Infant Eye Concerns - Tips from Pediatric Partners

Newborns and infants have several common eye conditions. Learn about the most common below:

• Clogged tear ducts: symptoms include watery eyes, tears without crying, matted lashes
• Subconjunctival hemorrhage: red line circling the iris after birth
• Yellow eyes are due to jaundice. This is common and your baby's jaundice is checked in the hospital and we will follow as indicated based on symptoms.

Cloggedtearducts

• A duct that normally carries tears from the eye to the nose becomes clogged/swollen can lead to tears not being able to drain into the nose.
• This is common! About 10% of newborns have this condition - both sides are blocked 30% of the time.
• A watery eye may not be noticed until 1 or 2 months old. This is because that's when the eye starts making more tears.
• Over 90% of tear ducts open up on their own by 12 months of age.
• If your child is over 12 months old and the clogged ducts persists, ask if a referral to an eye doctor is recommended.

SYMPTOMS OF A BLOCKED TEAR DUCT

• A constant watery eye - tears can fill the eye and run down the face because they can't drain into the nose due to the blocked duct (tube). This happens even when not crying.
• The eye is not red and the eyelid is not swollen. (Redness of the eye or swelling of the lid can indicate an infection and your child should be evaluated.)

TREATMENT AT HOME

• If there is pus WITHOUT redness to the eyeball:
  • Pus without redness of the eyeball is often associated with colds and congestion.
  • Remove any dried and liquid tears and pus from the eyelids with warm water and wet cotton balls.
• If there is pus WITH redness to the eye:
  • Your child should be seen to assess need for antibiotic.
  • Wipe the eyes before you use the prescription eyedrops. The eyedrops will not work unless the pus is removed first.
• Massage of area between the eye and nose: ​
  • Massage of the lacrimal sac (where tears drain) may help but it is not always necessary. The tear duct will usually open without any massage. If you want to try massage:
    • Wash hands before (and after) touching near your baby's eye.​
    • The lacrimal sac is in the inner corner of the lower eyelid. This sac can be massaged to empty it of old fluids. Don't be surprised if there is discharge when you massage the area.
    • Start at the inner corner of the eye and press upward. Be very gentle.
    • Repeat twice a day.
• Seek medical care (call us to schedule an appointment) if:
  • Eye looks infected
  • Eyelid becomes red or swollen
  • You think your child needs to be seen
  • Your child becomes worse

SubconjunctivalHemorrhage

Newborn eye hemorrhage, also known as subconjunctival hemorrhage, occurs when small blood vessels in the eye break and blood leaks into the white part of the eye (the sclera) or under the thin, clear membrane covering the eye (the conjunctiva). This condition is relatively common in newborns and can happen during the birthing process or shortly after.

Causes:

1. Birth Trauma: The pressure exerted on the baby's head during delivery can sometimes cause small blood vessels in the eyes to break.
2. Increased Pressure: Pushing during labor, the use of vacuum extraction or forceps, or a particularly rapid delivery can increase the likelihood of eye hemorrhage.
3. Maternal Factors: Medications used during labor, such as blood thinners, can increase the risk of eye hemorrhage in newborns.

Symptoms:

• Red or Pink Discoloration: You may notice a patch of red or pink on the white part of your baby's eye.
• No Discomfort: Most babies with subconjunctival hemorrhage do not experience any pain or discomfort. Your baby's behavior should remain unchanged.
• No Effect on Vision: Subconjunctival hemorrhage typically does not affect your baby's vision.

Treatment:

In most cases, no specific treatment is needed for newborn eye hemorrhage. The blood will gradually be absorbed by the body over the course of a few weeks, and the redness will fade on its own. It's essential to avoid putting any pressure on your baby's eyes and to handle them gently during this time.

Do not be surprised if the redness turns yellow as it resolves. This is typical of the body's process to break down blood cells and why bruises turn green/yellow as they heal in skin.

When to Seek Medical Attention:

While newborn eye hemorrhage is usually harmless, there are instances where you should consult a healthcare professional:

• If you notice any other symptoms accompanying the eye hemorrhage, such as swelling, discharge, or changes in your baby's behavior.
• If the redness persists or worsens after a few weeks.
• If you have any concerns or questions about your baby's eye health.