If your new baby has some green discharge coming from one or both eyes, you may think it’s pink eye. Almost all of us have had a case of pink eye at some point. Pink eye, also known as conjunctivitis, is an infection of our eye. This is usually a relatively benign condition, treated usually with some antibiotic eye drops. But for a newborn, not all cases of a goopy eye are pink eye.
Causes of Discharge
For newborns (less than 30 days old), the causes of eye discharge are:1
- Infectious conjunctivitis
- Chemical conjunctivitis
- Lacrimal duct stenosis
The symptoms of conjunctivitis are a red eyeball, colored discharge from the eye or eyes, and often a puffy, red eyelid or lids.
Ophthalmia neonatorum, also known as neonatal conjunctivitis, denotes all the types of infectious conjunctivitis in the first four weeks of life. Up to 12% of newborns will be contract ophthalmia neonatorum.1
In the newborn period, an infection in the eye is often caused by germs from the mother that the baby either acquired coming through the birth canal or that traveled from the birth canal to the baby in the womb.
The most common cause of bacterial conjunctivitis in newborns is Chlamydia trachomatis, which causes as much as 40% of these cases.1 Many mothers don’t know they are infected with chlamydia, as the infection is often asymptomatic in women. Symptoms typically appear in newborns between day 5 and 12.2
Other bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae (which is not the influenza virus), cause 30-50% of the cases of ophthalmia neonatorum.1
Neiserria gonorrhoeae, the germ that cause gonorrhea, used to be a common cause of neonatal conjunctivitis, accounting for 10% of cases in the past. Because this infection can cause corneal scarring, blindness, and infection throughout the body, all babies born in the U.S. have been treated for decades with something to prevent this infection. In the past, 2% silver nitrate was used, but now erythromycin ointment is placed in the baby’s eyes right after birth. This has decreased the incidence of this infection to 0.3%. Although erythromycin has helped to decrease the incidence of gonococcal infection, it does not prevent it entirely. Gonococcal conjunctivitis usually presents around day 2 to 5 of life.1,2
Other bacteria and viruses can cause ophthalmia neonatorum as well, but these are less common. The viruses that causes genital and oral herpes can be a cause, and can lead to severe eye damage, but this infection is rare.2
The good news is that for all of the infections listed above, there is treatment. Doctors usually use oral antibiotics for chlamydia, IV antibiotics for gonococcal conjunctivitis to prevent blindness, and ointment or drops for the other causes.2 The key is alerting your health care provider quickly if you suspect conjunctivitis.
Some conjunctivitis may be due from a irritant that gets into the eye, and not from an infection. Ironically, one of the irritants may be the antibiotic ointment or drops used in all hospitals to prevent an infection. The symptoms are the same: red eyeball, discharge, and puffy, red lids. However, the symptoms are usually milder, and last for only 24-36 hours, resolving on their own without any treatment.2
When coming through the birth canal, babies often get subconjunctival hemorrhages: tiny, painless, collections of blood in the whites of the eyes. This does not present with diffuse redness to the eyeball, but discrete areas of intense redness from ruptured blood vessels. Such trauma does not result in discharge or puffy eyelids, either. There is no treatment for this, as these hemorrhages resolve on their own.
Rarely, a scratch to the cornea, the clear covering of the central part of the eye, can result in symptoms of conjunctivitis. Usually, the scratch was from the infant’s own fingernail. This is easily treated with an antibiotic ointment.
Lacrimal Duct Stenosis
The eye makes tears in the upper, outer part of the eye socket. The tears wash across the eyeball, and remove debris. The tears then drain into the lacrimal duct, which starts at the lower lid, at the point closest to the nose on both sides. If you pull down your own lower lid, you can see the opening to the lacrimal duct.
Like everything else on a newborn, this duct is very small, and can get plugged up easily. With time, it will grow, but as a neonate, it is often blocked. The natural narrowing of this duct is called lacrimal duct stenosis, and it presents with discharge from one or both eyes, but unlike conjunctivitis, it usually does not present with a red eyeball or swollen lids.
This problem usually resolves on its own. One study found that 95% of the cases resolved by 8 months of age without any treatment.3 For those that persist, a pediatric ophthalmologist may need to place a tiny probe into the duct to unclog it.
If your child has lacrimal duct stenosis, you can massage the duct to try to keep it open, thereby reducing the amount of discharge. To be clear, this condition does not seem to bother the infants, but it bothers the parents and caregivers. To massage the eye, place your index finger over the lower lid where the lacrimal duct opens (near the nose), and push firmly downward along where the nose meets the face. If you perform this massage several times a day (for example, 3-4 times each time you feed the baby), you may help open up the duct.3
Call Your Doctor
If your newborn has eye discharge, you should call your doctor. Since many of the causes of eye discharge can result in similar symptoms, it is important to have a professional distinguish between the benign causes from the more serious ones that require urgent treatment.
- Singh G, Galvis A, Das S. Case 1: Eye discharge in a 10-day-old neonate born by Cesarean delivery. Pediatr Rev. 2018 Apr;39(4):210-2.
- CDC. Conjunctivitis (Pink Eye) in Newborns. www.cdc.gov/conjunctivitis/newborns.html Last updated 10/2/17. Accessed 10/13/18.
- Nelson LB, Calhoun JH, Menduke H. Medical management of congenital nasolacrimal duct obstruction. Pediatrics. 1985 Aug;76(2):172-5.