Merck Manual

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Conjunctivitis in Newborns

(Neonatal Conjunctivitis; Ophthalmia Neonatorum)


Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Reviewed/Revised Oct 2022
Topic Resources

Conjunctivitis is inflammation of the conjunctiva, the membrane that lines the eyelid and covers the white of the eye.

  • Conjunctivitis is caused by bacteria, viruses, or a reaction to chemicals.

  • Symptoms vary but may include inflammation of and a discharge from the eyes.

  • The diagnosis is typically based on the appearance of the eyes.

  • The infection may be prevented by drops or ointments that are put in the eyes after birth.

  • Antibiotics and antibiotic ointments are given to treat the infection.

An Inside Look at the Eye

An Inside Look at the Eye

Causes of Conjunctivitis in Newborns

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

Symptoms of Conjunctivitis in Newborns

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.

Conjunctivitis caused by gonorrhea usually begins 2 to 5 days after delivery. Newborns have severe inflammation of the eyelids and discharge of pus from the eyes. Without treatment, blindness may occur.

Conjunctivitis caused by chemicals, such as eye drops, usually begins within 6 to 8 hours after the drops are put in and goes away by itself within 2 to 4 days.

Conjunctivitis caused by other bacteria begins from 4 days up to several weeks after delivery.

Diagnosis of Conjunctivitis in Newborns

  • Testing of the eye discharge

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.

Prevention of Conjunctivitis in Newborns

In the United States, erythromycin ointment or drops are routinely put into each of the newborn's eyes after delivery to prevent conjunctivitis caused by Neisseria gonorrhoeae. In other countries, silver nitrate, tetracycline, or povidone iodine also may be used. Except for povidone iodine, these substances do not prevent conjunctivitis caused by Chlamydia.

Newborns of women who have untreated gonorrhea should receive a single injection of the antibiotic ceftriaxone even if they are not yet ill.

Treatment of Conjunctivitis in Newborns

  • Antibiotics

For conjunctivitis caused by Chlamydia, the antibiotic erythromycin or azithromycin is given by mouth.

For conjunctivitis caused by Neisseria gonorrhoeae, newborns are hospitalized and given the antibiotic ceftriaxone or cefotaxime by vein or injection.

For conjunctivitis caused by other bacteria, ointments containing polymyxin plus bacitracin, erythromycin, or tetracycline are applied.

Drugs Mentioned In This Article

Generic Name Select Brand Names
A/T/S, Akne-mycin, E.E.S., Emcin Clear , EMGEL, E-Mycin, ERYC, Erycette, Eryderm , Erygel, Erymax, EryPed, Ery-Tab, Erythra Derm , Erythrocin, Erythrocin Lactobionate, Erythrocin Stearate, Ilosone, Ilotycin, My-E, PCE, PCE Dispertab , Romycin, Staticin, T-Stat
No brand name available
Emtet-500, Panmycin, Sumycin
Ceftrisol Plus, Rocephin
Azasite, Zithromax, Zithromax Powder, Zithromax Single-Dose , Zithromax Tri-Pak, Zithromax Z-Pak, Zmax, Zmax Pediatric
AK-Tracin, Baciguent, BaciiM, Baci-Rx, Ocu-Tracin
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