A red eye in an infant is a cause for immediate concern, as parents worry about their baby’s comfort and vision. The redness can appear in the sclera, the white part of the eye, or affect the inner eyelid and surrounding skin. While often a temporary and minor issue, a red eye should always be observed carefully, as it can signal a condition that needs prompt medical attention. Understanding the common causes helps distinguish between minor irritation and a symptom requiring professional evaluation.
Non-Infectious and Minor Causes
Many instances of a baby’s red eye are caused by minor issues that are not contagious and often resolve on their own. One frequent cause is dacryostenosis, or a blocked tear duct, which affects approximately 6% of newborns. This blockage occurs because a thin membrane at the end of the tear duct, located near the nose, has not fully opened at birth.
The tear backup caused by this obstruction leads to excessive watering and can result in a sticky discharge. This pooling of tears may irritate the eye surface, causing mild redness. The condition generally improves naturally within the first year of life, and parents are often instructed to perform a gentle massage near the tear duct to help open the membrane.
Another common cause, particularly in newborns, is a subconjunctival hemorrhage. This happens when tiny blood vessels rupture beneath the conjunctiva, the transparent layer covering the white of the eye. The rupture usually results from the intense pressure experienced during birth, or from a sudden spike in pressure from vigorous crying, coughing, or vomiting.
The result is a bright red patch on the sclera that is painless and does not affect vision. This condition is harmless and requires no treatment, as the body naturally reabsorbs the blood over one to three weeks, much like a bruise fading away. Temporary redness can also be caused by environmental irritants or the prophylactic eye drops administered shortly after birth, which usually clears up within 24 to 36 hours.
Understanding Conjunctivitis (Pink Eye)
Conjunctivitis, or pink eye, is an inflammation of the conjunctiva caused by a bacterial or viral infection. Both types are highly contagious and typically present with eye redness and discharge, often starting in one eye and spreading to the other.
Bacterial conjunctivitis is characterized by a thick, yellow or green, pus-like discharge that can cause the eyelids to stick together upon waking. Treatment usually involves antibiotic eye drops or ointment to shorten the duration of the infection.
Viral conjunctivitis frequently occurs alongside a cold or upper respiratory infection and typically produces a thin, watery discharge. Viral infections generally resolve on their own within one to three weeks, with treatment focused on symptom relief. Preventing the spread involves diligent hand washing, avoiding the sharing of towels, and cleaning away discharge.
Neonatal Conjunctivitis
Neonatal conjunctivitis, or ophthalmia neonatorum, occurs within the first month of life and can have more severe causes. It can be due to chemical irritation from eye drops given at birth, or by bacteria or viruses acquired during passage through the birth canal, such as Chlamydia or Neisseria gonorrhoeae. Since infections in newborns can quickly lead to systemic issues or vision damage, any red eye with discharge in an infant under one month old requires immediate medical evaluation.
When Redness Signals an Emergency
While most red eye causes are minor, certain accompanying symptoms require urgent medical attention. One serious condition is periorbital cellulitis, a bacterial infection of the eyelid and surrounding tissues. Symptoms include rapid swelling of the eyelid, redness, warmth to the touch, and sometimes fever.
This infection can potentially progress to orbital cellulitis, which affects the tissues deeper within the eye socket. Orbital cellulitis can threaten vision or lead to complications like meningitis. If the baby shows pain with eye movement, the eyeball appears to bulge, or their vision seems affected, it suggests the infection has spread.
Other indicators of an emergency warrant immediate consultation:
- Systemic symptoms like a high fever, extreme irritability, or lethargy accompanying the red eye.
- Localized signs such as light sensitivity, where the baby turns away from light.
- A visible cloudiness or white spot on the cornea.
- Any redness following a direct trauma to the eye.
- Any symptom that worsens rapidly or fails to improve after 24 to 48 hours.