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Conjunctivitis (Pink Eye) in Newborns

Español: La conjuntivitis en los recién nacidos

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 1 day to 2 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 bacteria or viruses that can be passed to babies during birth.

The most common types of neonatal conjunctivitis include the following:

  • Inclusion (chlamydial) conjunctivitis
    Inclusion conjunctivitis is caused by the bacterium called Chlamydia trachomatis, which a mother with untreated chlamydia (a sexually transmitted infection) may pass to her baby during childbirth. Symptoms of inclusion conjunctivitis include redness of the eye(s), swelling of the eyelids, and discharge of pus, and are likely to appear 5 to 12 days after birth.
  • Gonococcal conjunctivitis
    Gonococcal conjunctivitis is caused by the bacterium called Neisseria gonorrhoeae, which a mother with untreated gonorrhea (a sexually transmitted infection) can pass to her baby during childbirth. Symptoms in a newborn with gonococcal conjunctivitis usually include red eyes, thick pus in the eyes, and swelling of the eyelids. This type of conjunctivitis usually begins about 2 to 4 days after birth.
  • 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
    Red eye(s), and swollen eyelids with some pus, are also typical symptoms of conjunctivitis caused by viruses, and bacteria other than Chlamydia trachomatis and Neisseria gonorrhoeae. For example, bacteria that normally live in a woman's vagina and are not sexually transmitted can also 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. 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 the newborn baby.
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Prevention and Treatment of Conjunctivitis in Newborns

To prevent neonatal conjunctivitis, most hospitals are required by state law to put drops or ointment in a newborn's eyes to prevent disease. In the past, silver nitrate was used; it has been mostly replaced with antibiotic eye drops, such as erythromycin.

Neonatal conjunctivitis caused by a bacterial infection may be treated with antibiotics in the form of topical (eye drops and ointments applied to the eye), oral, or intravenous (given through a vein), depending on the severity of the infection and the bacteria that caused it. It can also be treated with a combination of topical, and either oral or intravenous antibiotics. The newborn’s infected eye may also be rinsed with a saline solution to remove any pus that builds up.

If the conjunctivitis is caused by a blocked tear duct, a gentle, warm massage between the eye and nasal area may help. If the blocked tear duct is not cleared by 1 year of age, the newborn may require surgery.

Treatments for the common causes of neonatal conjunctivitis are as follows:

  • Inclusion (chlamydial) conjunctivitis
    Oral antibiotics are usually used to treat inclusion conjunctivitis.
  • Gonococcal conjunctivitis
    Intravenous (IV) antibiotics are usually given 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
    Antibiotic drops or ointments for the eye are usually given to treat conjunctivitis caused by bacteria other than Chlamydia trachomatis and Neisseria gonorrhoeae. 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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