Pink eye, or conjunctivitis, causes swelling and redness inside the eyelid and the white part of the eye. It can also make eyes feel itchy and painful.

Newborns who get pink eye will usually have these symptoms 1 day to 2 weeks after birth.

Pink eye can cause serious health problems for newborn babies. Call your baby’s doctor right away if your baby has:

• Unusual fluid (discharge) coming from the eye
• Puffy red eyelids

Pink eye in newborns can be caused by an infection, irritation, or a blocked tear duct.

Infection

During birth, bacteria and viruses in the mother’s vagina can pass to the baby and cause a pink eye infection. This can happen with normal, healthy bacteria that live in the mother’s vagina, or with harmful bacteria and viruses that cause infections, like sexually transmitted diseases (STDs). If you’re pregnant and have an STD, your baby may be at higher risk for pink eye.

Bacteria that cause sexually transmitted diseases (STDs), like chlamydia and gonorrhea, can cause pink eye in newborns.

If you’re pregnant and have an STD, talk to your doctor about how to prevent pink eye in your baby.

Irritation

Newborns can also get pink eye if their eyes are irritated by chemicals, like eye drops that they’re given when they’re born. Doctors give babies eye drops to prevent infections, but these eye drops can also irritate some babies’ eyes. The good news is, this kind of pink eye usually gets better on its own in 1 to 2 days — and it’s much less serious than an infection.

Blocked tear duct

Newborns may also get pink eye from a blocked tear duct. Healthy eyes make tears to keep the eyes moist, then drain them through the tear duct in the corner of the eye. If the tear duct is blocked, your baby’s eye could get irritated, leading to pink eye.

Newborns with conjunctivitis develop drainage from the eyes within a few days to several weeks after birth. Their eyelids become puffy, red, and tender. The cause of neonatal conjunctivitis is often difficult to determine because, in many instances, the symptoms don’t vary by cause.

Conjunctivitis in a newborn may be caused by a blocked tear duct, irritation produced by the topical antimicrobials given at birth, or infection with a virus or bacterium passed from the mother to her baby during childbirth. Even mothers without symptoms (asymptomatic) at the time of delivery can carry and pass bacteria or viruses to babies during birth.

The most common types of neonatal conjunctivitis include the following:

• Inclusion (chlamydial) conjunctivitis
  Chlamydia trachomatis can cause inclusion conjunctivitis and genital infections (chlamydia). A woman with untreated chlamydia can pass the bacteria to her baby during childbirth. Symptoms of inclusion conjunctivitis include redness of the eye(s), swelling of the eyelids, and discharge of pus. Symptoms are likely to appear 5 to 12 days after birth. Symptoms can develop earlier if the amniotic sac is ruptured during delivery. Some newborns with chlamydial conjunctivitis can have the infection in other parts of their bodies. The bacteria can infect the lungs and nasopharynx (where the back of the nose connects to the mouth).
• Gonococcal conjunctivitis
  Neisseria gonorrhoeae can cause gonococcal conjunctivitis, as well as the sexually transmitted infection called gonorrhea. A woman with untreated gonorrhea can pass the bacteria to her baby during childbirth. Symptoms usually include red eyes, thick pus in the eyes, and swelling of the eyelids. This type of conjunctivitis usually begins in the first 2-5 days of life. It can also progress to serious infections of the bloodstream (bacteremia) and lining of the brain and spinal cord (meningitis) in newborns.
• Chemical conjunctivitis
  When eye drops are given to newborns to help prevent a bacterial infection, the newborn’s eye(s) may become irritated. This may be diagnosed as chemical conjunctivitis. Symptoms of chemical conjunctivitis usually include mildly red eye(s) and some swelling of the eyelids. Symptoms are likely to last for only 24 to 36 hours.
• Other neonatal conjunctivitis
  Viruses and bacteria other than Chlamydia trachomatis and Neisseria gonorrhoeae can cause conjunctivitis. For example, bacteria that normally live in a woman’s vagina and are not sexually transmitted can cause conjunctivitis. Additionally, the viruses that cause genital and oral herpes can cause neonatal conjunctivitis and severe eye damage. The mother may pass such viruses to her baby during childbirth. However, herpes conjunctivitis is less common than conjunctivitis caused by gonorrhea and chlamydia. Symptoms usually include red eye(s) and swollen eyelids with some pus.

For all kinds of pink eye, you can use a warm compress (like a warm baby washcloth) to help get rid of crust and fluid (discharge). A cool compress (like a washcloth with cool water) may help with swelling and puffiness. Your baby’s doctor may also recommend using a saline (salt) solution to help rinse out your baby’s eyes.

If your newborn has pink eye caused by bacteria, the doctor may also prescribe an antibiotic. The type of antibiotic depends on the kind of bacterial pink eye your baby has:

• For chlamydial conjunctivitis, your doctor may prescribe an antibiotic that you’ll need to give your baby by mouth. You may need to take an antibiotic, too.
• For gonococcal conjunctivitis, your doctor may give your baby antibiotics through an IV.
• For other types of pink eye caused by bacteria, your doctor may prescribe antibiotic eye drops or ointment (cream) to put in your baby’s eyes.

If your baby’s pink eye is caused by a virus or by irritation from chemicals, antibiotics won’t help. Viral pink eye will usually heal on its own in 1 to 2 weeks, and pink eye from irritation will usually heal within 1 to 2 days.

If your newborn has pink eye that’s caused by a blocked tear duct, a gentle, warm massage between their eye and nose can help. If the blocked tear duct isn’t clear by the time your baby is a year old, they may need surgery.

Remember, always wash your hands before and after touching your baby’s eyes.

To prevent neonatal conjunctivitis, most states have laws requiring providers to put drops or ointment in a newborn’s eyes, typically within 2-3 hours of birth. In the past, hospitals used silver nitrate; now hospitals mostly use antibiotic eye drops, typically erythromycin. During pregnancy and prior to giving birth, women with genital herpes should consult with their physician about ways to minimize the chances of spread to their newborn baby.

Doctors may treat neonatal conjunctivitis caused by a bacterial infection with antibiotics. It will depend on the severity of the infection and the bacteria that caused it. Some antibiotics are applied as an eye drop or ointment in the eye (topical). Other antibiotics are given by mouth (orally), through a vein (intravenous), or as a shot (intramuscular). Doctors may treat a newborn’s conjunctivitis with a combination of topical, and either oral, intravenous, or intramuscular antibiotics. Rinsing the newborn’s infected eye with a saline solution will remove any debris that may develop in response to the infection.

If a blocked tear duct causes conjunctivitis, a gentle, warm massage between the eye and nasal area may help. If the blocked tear duct does not clear by 1 year of age, the newborn may require surgery.

Treatments for the common causes of neonatal conjunctivitis are as follows:

• Inclusion (chlamydial) conjunctivitis
  Doctors usually use oral antibiotics to treat inclusion conjunctivitis.
• Gonococcal conjunctivitis
  Doctors give intravenous (IV) or intramuscular (IM) antibiotics to treat gonococcal conjunctivitis. If untreated, the newborn could develop corneal ulcerations (open sores in the cornea) and blindness.
• Chemical conjunctivitis
  Since this type of conjunctivitis is caused by chemical irritation, treatment is usually not required. The newborn will usually get better in 24 to 36 hours.
• Other bacterial and viral conjunctivitis
  Doctors usually give antibiotic drops or ointments to treat conjunctivitis caused by other bacteria For both bacterial and viral conjunctivitis, a warm compress to the eye may relieve swelling and irritation. Be sure to wash hands before and after touching the infected eyes.