Neonatal conjunctivitis

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.

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:

• Blindness
• Inflammation of the iris (the colored part of the eye)
• Scar or hole in the cornea -- the clear structure that is over the colored part of the eye

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.

Newborn conjunctivitis; Conjunctivitis of the newborn; Ophthalmia neonatorum; Eye infection - neonatal conjunctivitis

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, Kelly E. Infectious conjunctivitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 6th ed. Philadelphia, PA: Elsevier; 2023:chap 4.6.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.