Conjunctivitis (Pink Eye) in Newborns

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

sleeping baby

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.

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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.
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