Normal eye care

During the first baby check after birth, the doctor will check your baby’s eyes for

• Congenital abnormalities
• Eye infection
• Vision

In your daily care, clean around your baby’s eyes with a clean moistened soft cloth. Do not use soap as this will sting the eyes.

Subconjunctival haemorrhage

If you look closely at the ‘whites’ of the eyes, you may just be able to see a few tiny blood vessels. If one of these tiny blood vessels bursts, it bleeds into the whites of the eyes. This is called a ‘subconjunctival haemorrhage’ which usually happens around the time of birth.

• No treatment is required.
• There’s no harm to the eyes.
• The blood staining usually fades and disappears within 2 weeks.

The most common problems of the eye in an infant are:

• Conjunctivitis
• Tear duct obstruction

Conjunctivitis

“Conjunctivitis” means an inflammation of the conjunctiva, that is the ‘white’ of the eye and inner part of the eyelids. This can be brought about by infection, a blocked tear duct or irritation, eg. from a chemical.

In the newborn period, infection of the eye is usually caused by bacteria, such as Neisseria gonnorhea (gonorrheal infection) or that from Chlamydia trachomatis. Both are transmitted during the baby’s passage through the birth canal of an infected mother.

Signs and symptoms

• yellow discharge from the eye
• eyelids stuck together with pus, especially after sleeping
• dried eye discharge on the upper cheek
• white part of eyes may or may not have some redness or pinkness
• swelling of the eyelids

The conjunctivitis can be severe in gonorrheal infection and can potentially affect the vision of your baby. So, it is important to bring your baby for immediate medical treatment.

Treatment for Gonococcal conjunctivitis

If eye discharge or other signs are present within the first few hours or days of birth, your baby will be treated as having gonorrheal eye infection until the tests results are back. Treatment includes:

• Hourly eye cleansing with eye drops and antibiotic eye drops until the eye discharge lessens and the eye looks less red.
• Antibiotics given through the veins (intravenous).
• Parents (and any traceable past sexual contacts) should also be investigated and treated for gonorrhea.

Treatment for Chlamydia conjunctivitis

This type of conjunctivitis usually starts 5 to 12 days after birth. Treatment usually will include :

Points to remember :

• Oral antibiotics for fourteen to twenty-one days for baby and parents.
• Antibiotic eye drops and eye cleansing.
  • Bring your baby to see a doctor as soon as possible for eye discharge which is more than mild sticky eyes and or that does not get better.
  • A baby with eye discharge within the first few days of life should be brought to hospital immediately.
  • The baby should have his or her own washcloth and towels, because the infection is transmitted through eye secretions.
  • Never administer eye drops used to treat a previous illness unless directed by your doctor.

Prevention

Prophylactic eye drops, 1% silver nitrate, has been discontinued in Malaysia for many years, with the reduction of gonoccocal conjunctivitis and availability of topical antibiotics.

Tear (Nasolacrimal) duct obstruction

This means that the channel that normally carries tears from the eye to the nose is blocked. Newborn infants have the capacity to secrete tears (reflex tearing to irritants) but usually do not secrete emotional tears until 2-3 months of age. This can explain the onset of symptoms at a later age, even though the obstruction is present from birth. This happens in two to six percent of all newborn infants. Both sides may be blocked in a third of the babies with this problem. The majority of blocked tear ducts open up spontaneously by the age of one year. Tearing can also be a sign of congenital glaucoma (increased pressure in the eye). This may be associated with light sensitivity and enlargement of the affected eye. Signs and Symptoms

• Persistent tearing which usually within the first few weeks of life.
• Spilling of tears over the lower lid and cheek (a wet look in the involved eyes).
• The whites of the eyes initially do not look red or pink until infection sets in.
• There is a risk of eye infection (conjunctivitis) because of poor drainage.
• Rarely, if the infection is left untreated, this infection can spread to the surrounding eye area or cheek.

Treatment

Treatment will be required immediately if:

• The eyelid becomes very red or swollen
• A red lump appears at the inner lower corner of the eyelid.

See a doctor if :

• There are signs and symptoms of , such as yellowish discharge.
• If tearing persists after one year of age, seek treatment from an ophthalmologist (eye specialist).
• The baby is irritable to light or one eye appears larger than the other, as in congenital glaucoma.