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All babies are examined within 24 hours of birth at the hospital, and then again at six to eight weeks by a general practitioner (GP), to rule out any possible health issues. Thankfully, complications with newborn babies are rare, but here are four eye-related issues to look out for:

1. Cataract

Cataract only affects 2.5 out of 10,000 births1 and this is tested for using a ‘red reflex test’ during your baby’s physical examination. Any babies failing this test should be seen by a hospital eye service within two weeks.

2. Strabismus

Up to 70% of babies are born with a constant or occasional turning of the eye outwards (strabismus, commonly known as a squint), but this usually resolves itself within the first few months of life. A very small number of babies develop an inward turning squint, also known as infantile esotropia, between the ages of two to four months. In the rare case that your baby’s eyes do not straighten up three months after birth, visit your local optometrist or GP who will be able to arrange a hospital referral, as any surgical intervention required is often advised before the age of one year. 2, 3

3. Conjunctivitis

Some babies under four weeks old can develop conjunctivitis of the new born, also called ophthalmia neonatorum, where the infection can occur either during delivery or after birth. There are many causes for the infection but some can cause serious damage to the eye. If your baby has swollen eyelids, redness of the eyes, and a lot of sticky discharge or persistent infection, they should be seen as soon as possible in the hospital for treatment.

4. Watery eyes

This happens when the normal drainage of the tears into the nose has not fully opened up (nasolacrimal duct obstruction), resulting in watery eyes, crusting of the eyelashes in the morning, and sometimes recurrent conjunctivitis. This usually clears up by the time babies reaches one year.

Treatment is to regularly and gently massage upper side of the nose to help move tears out of the nasolacrimal sac and into the eye to prevent infection. If the skin around the eyes becomes sore, it should be cleaned using cotton wool pads and clean water. Putting some petroleum jelly (e.g. Vaseline) on the skin around the eye after cleaning helps protect the skin. Antibiotic eye drops are only advised if the eye becomes red or conjunctivitis develops. If your baby is still having symptoms after they reach one year, they may need to be referred to the hospital eye department for treatment to open up the duct.

A very rare cause of watery eyes in very young children is congenital glaucoma. Look out for enlarged eyes and possibly hazy corneas. These children require urgent referral to the hospital eye department.

It’s important to remember that most babies have healthy eyes and serious problems are very rare. Make sure you take your baby to the six-to-eight-week check with your GP. If your baby is referred to the hospital, please make sure you keep your appointment.

References

  1. Rahi JS, Dezateux C, for the British Congenital Cataract Interest
    Group. National cross-sectional study of detection of congenital
    and infantile cataract in the United Kingdom: role of screening and
    surveillance. BMJ. 1999;318:362–365.
  2. Sondhi N, Archer SM, Helveston EM. Development of normal ocular alignment. J Pediatr Ophthalmol Strabismus. 1988;25(5):210–1.
  3. Nixon RB, Helveston EM, Miller K, Archer SM, Ellis FD. Incidence of strabismus in neonates. Am J Ophtalmol. 1985;100(6):798–801.

Gill Adams is a consultant paediatric ophthalmologist and strabismologist at Moorfields Eye Hospital and is a subspecialist in strabismus (squint) and paediatric ophthalmology.

W: www.moorfields.nhs.uk/consultant/gillian-adams

March 2, 2021