Pink Eye (Conjunctivitis) in Newborns: An Overview

What to do if your baby shows signs of pink eye

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Pink eye in newborns, or neonatal conjunctivitis, is the most common eye infection affecting new babies. Also known as ophthalmia neonatorum, it's defined as pink eye that occurs within the first month of life.

This type of pink eye has several causes, including sexually transmitted infection (STI) during vaginal delivery. The conjunctiva infection can be serious, even leading to blindness, although that's more common in parts of the world outside the United States.

This article explains the symptoms and causes of newborn pink eye, as well as its treatment. Keep in mind that newborns with pink eye should always be seen by a healthcare provider.

Causes of pink eye in newborns

Verywell / Brianna Gilmartin

Neonatal Conjunctivitis Symptoms

Conjunctivitis is the inflammation or infection of the conjunctiva, the clear lining of the eye and eyelid. 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.

Preventing Newborn Pink Eye at Birth

Babies born to people with gonorrhea infections will contract the infection themselves between 30% and 50% of the time. With this cause of neonatal conjunctivitis, eye damage including blindness can occur within the first 24 hours of birth. For this reason, the United States Preventive Services Task Force recommends that all newborns be treated with a 0.5% erythromycin ointment.

Causes

While most infants receive eye drops right after birth to prevent gonorrhea and other infections, there is still a chance the baby may develop pink eye either in a hospital or at home.

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 a blocked tear duct. This type of infection usually develops a couple of 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 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.

You'll often recognize a blocked tear duct 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 is referred to as chemical conjunctivitis.

Bacterial Conjunctivitis

Bacterial conjunctivitis may be caused by bacteria transmitted to the newborn's eyes as it passes through the birth canal during vaginal delivery. 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. In addition to Neisseria gonorrhoeae, the bacteria responsible for gonorrhea, a newborn may contract Chlamydia trachomatis (chlamydia).

Both bacteria may be found in high concentrations in the vagina during an active infection.

Viral Conjunctivitis

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

If an active genital herpes infection exists during pregnancy, or there is risk of a flare-up, the obstetrician may recommend a cesarean section instead of a vaginal delivery.

Does COVID-19 Cause Newborn Pink Eye?

Researchers have found neonatal conjunctivitis in a days-old baby who tested positive for the COVID-19 virus, but more research is needed to determine how often this happens and why it occurs. Pink eye is the most common eye-related COVID symptom seen in adults and older children as well.

Diagnosis

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.

Treatment

Treatment for pink eye in babies will depend on the underlying cause. For these specific conditions:

  • 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 is often relieved with special neonatal eyedrops, and eased by placing a warm, moist cloth over the eyes.
  • Bacterial infections are treated with antibiotics. Depending on the severity, the antibiotic may be delivered in an eyedrop, 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 eyedropper 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 healthcare provider prescribes.

Frequently Asked Questions

  • Is pink eye in babies contagious?

    It depends on the cause. Pink eye is contagious if a viral or bacterial infection is the cause. Antibiotics can treat the bacterial infection and it won't be contagious in 24 hours. A viral cause will need to run its course.

  • Can pink eye go away on its own?

    It's true that in most cases, pink eye will go away on its own. It may take several weeks, depending on the cause. However, all newborns should be seen by a healthcare provider if they develop pink eye in the first month of life. Home remedies may be tried first in older children and adults.

  • Does breast milk help baby eye discharge?

    Some studies suggest that breast milk is as effective as eyedrop solution in treating babies with eye discharge who are six months old or younger. However, the practice remains controversial, with other experts unready to endorse the practice. Ask your healthcare provider for more information.

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11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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