Newborns with symptoms of conjunctivitis (pink eye) should see a doctor right away.
Neonatal conjunctivitis is a red eye in a newborn caused by infection, irritation, or a blocked tear duct. When caused by an infection, neonatal conjunctivitis can be very serious.
Symptoms and Causes of Conjunctivitis in Newborns
Newborns with conjunctivitis develop drainage from the eyes within a few days to several weeks after birth. Their eyelids become puffy, red, and tender. The cause of neonatal conjunctivitis is often difficult to determine because, in many instances, the symptoms don’t vary by cause.
Conjunctivitis in a newborn may be caused by a blocked tear duct, irritation produced by the topical antimicrobials given at birth, or infection with a virus or bacterium passed from the mother to her baby during childbirth. Even mothers without symptoms (asymptomatic) at the time of delivery can carry and pass bacteria or viruses to babies during birth.
The most common types of neonatal conjunctivitis include the following:
Inclusion (chlamydial) conjunctivitis Chlamydia trachomatis can cause inclusion conjunctivitis and genital infections (chlamydia). A woman with untreated chlamydia can pass the bacteria to her baby during childbirth. Symptoms of inclusion conjunctivitis include redness of the eye(s), swelling of the eyelids, and discharge of pus. Symptoms are likely to appear 5 to 12 days after birth. Symptoms can develop earlier if the amniotic sac is ruptured during delivery. Some newborns with chlamydial conjunctivitis can have the infection in other parts of their bodies. The bacteria can infect the lungs and nasopharynx (where the back of the nose connects to the mouth).
Gonococcal conjunctivitis Neisseria gonorrhoeae can cause gonococcal conjunctivitis, as well as the sexually transmitted infection called gonorrhea. A woman with untreated gonorrhea can pass the bacteria to her baby during childbirth. Symptoms usually include red eyes, thick pus in the eyes, and swelling of the eyelids. This type of conjunctivitis usually begins in the first 2-5 days of life. It can also progress to serious infections of the bloodstream (bacteremia) and lining of the brain and spinal cord (meningitis) in newborns.
Chemical conjunctivitis When eye drops are given to newborns to help prevent a bacterial infection, the newborn’s eye(s) may become irritated. This may be diagnosed as chemical conjunctivitis. Symptoms of chemical conjunctivitis usually include mildly red eye(s) and some swelling of the eyelids. Symptoms are likely to last for only 24 to 36 hours.
Other neonatal conjunctivitis Viruses and bacteria other than Chlamydia trachomatis and Neisseria gonorrhoeae can cause conjunctivitis. For example, bacteria that normally live in a woman’s vagina and are not sexually transmitted can cause conjunctivitis. Additionally, the viruses that cause genital and oral herpes can cause neonatal conjunctivitis and severe eye damage. The mother may pass such viruses to her baby during childbirth. However, herpes conjunctivitis is less common than conjunctivitis caused by gonorrhea and chlamydia. Symptoms usually include red eye(s) and swollen eyelids with some pus.
Prevention and Treatment of Conjunctivitis in Newborns
To prevent neonatal conjunctivitis, most states have laws requiring providers to put drops or ointment in a newborn’s eyes, typically within 2-3 hours of birth. In the past, hospitals used silver nitrate; now hospitals mostly use antibiotic eye drops, typically erythromycin. During pregnancy and prior to giving birth, women with genital herpes should consult with their physician about ways to minimize the chances of spread to their newborn baby.
Doctors may treat neonatal conjunctivitis caused by a bacterial infection with antibiotics. It will depend on the severity of the infection and the bacteria that caused it. Some antibiotics are applied as an eye drop or ointment in the eye (topical). Other antibiotics are given by mouth (orally), through a vein (intravenous), or as a shot (intramuscular). Doctors may treat a newborn’s conjunctivitis with a combination of topical, and either oral, intravenous, or intramuscular antibiotics. Rinsing the newborn’s infected eye with a saline solution will remove any debris that may develop in response to the infection.
If a blocked tear duct causes conjunctivitis, a gentle, warm massage between the eye and nasal area may help. If the blocked tear duct does not clear by 1 year of age, the newborn may require surgery.
Treatments for the common causes of neonatal conjunctivitis are as follows:
Inclusion (chlamydial) conjunctivitis Doctors usually use oral antibiotics to treat inclusion conjunctivitis.
Gonococcal conjunctivitis Doctors give intravenous (IV) or intramuscular (IM) antibiotics to treat gonococcal conjunctivitis. If untreated, the newborn could develop corneal ulcerations (open sores in the cornea) and blindness.
Chemical conjunctivitis Since this type of conjunctivitis is caused by chemical irritation, treatment is usually not required. The newborn will usually get better in 24 to 36 hours.
Other bacterial and viral conjunctivitis Doctors usually give antibiotic drops or ointments to treat conjunctivitis caused by other bacteria For both bacterial and viral conjunctivitis, a warm compress to the eye may relieve swelling and irritation. Be sure to wash hands before and after touching the infected eyes.
Neonatal conjunctivitis Information | Mount Sinai
Newborn conjunctivitis; Conjunctivitis of the newborn; Ophthalmia neonatorum; Eye infection - neonatal conjunctivitis
Conjunctivitis is swelling or infection of the membrane that lines the eyelids and covers the white part of the eye.
Conjunctivitis may occur in a newborn child.
Swollen or inflamed eyes are most commonly caused by:
A blocked tear duct
Eye drops with antibiotics, given right after birth
Infection by bacteria or viruses
Bacteria that normally live in a woman's vagina may be passed to the baby during childbirth. More serious eye damage may be caused by:
Gonorrhea and chlamydia: These are infections spread from sexual contact.
The viruses that cause genital and oral herpes: These may lead to severe eye damage. Herpes eye infections are less common than those caused by gonorrhea and chlamydia.
The mother may not have symptoms at the time of delivery. She still may carry bacteria or viruses that can cause this problem.
Infected newborn infants develop drainage from the eyes within 1 day to 2 weeks after birth.
The eyelids become puffy, red, and tender.
There may be watery, bloody, or thick pus-like drainage from the infant's eyes.
Exams and Tests
The health care provider will perform an eye exam on the baby. If the eye does not appear normal, the following tests may be done:
Culture of the drainage from the eye to look for bacteria or viruses
Slit-lamp exam to look for damage to the surface of the eyeball
Eye swelling that is caused by the eye drops given at birth should go away on its own.
For a blocked tear duct, gentle warm massage between the eye and nasal area may help. This is most often tried before starting antibiotics. Surgery may be needed if a blocked tear duct has not cleared up by the time the baby is 1 year old.
Antibiotics are often needed for eye infections caused by bacteria. Eye drops and ointments may also be used. Salt water eye drops may be used to remove sticky yellow drainage.
Special antiviral eye drops or ointments are used for herpes infections of the eye.
Quick diagnosis and treatment often leads to good outcomes.
Complications may include:
Inflammation of the iris
Scar or hole in the cornea -- the clear structure that is over the colored part of the eye (the iris)
When to Contact a Medical Professional
Talk to your provider if you have given birth (or expect to give birth) in a place where antibiotic or silver nitrate drops are not routinely placed in the infant's eyes. An example would be having an unsupervised birth at home. This is very important if you have or are at risk for any sexually transmitted disease.
Pregnant women should get treatment for diseases spread through sexual contact to prevent newborn conjunctivitis caused by these infections.
Putting eye drops into all infants' eyes in the delivery room right after birth can help prevent many infections. (Most states have laws requiring this treatment.)
When a mother has active herpes sores at the time of delivery, a Cesarean section (C-section) is recommended to prevent serious illness in the baby.
Olitsky SE, Marsh JD. Disorders of the conjunctiva. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 644.
Orge FH. Examination and common problems in the neonatal eye. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 95.
Rubenstein JB, Spektor T. Conjunctivitis: infectious and noninfectious. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 4.6.
Last reviewed on: 12/10/2021
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Eye diseases of newborns: causes and treatment
Every parent strives to protect his child from health problems. But no matter what efforts are made, it is impossible to completely protect the child from diseases. Some health problems are prevented by vaccination. But this does not apply to pathologies of the organs of vision. Eye diseases in newborns - let's figure it out together what we can do, and what only specialists can help with.
Eye diseases in newborns
Eye diseases in newborns are divided into two types:
Congenital. These eye diseases occur even in the prenatal period and are provoked by various complications of pregnancy. The main reason is infectious and viral diseases carried by a pregnant woman. An infection that enters the body of a future mother is very dangerous for the baby. It is also worth mentioning that parents with myopia can transmit the pathology to the newborn. In this case, the probability of visual impairment in the child is approximately 50/50.
Hereditary. Passed down genetically from parents, grandparents, and so on.
Symptoms and treatment of eye diseases:
Children's eye diseases cause a lot of trouble. Treatment takes time, resources, and the professional help of an ophthalmologist. Frequent eye diseases in newborns are:
Conjunctivitis. With this disease, inflammation of the conjunctiva occurs. This is a mucous membrane that covers the eye protein and eyelids with a thin layer from the inside. An ophthalmic disease occurs due to an irritant, allergy or infection. The peculiarity of conjunctivitis is that it is capable of affecting a healthy eye after a diseased eye. Symptoms - redness of the eyeballs, increased tearing and various discharges. Treat with antiviral and antibacterial drugs. Conjunctivitis in newborns requires urgent treatment. Treatment is prescribed after examination and consultation with an ophthalmologist.
Halazion. Accompanied by blockage and inflammation of the meibomian glands of the eyelids. Often diagnosed in preschoolers and schoolchildren. It affects both the upper and lower eyelids. In some cases, both eyes are affected at once. Often a chalazion is a consequence of SARS, influenza or diabetes. But the most common cause is infection in the eyes due to contact with dirty hands. Medical care for chalazion is hygienic measures to restore the ducts of the glands and relieve inflammation.
Barley. Occurs due to pathogenic bacteria such as Staphylococcus aureus. The infection provokes an inflammatory process in the eyelash follicle or sebaceous gland. Barley is typical for children of any age. Symptoms: swelling at the edge of the eyelid and redness, then from the 3rd day a white purulent top forms, which breaks through on the 5th-6th day and the process ends on its own.
Congenital cataract - clouding of the lens. Depending on the size, opacities are divided into point, partial and complete. If a cataract impairs the visibility of the fundus, which implies a child's low vision in the future, the question is raised about removing the cataract and replacing the lens with an artificial one. In this case, the correct clear image will be formed on the retina, further stimulating the normal development of the eye.
Infant Eye Hygiene
Often discharge accumulates in the corners of the child's eyes after waking up. To remove, a cotton swab is wetted in boiled warm water. The movement is carried out from the outer corner to the inner.
Make sure you have good lighting. Use combined lighting (electric and daylight). The best source of electrical lighting is incandescent lamps. It is important that during the development of color vision the child is surrounded by colored, bright things.
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