Newborn Eye Crust: What's Normal And What's Not?

It is normal for newborns to have crusty eyes, and this is usually caused by blocked tear ducts, which occur when the end of the tear duct does not open properly at birth. This affects at least 6% of newborns, and the crustiness is typically a sticky discharge that forms in the corners of the eyes. In most cases, this will clear up on its own by the time the child is one year old, but a doctor can advise on home remedies to help manage the condition.

Blocked tear ducts

The most common cause of blocked tear ducts in newborns is the presence of a membrane covering the tear duct. This membrane typically breaks as the baby's face grows. In some cases, the openings into the nasolacrimal duct may not have formed properly at birth, leading to a blockage.

Symptoms of blocked tear ducts include tears pooling or draining down the cheeks, mucus or yellowish discharge, and reddening of the skin from rubbing. The symptoms may be more noticeable when the baby cries or is exposed to cold or windy weather.

At-home treatments for blocked tear ducts include regularly cleaning the eyelids with a saline solution and gently massaging the tear duct area to encourage drainage and prevent infections. This can be done by applying moderate pressure with your finger on the side of the baby's nose and sliding it downwards towards the tip.

Conjunctivitis

Causes

If certain bacteria are present in the mother's vagina, they can be passed to the newborn during delivery. Such bacteria include Chlamydia, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria gonorrhoeae, and others.

Chemical conjunctivitis is a reaction to the eye drops that newborns receive to prevent infection.

Symptoms

Symptoms of conjunctivitis may vary depending on the cause of the infection. Conjunctivitis caused by chlamydia usually begins 5 to 14 days after delivery but sometimes as late as 6 weeks after. Newborns have swollen eyelids and a watery discharge from the eyes that contains increasing amounts of pus. The infection can sometimes be severe.

Diagnosis and Treatment

Doctors evaluate the newborn's symptoms and appearance of the eyes. Samples of eye discharge are sent to a laboratory to identify the infecting organism.

Antibiotics and antibiotic ointments are given to treat the infection. For conjunctivitis caused by chlamydia, erythromycin is often prescribed. For gonorrhea-caused conjunctivitis, intravenous antibiotics are often used.

Prevention

Bacterial or viral infections

It is common for newborns to have crusty or sticky eyes due to blocked tear ducts, which affect at least 6% of newborns. This occurs when the end of the tear duct does not open properly at birth, causing tears to be unable to drain away from the eye's surface. Blocked tear ducts can usually be treated at home and will clear up on their own by the time the baby is one year old.

However, crusty eyes in newborns can sometimes be a sign of a bacterial or viral infection, such as conjunctivitis or ophthalmia neonatorum (ON).

Conjunctivitis

Conjunctivitis is an inflammation of the conjunctiva, a thin membrane that protects the front of the eye. It can be caused by a bacterial or viral infection, or by chemical irritation from eye drops and ointments used to prevent infection in newborns. Conjunctivitis is characterised by red, swollen, and tender eyelids, with a yellowish discharge. It can spread from one eye to the other and usually occurs within 1 to 12 days after birth.

Treatment for conjunctivitis depends on the cause. Chemical conjunctivitis usually clears up on its own within 24 to 36 hours and requires no treatment. Conjunctivitis caused by a blocked tear duct can be treated with a gentle warm massage between the eye and nasal area. For bacterial conjunctivitis, doctors may prescribe antibiotics, eye drops, or ointments.

Ophthalmia Neonatorum (ON)

ON is a rare bacterial infection that can occur during childbirth if the baby passes through an infected birth canal. Symptoms include red, itchy, and swollen eyes with pus discharge, and usually appear 5 to 12 days after birth. ON can affect other areas of the body and may require treatment with oral antibiotics.

If you suspect your newborn has a bacterial or viral eye infection, it is important to consult a doctor as soon as possible.

Allergies

Allergic conjunctivitis is characterised by red, itchy, and watery eyes, similar to the symptoms of a cold. The eyes may also become swollen and tender. Allergic conjunctivitis is typically not serious and can be treated at home by avoiding allergens and irritants, gently wiping away discharge, and applying a warm compress. However, if symptoms persist or worsen, it is important to consult a doctor.

It is important to note that conjunctivitis can also be caused by bacterial or viral infections, which may require medical treatment. Therefore, if you suspect that your newborn's crusty eyes are due to allergies, pay close attention to their symptoms and seek medical advice if necessary.

Eye injury or foreign object in the eye

It is normal for newborns to have eye discharge, and it is usually caused by a blocked tear duct. This condition, also known as "sticky eye", affects at least 6% of newborns and is typically treatable at home. It occurs when tears are unable to drain away from the eye's surface, causing watery eyes and sticky discharge in the corners. In most cases, the blockage will clear up by itself within several months of birth and can be treated at home. However, if the blockage persists until the baby's first birthday, medical intervention such as nasolacrimal duct probing may be necessary.

Now, if you suspect that your newborn's crusty eyes are due to a foreign object in the eye, here are some instructions to follow:

Instructions for Eye Injury or Foreign Object in the Eye:

• Do not rub the eye: Rubbing the eye can worsen the situation and make it harder to remove the foreign object.
• Wash your hands: Before examining or touching the eye, ensure your hands are clean to prevent infections.
• Examine the eye in a well-lit area: Look up and down, then from side to side to locate the object. If you cannot find it, proceed to the next steps to check inside the eyelids.
• Check inside the lower eyelid: Look up, then gently grasp the lower eyelid and pull down to inspect for the object.
• Check inside the upper eyelid: Place a cotton-tipped swab on the outside of the upper lid and gently flip the lid over the swab to look underneath. Alternatively, you can pull the upper lid out and draw it over the lower lid while the eye is closed.
• Remove the object: If you see the object, try to gently flush it out with water or use a cotton-tipped swab to remove it. If it is on the white of the eye, you can rinse the eye gently with water or eye drops. If it is on the coloured part of the eye, do not attempt to remove it.
• Seek medical attention if necessary: If you cannot remove the object, or if there is still discomfort or blurred vision after removal, contact your healthcare provider. Additionally, if you experience eye pain, sensitivity to light, decreased vision, red or painful eyes, flaking, discharge, or a sore on your eye or eyelid, do not treat yourself and seek medical help.

Frequently asked questions