Pink eye, which is medically termed conjunctivitis, affects infants just as it does older children and adults. Conjunctivitis is the inflammation of the conjunctiva, the thin, clear membrane that covers the white part of the eye and the inner surface of the eyelids. This inflammation can arise from several different sources, each with its own level of seriousness, making prompt medical attention for a newborn necessary.
Specific Causes of Neonatal Conjunctivitis
The condition in infants is specifically known as Ophthalmia Neonatorum. Its causes are often categorized by when symptoms first appear. One of the earliest causes is chemical conjunctivitis, occurring within the first 24 hours of life due to prophylactic eye drops given at birth to prevent infection. This irritation is mild, quickly resolves on its own, and is a transient reaction to the medication.
Infectious causes are often acquired during the birthing process from the mother’s birth canal. The bacterium Neisseria gonorrhoeae (gonorrhea) leads to gonococcal conjunctivitis, presenting rapidly within two to five days after birth. This infection can quickly cause corneal ulceration and permanent vision loss if not treated immediately. Another bacterial cause is Chlamydia trachomatis, which typically appears five to 14 days after birth. Chlamydial conjunctivitis requires treatment because the bacteria can colonize the nose and throat, potentially leading to pneumonia.
Less common are viral causes, most notably the herpes simplex virus (HSV), which may manifest between five and 14 days after delivery. A common non-infectious cause that mimics conjunctivitis is a blocked tear duct (dacryostenosis). While not an infection itself, this blockage can lead to secondary infections and requires different management than bacterial or viral pink eye.
Recognizing the Signs in a Newborn
Parents should watch for several visual indicators that suggest their newborn may have conjunctivitis. The most obvious sign is pink or red discoloration of the white part of the eye and the inner lining of the eyelids. Discharge from the eye varies in consistency and color depending on the underlying cause. A clear or watery discharge may signal a viral cause or chemical irritation.
A thick, pus-like, yellowish, or greenish discharge suggests a bacterial infection. This thick discharge often leads to crusting along the eyelashes, making the baby’s eyelids stick together. Swelling of the eyelids is also frequently seen. If any of these signs appear, contacting a pediatrician immediately is necessary.
Standard Medical Treatment
The first step in medical treatment is often a laboratory test, such as a swab of the eye discharge, to identify the exact pathogen, as treatment differs significantly for each type of infection. For chemical conjunctivitis, no specific treatment is usually required beyond supportive care, as the irritation typically clears within 24 to 36 hours.
For bacterial infections, treatment involves antibiotics, which may be topical or systemic depending on the organism. If gonococcal conjunctivitis is diagnosed or strongly suspected, intravenous or intramuscular antibiotics, such as ceftriaxone, are administered due to the risk of corneal damage and widespread infection. Chlamydial conjunctivitis requires oral antibiotics, typically erythromycin, because the infection often resides in the nasopharynx and cannot be eradicated with topical drops alone. If the cause is a blocked tear duct, treatment involves gentle massage of the area between the eye and nose, often combined with warm compresses to help clear the blockage.
Prophylaxis and Mandatory Prevention Protocols
The standard of care for newborns immediately after birth includes a mandatory preventative measure to protect their eyes. This procedure involves the application of a prophylactic antibiotic eye ointment, most commonly 0.5% erythromycin, into both eyes. The ointment is typically applied within the first hour of birth.
This protocol was established primarily to prevent gonococcal ophthalmia neonatorum, which historically was a major cause of blindness in infants. While the erythromycin ointment is highly effective against the Neisseria gonorrhoeae bacterium, it is less effective against Chlamydia trachomatis. The most effective prevention strategy is still the prenatal screening and treatment of the pregnant mother for sexually transmitted infections. Even with widespread maternal screening, this immediate post-birth application remains a routine and legally required public health measure in many regions to safeguard the newborn’s vision.