral Zovirax (acyclovir).

If treating your baby's pink eye at home, always wash your hands with soap and water beforehand. If only one eye is affected, use a different washcloth for each eye, and avoid touching the tip of the eye dropper on the baby's eye or skin.

A Word From Verywell

While pink eye is usually mild and easy to treat, don't take any chances or treat the newborn with the same medications you would use to treat your other children or yourself. Always see your pediatrician as soon as possible and use only those drugs or drops your doctor prescribes.

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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.