Conjunctivitis in Babies: Types, Treatment, and When to See a GP

Sticky or gunky eyes are among the most common concerns in the first weeks and months of a baby's life. While most cases are mild and resolve without treatment, it is worth understanding the different causes — because the management varies considerably depending on what is causing the discharge.

Sticky Eye vs Conjunctivitis

These terms are often used interchangeably, but they describe different things.

Sticky eye in newborns is typically caused by a blocked nasolacrimal duct (tear duct). The tear duct, which normally drains tears from the eye into the nasal passage, is narrow or blocked at birth in around 20 per cent of newborns. Tears cannot drain properly and pool in the corner of the eye, becoming a yellowish discharge — particularly noticeable on waking. The eye itself is not inflamed and there is no redness of the white of the eye. This is not an infection.

Conjunctivitis is inflammation of the conjunctiva — the thin, transparent membrane covering the white of the eye and the inner surface of the eyelids. It can be caused by viral infection, bacterial infection, or allergy, and each type has different characteristics and treatment.

Types of Conjunctivitis

Viral conjunctivitis

The most common type. Usually associated with a cold or upper respiratory tract infection. Characteristics:

• Watery, clear, or slightly mucoid discharge
• Redness of the white of the eye
• Often starts in one eye and spreads to the other within a day or two
• May feel gritty or uncomfortable

Viral conjunctivitis is self-limiting and does not respond to antibiotics. Treatment is supportive — cleaning the eye with cooled boiled water and a clean cotton pad, wiped from the inner corner outwards. It usually resolves within one to two weeks.

Bacterial conjunctivitis

More common in younger babies. Characteristics:

• Thicker, more purulent (yellow-green, opaque) discharge
• Can be copious — the eye may be stuck shut on waking
• Redness and sometimes swelling of the eyelids
• Both eyes may be affected, or infection may begin in one and spread

Treatment for confirmed or strongly suspected bacterial conjunctivitis is antibiotic eye drops or ointment (chloramphenicol is most commonly prescribed in the UK). A GP appointment is required for prescription. Antibiotic eye drops are not available over the counter for babies — they are only available without prescription for adults aged 2 years and over.

Allergic conjunctivitis

Less common in young babies (seasonal allergies are rare under two years old). More likely in older babies and toddlers with a family history of atopy. Characteristics:

• Itchy, watery eyes
• Both eyes affected simultaneously
• Associated with other allergic symptoms (sneezing, runny nose)
• No discharge, or minimal clear discharge

Management involves identifying and avoiding the trigger where possible, and antihistamine eye drops in older children.

Blocked Tear Duct: When It Resolves and What to Do

Around 90 per cent of blocked tear ducts resolve spontaneously by the time the baby is 12 months old. In the meantime:

• Clean the eye regularly with cooled boiled water and a clean cotton pad, wiping from the inner corner outwards. Use a fresh pad for each wipe and each eye.
• Lacrimal massage can help. Using a clean fingertip, apply gentle pressure to the lacrimal sac — the small area on the inner corner of the eye, just below the level of the eye itself — and massage downward towards the nose. Do this two to three times a day. Some evidence suggests this can help open the duct more quickly.
• If the discharge becomes significantly purulent or the eye becomes red and inflamed, a bacterial infection may have developed on top of the blocked duct — see your GP.

If the duct has not opened by 12 months, referral to a paediatric ophthalmologist is usual. A simple procedure called probing can open the duct under brief general anaesthetic and is highly effective.

Neonatal Conjunctivitis: A Special Case

Conjunctivitis that develops in the first 28 days of life (neonatal conjunctivitis, or ophthalmia neonatorum) requires prompt medical attention. In newborns, certain infections can cause conjunctivitis that, if untreated, leads to serious complications including corneal damage and blindness.

The most serious causes are:

• Neisseria gonorrhoeae — gonococcal ophthalmia. Presents within 24–72 hours of birth with rapidly worsening, copious purulent discharge. A medical emergency.
• Chlamydia trachomatis — chlamydial conjunctivitis. Presents at 5–14 days with watery or mucopurulent discharge. Requires systemic (oral) antibiotics in addition to topical treatment.

Both can be acquired from the mother during delivery if she has an untreated STI. Any newborn with significant eye discharge in the first month of life should be seen by a GP or in A&E on the same day.

When to Seek Urgent Help

Seek urgent medical attention — same day GP, 111, or A&E — if:

• Your baby is under four weeks old and has any eye discharge
• The eyelids are very swollen, red, and warm to touch (cellulitis)
• Your baby seems to be in pain or their vision appears affected
• The eye is very red and the discharge is copious and purulent
• There is no improvement after 48 hours of antibiotic drops (if prescribed)
• You are worried and unsure

Routine sticky eye in a baby over a month old with no redness of the white of the eye, no swelling of the eyelids, and normal behaviour is almost always a blocked tear duct and can be managed at home with cleaning and massage. When in doubt, speak to your health visitor or GP.