Manual Inspecting the Newborn Baby’s Eyes

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Conjunctivitis is the inflammation or infection of the conjunctiva, the clear lining of the eye and eyelid.

Inspecting the Newborn Baby's Eyes

While most infants receive eye drops right after birth to prevent multiple infections there is still a chance the baby may develop pink eye either in a hospital or at home. Infants that develop neonatal conjunctivitis will typically develop swelling of the eyelids, usually within 14 days of birth. Their eyes may also become red and tender. Most will also develop a watery or viscous discharge from the eyes , causing the eyelids to stick together. The cause of neonatal conjunctivitis is often difficult to discern as the symptoms tend to be the same.

As such, newborns with pink eye should always be seen by a doctor. When caused by an infection, neonatal conjunctive can be very serious.

A Comprehensive Newborn Examination: Part I. General, Head and Neck, Cardiopulmonary

The causes of pink eye in newborns include both physical causes like a blocked tear duct and external ones like irritants and infection. In some cases, there may be multiple causes, each of which may require separate investigation and treatment. The most common cause of a red, crusty eye in a newborn is a nasolacrimal obstruction, commonly known as blocked tear duct.

This type of infection usually develops a couple of weeks after birth.

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Blocked tear duct occurs in up to 20 percent of newborns. Tears normally drain through small holes located in the corners of the upper and lower eyelids. A blocked tear duct occurs when this drainage system is obstructed or has not opened properly. In infants, the drainage system may not be completely mature at the time of birth, causing the duct to be narrower than usual.

It a tear duct is blocked, tears have nowhere to drain, and the accumulated fluid can quickly become a hotbed for infection. Blocked tear duct will often be recognized when tears begin to spill over onto the eyelid, eyelashes, and down the cheek. Crusting may appear on the eyelashes, especially after sleeping. If an infection develops, the eyelids will appear red and swollen. Sometimes a greenish-yellow mucus may appear. Sometimes the application of eye drops or eye ointments to newborn babies to help prevent bacterial infections can irritate their eyes.

This irritation can cause the eye to become inflamed, the reaction of which is referred to as chemical conjunctivitis. The bacteria may or may not be sexually transmitted. In some cases, it may be an otherwise harmless bacteria to which your baby has not yet developed an immunity. Sexually transmitted bacteria are especially concerning since they can cause serious systemic infections or cause ocular infections that lead to blindness.

These include Chlamydia trachomatis chlamydia and Neisseria gonorrhoeae gonorrhea , both of which can be in high concentrations in the vagina during an active infection. Generally speaking, if the baby's eye and the lower eyelid looks red and inflamed, an eye infection is to blame. While far less common, some viruses can cause neonatal conjunctivitis. Herpes infections in the eyes can be extremely serious, leading to eye damage and vision loss.

Pink eye can often be diagnosed by a physical examination but may also involve a swab of the eye discharge if an infection is suspected. This is especially true if there other signs of infection including fever, crying, poor feeding, and changes in skin color. Depending on the confirmed or suspected cause, treatment may involve:. If treating your baby's pink eye at home, always wash your hands with soap and water beforehand. If only one eye is affected, use a different washcloth for each eye, and avoid touching the tip of the eye dropper on the baby's eye or skin. While pink eye is usually mild and easy to treat, don't take any chances or treat the newborn with the same medications you would use to treat your other children or yourself.

Your Care Instructions

A red reflex was not present on the right side. This photo was taken after dilating drops were placed. Some dilation of the right pupil is noted, but it was not equal with the left, and still the retina could not be well seen. The differential diagnosis includes tumor and vascular abnormalities. An ultrasound of the eye was done to evaluate this finding further. This is the same infant shown in the previous photo.

Here the light from the ophthalmoscope is shined obliquely across the front of the eye. Without any special equipment, a red tinge described by the ophthalmologist as a lacy network of peripupillary vessels can be appreciated at the rim of the pupil. When the other eye was evaluated in this way, no red color was seen. When gonococcal conjunctivitis occurs, it typically presents in the first few days of life with copius, purulent discharge in the eyes.


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In this infant, the marked edema of the eyelids was the first symptom noted, but with just slight pressure on the lids, purulent material oozed out seen here. Unlike the typical "pink eye" conjuncitivitis that occurs in older children, gonococcal conjunctivitis is an ophthalmologic emergency. Because the bacteria can erode through an intact cornea, treatment is very aggressive and includes systemic intravenous antibiotics, frequent eye washes, and monitoring in a neonatal intensive care unit.

Fortunately, this diagnosis is very uncommon in places where prophylactic antibiotic eye ointment is used at birth.

Looking at Your Newborn: What’s Normal

This infant presented with hazy bilateral corneal opacities on the initial newborn exam. Congenital glaucoma was the underlying cause. This infant has haziness of the central cornea visible without special equipment. On evaluation with an ophthalmoscope, red reflexes could not be seen due to this opacity. Although the opacity is central and could be mistaken for opacity of the lens, a view from a more oblique angle showed that the cloudiness extended over parts of the iris as well. In contrast to the previous photo, the opacities here occur behind the pupil, as the pupil is easily and clearly seen along its entire circumference.

Again, the opacity can be appreciated without any special equipment a good reminder to assess the eyes visually even if an ophthalmoscope is not readily available. A red light reflex could not be obtained. Congenital cataracts require early intervention to preserve sight, so immediate referral to a pediatric ophthalmologist is indicated.

Caring For Your Newborn

It is important to remember that cataracts that are less dense may not be visibly cloudy, so any time red reflexes cannot be obtained on exam, even if the eye appears grossly normal, referral is required. Clinical Guidelines Hypoglycemia Vitamin K. Newborn Exam Barlow and Ortalani Manuevers. Eyelid Edema. Dysconjugate Eye Movements. Subconjunctival Hemorrhage. Injected Eye. Peripupillary Vascularity.

Gonococcal Conjunctivitis. Congenital Glaucoma. Peter's Anomaly. Congenital Cataract. Eyelid Edema Most infants exhibit some degree of eyelid edema after birth. Dysconjugate Eye Movements During the first few months of life, newborns will frequently have dysconjugate eye movements, where the eyes appear to move independently.

Dysconjugate Eye Movements Here is another example of dysconjugate eye movements. Dacrocystoceles This infant was noted at birth to have some bluish nodules inferior to the medial canthi of both eyes, widely spaced eyes hypertelorism , and a flat nasal bridge. Dacrocystocele An intra-operative photo shows the degree of obstruction of the nasal passage on the right side.

Infant Vision Development Starts During Pregnancy

Dacrostenosis Here is an example of dacrostenosis. Subconjunctival Hemorrhage Subconjunctival hemorrhage is a frequent finding in normal newborns. Iris Cyst This infant had a normal physical exam at birth. Normal Eye For comparison, this is the completely normal right eye of the same infant. Injected Eye This is another newborn with unilateral conjunctival injection.