Neonatal conjunctivitis means inflammation and discharge of the eye surface in a newborn baby during the first 28 days of life. The thin, clear skin that covers the white of the eye and the inside of the eyelids becomes red, swollen, and sticky. The discharge can be watery, mucoid, or full of pus. It may affect one eye or both eyes. The cause can be chemical irritation or an infection by bacteria or viruses. Doctors sometimes call it ophthalmia neonatorum. This is a medical problem because some infections can move fast and may harm the clear front window of the eye (the cornea) and, if untreated, can threaten vision. MSD ManualsStatPearls
Neonatal conjunctivitis is inflammation and discharge from a newborn’s eyes that begins in the first 4 weeks of life. The eyelids can look puffy and red, and there may be watery or pus-like discharge. Most cases are caused by infection the baby encounters during birth (most notably Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes simplex virus), less often by other bacteria (such as Staphylococcus aureus, Streptococcus pneumoniae, or nontypeable Haemophilus influenzae), and occasionally by a chemical irritant from prophylactic eye drops given at birth. A blocked tear duct (nasolacrimal duct obstruction) can mimic infection but is not the same thing. Merck Manuals
Some germs, like Neisseria gonorrhoeae and Chlamydia trachomatis, can be passed from the mother during birth. Gonococcal infection can cause very heavy pus, severe swelling, corneal ulcers, and even perforation in a short time. Chlamydial infection often starts a bit later and can also be linked to a type of pneumonia in young infants. Herpes simplex virus (HSV) is less common but serious and needs urgent treatment. Because of these risks, quick recognition, correct testing, and prompt, targeted treatment are very important. Merck ManualsCDC+1StatPearls
Types of neonatal conjunctivitis
By cause
Chemical conjunctivitis: irritation from a chemical placed in the eye soon after birth (for example, preventive eye drops or skin antiseptics). It starts very early (first day) and settles in 24–72 hours. Merck Manuals
Bacterial conjunctivitis: caused by bacteria such as N. gonorrhoeae, C. trachomatis, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and others. Timing and symptoms vary by germ. Merck Manuals+1
Viral conjunctivitis: most important is HSV in newborns; adenovirus is less common in this age group. HSV eye disease is an emergency because it may be part of a whole-body infection. NCBI
By time of onset
0–24 hours: often chemical irritation. Gonorrhea can appear at 2–5 days. Merck Manuals
2–5 days: gonococcal conjunctivitis usually appears here and can be very aggressive. CDC
5–14 days (sometimes up to ~60 days): chlamydial conjunctivitis commonly appears in this window. HSV can also present in the first 2 weeks. CDCNCBIclinicalguidelines.scot.nhs.uk
Causes
In newborns, causes often relate to what the baby’s eyes met during or right after delivery. Below are 20 clearly described causes. Some are common, some are rare. I note if a cause is common, less common, or rare.
Neisseria gonorrhoeae (common, severe): A sexually transmitted bacterium that can pass from mother to baby during birth and causes very heavy pus and quick corneal damage if not treated fast. CDC
Chlamydia trachomatis (common): A common cause worldwide; starts later (usually day 5–14), can affect one or both eyes, and may link to infant pneumonia. CDCNCBI
Staphylococcus aureus (less common): A skin bacterium that can infect the eye and produce sticky, yellow discharge. Merck Manuals
Streptococcus pneumoniae (less common): A respiratory bacterium that can also cause eye infection in newborns. Merck Manuals
Haemophilus influenzae, nontypeable (less common): A bacterium of the nose and throat that can infect the conjunctiva. Merck Manuals
Escherichia coli (less common): A gut bacterium that can contaminate the birth canal and infect the newborn eye. Merck Manuals
Klebsiella species (less common): Another gut bacterium linked to hospital or maternal sources. Merck Manuals
Moraxella catarrhalis (less common): A respiratory bacterium that can infect conjunctiva in babies. Merck Manuals
Enterococcus species (less common): Gut bacteria occasionally causing neonatal eye infection. Merck Manuals
Pseudomonas aeruginosa (rare but serious): Hospital-linked bacterium that can cause aggressive eye infection. (Recognized in neonatal infections, though less common.) Merck Manuals
Herpes simplex virus type 1 or 2 (uncommon but serious): Virus passed during delivery; eye involvement may be part of skin-eye-mouth or systemic disease; needs urgent systemic antivirals. NCBI
Adenovirus (uncommon in neonates): A common pink-eye virus in older ages but less common in newborns; still possible. Merck Manuals
Chemical irritation from prophylaxis (historically silver nitrate; also possible with other agents): Causes early redness and tearing without true infection; usually settles quickly. CDC
Irritation from povidone-iodine or other antiseptics: If used around the eyes, can irritate the conjunctiva in the first day. (Chemical type.) Merck Manuals
Irritation from topical antibiotics themselves (e.g., erythromycin ointment sensitivity, rare): Some babies react with mild redness and swelling that improves on its own. Merck Manuals
Nasolacrimal duct obstruction with secondary infection: A blocked tear duct keeps tears and mucus from draining; stagnation can invite infection. NCBI
Traumatic irritation from rubbing or rough wiping: Mechanical irritation can inflame the conjunctiva and allow germs to enter. Merck Manuals
Foreign material (e.g., talc, dust, eyelash): May scratch and inflame the surface and be a focus for infection. Merck Manuals
Fungal infection (e.g., Candida) in NICU settings (rare): Can occur in very ill or premature infants, especially with prolonged hospital exposure. Merck Manuals
Neisseria meningitidis (very rare): A related bacterium that can rarely infect the newborn eye. Merck Manuals
Symptoms and signs
Babies cannot tell us what they feel. We look at the eyes, the eyelids, and the discharge. These are common symptoms and signs parents or clinicians may notice.
Red eyes (the white part looks pink or red). CDC
Swollen eyelids that look puffy and thick. CDC
Sticky discharge that glues the eyelids, especially after sleep. Merck Manuals
Pus (yellow or green thick discharge), often heavy in gonococcal infection. CDC
Watery discharge (more common in viral or chemical irritation). Merck Manuals
Crusting on lashes and on the eyelid edges. CDC
Light sensitivity (baby squeezes eyes shut in light). Merck Manuals
Eye pain or irritation (baby may be fussy when the eye is opened or cleaned). Merck Manuals
Trouble opening eyes because the lids are stuck and swollen. CDC
Redness inside the eyelid when the lid is gently flipped. Merck Manuals
Corneal haze or spots if the front window is affected (danger sign). StatPearls
One eye first, then both (chlamydia often starts in one eye, then the other). NCBI
Start time linked to cause (very early with chemical; days 2–5 with gonorrhea; days 5–14 with chlamydia). CDC+1
Swollen lymph node in front of the ear (sometimes with viral causes). Merck Manuals
Systemic signs in severe infections (fever, poor feeding, or rash with HSV; cough/tachypnea later with chlamydial pneumonia). CDCNCBI
Diagnostic tests
Doctors choose tests based on the baby’s age at symptom start, the look of the discharge, the mother’s health history, and how sick the baby seems. The goal is to find the cause quickly and treat safely.
A) Physical Exam
External eye inspection: The doctor looks at redness, swelling, and the type of discharge to judge how severe the infection is and to look for danger signs like corneal spots. Merck Manuals
Eyelid eversion with light: The inside of the eyelid is inspected for redness, small bleeding spots, membranes, or foreign material. This helps separate chemical irritation from infection. Merck Manuals
Corneal clarity check (penlight or slit-lamp if available): Any corneal haze, ulcer, or perforation is an emergency, especially with gonococcal disease. StatPearls
Preauricular lymph node check: Gently feeling for a small tender node in front of the ear can hint at a viral cause. Merck Manuals
Skin exam of face and scalp: Vesicles (small blisters) raise concern for HSV eye disease or skin-eye-mouth HSV. NCBI
Breathing and feeding check: Babies with chlamydial eye disease can later show a quiet, afebrile pneumonia; poor feeding or respiratory signs guide broader testing. CDC
B) Manual / Bedside Tests
Fluorescein dye staining with cobalt blue light: A safe dye highlights corneal scratches or ulcers. Ulcers require urgent treatment. Merck Manuals
Lacrimal sac pressure (“reflux” test): Gentle pressure over the corner of the eye can push out mucus if the tear duct is blocked; this helps distinguish a blocked tear duct from true conjunctivitis. NCBI
Fluorescein dye-disappearance test (for tear duct blockage): A tiny drop of dye is placed; slow clearance suggests a blocked tear duct rather than primary conjunctivitis. NCBI
Careful swab collection from conjunctiva: Proper swab technique (without touching skin) is essential for accurate lab results such as cultures and NAAT tests. Merck Manuals
Visual behavior check: The clinician notes whether the baby tracks faces or lights; marked reduction plus corneal findings points to urgent referral. Merck Manuals
C) Laboratory & Pathology Tests
Gram stain of conjunctival discharge: A quick microscope test that can show gram-negative diplococci (suggesting gonorrhea) or other bacteria; guides urgent therapy. Merck Manuals
Giemsa stain (or equivalent) of conjunctival cells: Can show intracellular inclusions in chlamydial infection. Merck Manuals
NAAT (nucleic acid amplification tests) for N. gonorrhoeae and C. trachomatis from conjunctival swabs: Highly sensitive tests that confirm these two key causes. CDC
Bacterial culture and antibiotic susceptibility (including selective media for N. gonorrhoeae): Culture confirms the bacterium and the best antibiotics, crucial where resistance is a concern. CDC
HSV PCR from conjunctiva or skin lesions (and sometimes blood or CSF if ill): A fast, sensitive test when HSV is suspected; positive results trigger IV acyclovir. NCBI
Full blood count (FBC/CBC) and C-reactive protein if systemic illness suspected: Helps assess infection severity or complications beyond the eye. Merck Manuals
Blood culture if the baby looks unwell or septic: Searches for bacteria in the bloodstream, especially with severe gonococcal disease. Merck Manuals
D) Electrodiagnostic Tests
These are not routine for simple conjunctivitis. They may be considered only in unusual situations (for example, if the cornea is very opaque and the team needs to check deeper eye function, or if broader neurologic disease is suspected).
Visual evoked potential (VEP): Measures brain responses to visual signals; rarely used to assess the visual pathway when the front of the eye is too cloudy to examine. (Specialist use only.) Merck Manuals
Electroretinography (ERG): Measures retinal function; rarely used to confirm that the retina can still respond if the cornea is badly damaged and the team is planning sight-saving procedures. (Specialist use only.) Merck Manuals
E) Imaging Tests
Strictly speaking, typical conjunctivitis does not need imaging. However, if the doctor suspects deeper problems, imaging can help.
Slit-lamp biomicroscopy (a microscope with a bright light) gives a magnified view of the cornea and conjunctiva; it is more “examination” than imaging, but it functions like an optical imaging tool in older infants.
Anterior segment photography may document corneal ulcers or membranes.
Ocular ultrasound (if the cornea is opaque and the eye cannot be seen through) can check that the deeper eye structures look normal. These uses are uncommon and specialist-guided. Merck Manuals
Non-pharmacological treatments
Each item explains the description, purpose, and how it helps (mechanism) in simple terms. Use these only alongside doctor-directed care—never as a substitute when infection is suspected.
Gentle saline eye irrigation
What: Sterile saline is dripped across the eye to wash out thick discharge.
Purpose: Keeps the eye clear so medicines reach the surface.
How it helps: Physically removes germs and pus without irritating the cornea.Soft eyelid cleansing
What: Wipe lids/lashes from inner to outer corner with sterile gauze moistened with saline, discarding each wipe.
Purpose: Prevents crusts from sticking the lids shut.
How: Mechanical removal lowers the surface germ load.No eye patching
What: Keep eyes open to air; do not patch.
Purpose: Patches trap heat and moisture.
How: Airflow discourages bacterial overgrowth and allows frequent cleaning.Hand hygiene for all caregivers
What: Wash hands before and after touching baby’s face/eyes; keep nails short.
Purpose: Stops germs moving between people and between baby’s eyes.
How: Breaks the transmission chain.Separate clean cloths/towels
What: Baby gets dedicated face cloths; launder in hot water.
Purpose: Avoid cross-contamination.
How: Limits spread of eye secretions.Avoid home remedies and OTC “whitening” or steroid drops
What: No kohl/eyeliner, rosewater, breast milk in the eye, herbal drops, or steroid products.
Purpose: Many are contaminated or harmful; steroids can worsen infections.
How: Prevents chemical irritation and dangerous immune suppression on the eye. Merck ManualsTemperature-safe compresses
What: If baby seems uncomfortable, use a barely warm sterile compress for a minute, tested on your inner wrist first.
Purpose: Softens crusts before cleaning.
How: Gentle warmth loosens dried secretions. (Avoid hot packs in newborns.)Cool compress for swelling (short intervals)
What: Brief cool (not cold) sterile compresses if lids are very puffy.
Purpose: Reduces puffiness.
How: Mild vasoconstriction calms edema. (Stop if baby resists or skin looks pale.)Lubrication with preservative-free sterile saline/artificial tears (if advised)
What: Tiny amounts recommended by clinician.
Purpose: Soothes the surface if irritated.
How: Restores moisture film so lids glide without rubbing the cornea.Pseudomembrane removal (by clinician only)
What: Thin film on the inner lid is gently peeled in clinic.
Purpose: Decreases pain and lets drops contact tissue.
How: Removes inflammatory debris that blocks medicines.Hospital observation when severe causes are suspected
What: Admit if gonorrhea or HSV is possible, or if baby looks unwell.
Purpose: Allows IV medicines and close monitoring.
How: Timely care prevents corneal injury and systemic spread. CDCFrequent follow-up
What: Recheck within 24–48 hours after starting therapy, sooner if worsening.
Purpose: Ensures treatment is working.
How: Early course-correction if the cause is different than expected.Maternal and partner testing/treatment
What: Test and treat the birthing parent (and partners) for chlamydia/gonorrhea/HSV as appropriate.
Purpose: Prevents re-exposure and protects the baby.
How: Removes the source of infection. CDC+1Exclusive breastfeeding if possible
What: Breast milk provides antibodies (IgA), lactoferrin, oligosaccharides.
Purpose: Supports the baby’s immune defenses.
How: Maternal immune factors coat mucosal surfaces, helping neutralize pathogens. (Feeding guidance below.)Smoke-free, fragrance-light environment
What: Keep the room free of cigarette smoke and strong perfumes.
Purpose: Reduces eye irritation and reflex tearing.
How: Irritant avoidance calms inflamed tissue.Teach safe cleaning technique to all caregivers
What: Demonstrate one-direction wiping, hand hygiene, and drop/ointment placement.
Purpose: Consistency across shifts and relatives.
How: Reduces accidental contamination.Avoid contact lenses or decorative eye products
What: None should ever touch a newborn’s eye.
Purpose/How: Eliminates a source of trauma and infection.Manage blocked tear duct (when that’s the actual cause)
What: Clean as above; your clinician may teach gentle tear-sac massage.
Purpose: Helps open the duct naturally over time.
How: Mild pressure can clear a thin membrane at the duct’s end.Pain and fever assessment (no aspirin)
What: If baby is fussy or febrile, clinicians will guide safe options.
Purpose/How: Comfort improves feeding and healing; avoids unsafe medicines in neonates.Emergency triggers education
What: Caregivers learn “red flags” (listed below).
Purpose/How: Ensures rapid care if the condition turns serious.
Drug treatments
Medicines and doses in newborns are specific. Always follow your pediatrician’s instructions. Where guidelines list exact neonatal doses, I’ve included them with citations.
Ceftriaxone (for gonococcal conjunctivitis)
Class: 3rd-generation cephalosporin (antibiotic).
Dose & time: 25–50 mg/kg IV/IM once (single dose); do not exceed 250 mg. Avoid in jaundiced or premature infants at risk of hyperbilirubinemia. CDC
Purpose: Rapidly kills N. gonorrhoeae to protect the cornea and prevent spread.
Mechanism: Inhibits bacterial cell wall synthesis.
Side effects: Diarrhea; rare allergic reactions; bilirubin displacement (hence caution in some neonates).Cefotaxime (alternative when ceftriaxone is unsuitable)
Class: 3rd-generation cephalosporin.
Dose & time: 100 mg/kg IV/IM once when ceftriaxone cannot be used (e.g., concurrent IV calcium or certain jaundice scenarios). CDC
Purpose/Mechanism: Same as above.
Side effects: GI upset; rare allergy.Erythromycin (oral) for chlamydial conjunctivitis
Class: Macrolide antibiotic.
Dose & time: 50 mg/kg/day by mouth, divided into 4 doses, for 14 days. Effectiveness is ~80%, so a second course may be needed; monitor for infantile hypertrophic pyloric stenosis (IHPS) in infants <6 weeks. CDC
Purpose: Clears C. trachomatis from eye and nasopharynx, reducing risk of later chlamydial pneumonia.
Mechanism: Inhibits bacterial protein synthesis (50S ribosome).
Side effects: Vomiting/diarrhea; rare IHPS—watch for projectile vomiting.Azithromycin (oral) for chlamydial conjunctivitis—alternative
Class: Macrolide antibiotic.
Dose & time: 20 mg/kg by mouth once daily for 3 days; evidence is more limited than erythromycin. Monitor for IHPS in infants <6 weeks. CDC
Purpose/Mechanism: As above, with simpler dosing.
Side effects: GI upset; rare IHPS.Acyclovir (IV) for neonatal HSV eye disease (SEM: skin–eye–mouth)
Class: Antiviral (guanine analog).
Dose & time: 20 mg/kg IV every 8 hours (total 60 mg/kg/day) for 14 days for SEM disease; 21 days if CNS/disseminated. Requires kidney monitoring and good hydration. CDCNCBI
Purpose: Stops HSV replication and prevents spread to brain/other organs.
Mechanism: Activated in infected cells to block viral DNA synthesis.
Side effects: Kidney crystallization (prevent with fluids), neutropenia (monitor labs).Topical 1% trifluridine (adjunct for HSV eye involvement, specialist-directed)
Class: Ophthalmic antiviral.
Dose & time: Frequent drops initially (specialist sets schedule), then taper; always with systemic acyclovir. PMCMerck Manuals
Purpose/Mechanism: Directly blocks viral DNA synthesis on the cornea.
Side effects: Surface irritation; epithelial toxicity if overused.Topical 0.15% ganciclovir gel (adjunct for HSV, specialist-directed)
Class: Ophthalmic antiviral.
Dose & time: Typically several times daily until healing, per ophthalmology. Merck Manuals
Purpose/Mechanism: Inhibits viral DNA polymerase.
Side effects: Mild irritation.Erythromycin 0.5% ophthalmic ointment (prophylaxis and sometimes adjunct)
Class: Topical macrolide antibiotic.
Dose & time: Single ribbon in each eye soon after birth to prevent gonococcal disease; as a treatment adjunct, clinician may prescribe several times daily. Note: not effective at preventing chlamydial disease. CDC+1
Purpose: Reduces risk of sight-threatening gonococcal infection.
Mechanism: Local protein-synthesis inhibition.
Side effects: Mild, temporary redness.Trimethoprim–polymyxin B eye drops (for non-STI bacterial conjunctivitis)
Class: Combination topical antibiotic.
Dose & time: Specialist-directed dosing in neonates.
Purpose: Treats common non-gonococcal bacteria.
Mechanism: Two antibiotics block folate pathway and punch holes in bacterial membranes. Merck ManualsPovidone-iodine 2.5% (some settings, prophylaxis alternative where erythromycin unavailable)
Class: Broad antiseptic.
Use: Applied at birth in some countries; effective against both chlamydia and gonorrhea in lab/field studies but not widely available in the U.S. Merck Manuals
Note: Local policy and specialist guidance determine use.
Dietary “molecular” supports
In true neonatal conjunctivitis, antibiotics/antivirals—not supplements—cure the infection. Nutrition still matters for overall immune support. In newborns, direct supplementation is limited. The only routine supplement for healthy, term, breast-fed infants is vitamin D. Most other immune factors come naturally via breast milk or maternal diet. Always ask your pediatrician before giving any product to a newborn.
Vitamin D for the infant: 400 IU/day for breast-fed or partially breast-fed babies supports immune regulation and overall health (standard pediatric guidance). Function: immune modulation and barrier maintenance. Mechanism: vitamin-D receptor signaling tunes innate and adaptive responses.
Colostrum early and often: The first milk is rich in IgA, lactoferrin, and human milk oligosaccharides (HMOs). Function: coats mucosal surfaces, binds iron away from bacteria, and feeds beneficial gut microbes. Mechanism: passive immune transfer and microbiome shaping.
Maternal DHA (omega-3): ~200–300 mg/day in the lactating parent’s diet supports anti-inflammatory lipid mediators in milk. Function: balanced inflammatory response. Mechanism: resolvin/protectin pathways.
Maternal protein adequacy: Aim for balanced protein across the day. Function: supports antibody/immune factor production in milk. Mechanism: provides amino acids for lactoferrin, IgA, lysozyme.
Maternal vitamin A (RDA during lactation): Supports epithelial integrity in mother and infant via milk transfer. Mechanism: retinoic-acid-driven mucosal immunity. (Avoid megadoses.)
Maternal vitamin C (RDA during lactation): Antioxidant in milk; supports leukocyte function. Mechanism: scavenges reactive oxygen species.
Maternal zinc (RDA during lactation): Cofactor for many immune enzymes; transferred in milk. Mechanism: supports neutrophil and T-cell function.
Maternal probiotic foods (yogurt/fermented foods if tolerated): May influence maternal–infant microbiome axis. Mechanism: exposure to beneficial microbes through close contact; for direct infant probiotics, use only if prescribed (NICU protocols differ).
Maternal hydration: Adequate fluids help maintain milk supply and composition.
Rooming-in and responsive breastfeeding: Frequent feeds sustain transfer of protective factors.
Regenerative / stem-cell” drugs
It’s important to be blunt and safe here: there are no approved “hard immunity boosters,” regenerative medicines, or stem-cell drugs for neonatal conjunctivitis. Using such products would be unsafe. Below are therapies people sometimes ask about—and why they are not used for this condition:
IVIG (intravenous immunoglobulin)
Sometimes used in severe neonatal infections or immune conditions under specialist care. Not indicated for routine neonatal conjunctivitis.G-CSF (filgrastim)
Used for neonatal neutropenia in select cases. Not a treatment for conjunctivitis.Monoclonal antibodies (e.g., RSV nirsevimab/palivizumab)
Target RSV, not eye infections. No role in conjunctivitis.Stem-cell therapies
No approved neonatal ocular use; significant risk. Avoid.Systemic corticosteroids “to boost immunity”
Do the opposite—they suppress immunity and can worsen eye infections. Avoid.Unregulated “immune boosters” or herbal injections
Lack safety/efficacy data in newborns; do not use.
If anyone suggests these for a newborn’s conjunctivitis, seek a pediatric infectious disease/ophthalmology opinion immediately.
Procedures/surgeries
Most babies do not need any procedure beyond cleaning. In unusual or severe situations, specialists may do:
Pseudomembrane debridement
What: Carefully peel inflammatory membrane from inner eyelid.
Why: Reduces irritation and lets drops reach the surface.Incision and drainage of an eyelid abscess (preseptal cellulitis)
What: Drain pus if a localized eyelid abscess forms.
Why: Removes a walled-off infection that drops can’t penetrate.Corneal tissue glue (cyanoacrylate) for tiny perforation
What: Seal a small corneal hole from severe gonococcal ulcer.
Why: Emergency measure to save the globe before definitive surgery.Therapeutic penetrating keratoplasty (corneal transplant)
What: Replace a destroyed cornea in catastrophic cases.
Why: Vision-saving, last-resort step in ulcer/perforation.Nasolacrimal duct probing (only if the real problem is a persistent blocked tear duct, usually months later)
What: Open the duct in an operating room if it doesn’t resolve.
Why: Stops recurrent discharge that mimics infection.
Prevention
Prenatal screening and treatment for gonorrhea and chlamydia (early pregnancy and again later if at risk). This is the most effective prevention. CDC+1
Erythromycin eye ointment at birth for all newborns (within 24 hours) prevents most gonococcal disease; it’s required by law in many places. CDC
Treat the birthing parent and partners if tests are positive to prevent re-exposure. CDC+1
Understand limits: the birth ointment does not prevent chlamydial conjunctivitis—prenatal screening does. CDC
HSV precautions: suppressive antivirals at ≥36 weeks for parents with genital herpes; C-section if lesions are present at delivery. Merck Manuals
Clean delivery practices and careful eye handling after birth.
Exclusive breastfeeding if possible.
No unapproved eye products (kohl, powders, herbal drops).
Hand hygiene for everyone who touches the baby.
Early medical review for any eye redness, swelling, or discharge.
When to see a doctor urgently
Eye swelling with thick pus, especially 2–5 days after birth (think gonorrhea). Merck Manuals
Blister-like skin lesions, fever, poor feeding, or lethargy (possible HSV or systemic infection). Merck Manuals
Cloudy cornea, baby seems in pain with light, or the eye looks hazy.
Any eye redness or discharge in the first month of life—newborns should be examined the same day.
What to eat—and what to avoid
For newborns, feeding is simple: breast milk (or appropriate formula). The tips below focus on the infant and, where relevant, the lactating parent.
Do feed: Breast milk on demand.
Do supplement vitamin D: 400 IU/day for breast-fed infants (per pediatric guidance).
If using formula: Use a safe, age-appropriate formula mixed exactly as directed.
For the lactating parent: Eat a balanced diet with protein, vegetables, whole grains, and sources of DHA (e.g., fish low in mercury).
Hydration: Adequate fluid intake supports milk production.
Avoid: Putting anything in the baby’s eye unless prescribed (no breast milk directly in the eye, no herbal or cosmetic products).
Avoid: Honey before 12 months (botulism risk).
Avoid: Giving plain water or other drinks to newborns (can be unsafe).
Avoid: Smoke exposure (irritates eyes and airways).
Limit: Strong fragrances and aerosols near the baby.
FAQs
1) Is every red, sticky newborn eye an infection?
No. A blocked tear duct or mild chemical irritation can cause discharge. But because serious infections can look similar, any eye redness or discharge in the first month should be checked promptly.
2) How fast can gonococcal conjunctivitis harm vision?
Very quickly—within hours to days the cornea can ulcerate if untreated. That’s why doctors treat at once when they suspect it. Merck Manuals
3) Why do babies with chlamydial eye infection need oral antibiotics, not just ointment?
Because many also carry chlamydia in the nose/throat and some may develop pneumonia. Systemic therapy clears these reservoirs; ointment alone is not enough. CDC
4) What oral antibiotics are used for chlamydia in newborns?
Erythromycin for 14 days is standard; azithromycin for 3 days is an alternative when appropriate. Doctors recheck because erythromycin cures about 80%, and a second course may be needed. CDC
5) Is the birth-ointment enough to prevent all neonatal conjunctivitis?
No. It helps prevent gonorrhea, but it does not prevent chlamydia. Prenatal screening and treatment are key. CDC+1
6) When are antivirals needed?
If HSV is suspected, babies receive IV acyclovir (with eye drops/gel under specialist care). Early treatment protects the eyes and brain. CDC
7) Do both eyes always get infected?
Either one or both can be involved. Cleaning and drop placement are done in both eyes unless your clinician advises otherwise.
8) Can I keep cleaning at home while we wait to be seen?
Yes—gentle saline wiping is safe. Do not use steroid drops or home remedies.
9) How quickly should improvement appear after treatment starts?
Swelling and discharge usually begin to ease within 24–48 hours with the correct therapy. If not, the doctor will reassess the cause and culture results.
10) Will my baby need to be admitted to the hospital?
Possibly, if gonorrhea or HSV is suspected, or if the baby looks unwell. Hospital care allows IV medicines and close monitoring. CDC
11) Can neonatal conjunctivitis cause long-term problems?
With prompt, correct treatment, most babies recover fully. Delays—especially with gonorrhea or HSV—raise the risk of corneal damage. Merck Manuals
12) Should breastfeeding continue during treatment?
Yes, unless your doctor advises otherwise. It provides immune protection and helps recovery.
13) Do caregivers need treatment too?
The birthing parent and sexual partners need testing/treatment if chlamydia or gonorrhea is found, to prevent ongoing exposure. CDC+1
14) What about blocked tear duct care?
Your clinician will show gentle massage and cleaning. Most cases resolve by 6–12 months without surgery.
15) How do doctors decide which medicine to use?
They use the baby’s age at symptom onset, exam findings, and lab tests (Gram stain, culture, NAAT, PCR). Severe causes are treated immediately while tests are pending. Merck Manuals
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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 14, 2025.
