Redness in a baby’s eye is a common occurrence that frequently causes parental concern. While the appearance of a bloodshot or pink eye can be alarming, causes range widely from minor irritation to conditions requiring immediate medical attention. The delicate structure of an infant’s eye makes it susceptible to environmental factors and infections. Understanding the symptoms associated with the redness is the first step toward appropriate care, followed by distinguishing between non-infectious causes, types of infection, and urgent signs.
Common Non-Infectious Causes
One frequent reason for a persistently watery and mildly red eye is a blocked tear duct, known as dacryostenosis. This occurs because the thin membrane at the end of the nasolacrimal duct, which drains tears into the nose, has not fully opened. The resulting stagnation of tears causes mild irritation and redness, often presenting with a sticky, crusty discharge, particularly after waking.
A subconjunctival hemorrhage is a bright red patch on the white of the eye. This occurs when a tiny blood vessel breaks beneath the conjunctiva, the clear membrane covering the eye, causing a small pool of blood. It is commonly seen in newborns due to pressure changes during birth, or in older infants from straining during crying or coughing.
Minor irritation from the environment, such as exposure to dust, soap, or strong wind, can cause transient redness. A simple corneal abrasion, a scratch on the clear front surface of the eye, is often caused by a baby’s own fingernail or a small foreign object. Redness from an abrasion is accompanied by excessive tearing, light sensitivity, and fussiness, as the cornea is rich in nerve endings.
Redness Due to Infection and Inflammation
Redness accompanied by a discharge often signals conjunctivitis, commonly called pink eye, which can be either viral or bacterial. Distinguishing the type of infection is done by observing the nature of the discharge. Viral conjunctivitis is often associated with a cold or upper respiratory symptoms, producing a watery, clear discharge that may cause the eyes to be sticky in the morning.
Bacterial conjunctivitis is characterized by a thick, purulent discharge that is yellow or greenish and causes the eyelids to stick together throughout the day. This form of infection tends to be more localized and requires antibiotic treatment to clear. Both viral and bacterial conjunctivitis are highly contagious and can spread easily through contact.
Allergic conjunctivitis is less common in newborns than in older children. This condition is not contagious and is triggered by environmental allergens like dust, pet dander, or pollen. The hallmark symptom is intense itching, which leads to eye rubbing, causing redness and swelling, often affecting both eyes simultaneously.
Signs of Serious or Less Common Issues
A less frequent but more serious cause of redness and swelling is periorbital cellulitis, a bacterial infection of the eyelid and surrounding skin. This infection presents with sudden, significant redness and swelling of the eyelid, often accompanied by a fever. The eyeball itself does not bulge, and there is no pain with eye movement.
Glaucoma, in its rare congenital form, can cause eye redness, though it is usually part of a noticeable triad of symptoms. This involves high pressure inside the eye, which manifests as excessive tearing, extreme sensitivity to light, and an enlarged or cloudy appearance to the cornea. Immediate specialized attention is required to prevent permanent vision loss.
Any injury involving trauma or chemical exposure warrants immediate evaluation. Signs of a deeper injury include a visible foreign object, a misshapen or unequal pupil size, or bleeding within the colored part of the eye. Exposure to household chemicals or sprays results in immediate and severe redness, burning, and pain, indicating an ocular emergency.
Immediate Home Care and When to Contact a Doctor
For minor irritation or suspected blocked tear ducts, gentle home care is appropriate. Parents should use a clean, warm compress to loosen any crusting around the eyelids and gently clean the eyes with lukewarm water, wiping from the inner corner outward. Strict hand washing before and after touching the baby’s eyes is necessary to prevent infection spread.
If a chemical has splashed into the eye, the immediate priority is to flush the eye continuously with clean, lukewarm water for a minimum of 20 minutes before seeking emergency care. A doctor should be contacted if the redness persists beyond 48 hours, if there is a mild discharge, or if a blocked tear duct is suspected. Over-the-counter adult eye drops or ointments should never be used on an infant without professional guidance.
Emergency medical attention is necessary if the baby develops a fever accompanying the redness, or if the eye begins to swell significantly. Signs of a potentially serious condition include severe pain, light sensitivity, changes in the pupil’s appearance, or if the baby refuses to open the eye. Seek urgent care immediately if the baby is excessively irritable, has pain when moving the eye, or if the eyeball appears to be bulging.