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.
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.
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. A 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.
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 a risk of a flare-up, the obstetrician may recommend a cesarean section instead of a vaginal delivery.
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).
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.
