A child waking with one or both eyes crusted shut is a common enough occurrence, usually announcing a viral cold or a bacterial infection that has spread to the eye. For most children beyond the newborn period, conjunctivitis is uncomfortable but resolves quickly and does not threaten vision.
The newborn period is different. Neonatal conjunctivitis, particularly that caused by Neisseria gonorrhoeae or Chlamydia trachomatis from the birth canal, requires urgent assessment and specific treatment. Any conjunctivitis in the first four weeks of life should be seen by a doctor.
Healthbooq (healthbooq.com) covers common childhood health conditions and when to seek medical assessment.
Types of Conjunctivitis
Viral conjunctivitis is the most common type overall. It usually comes alongside a cold or other viral illness, affects one or both eyes, and produces a watery discharge. The eye is red and may be itchy or gritty but is not usually very painful. It resolves on its own within one to two weeks. Antibiotic drops do not help viral conjunctivitis.
Bacterial conjunctivitis produces a thicker, often yellow-green, sticky discharge. The discharge crusts over during sleep, making the eyes difficult to open in the morning. Both eyes are often affected, though one may be worse than the other. It is more common in younger children and spreads easily in nurseries and schools through hand-to-eye contact.
Allergic conjunctivitis produces itching rather than pain, watery discharge, and usually affects both eyes symmetrically. It is often seasonal (hay fever season) and comes alongside other allergic symptoms like a runny nose.
Treatment
For viral conjunctivitis, the main management is cleaning the eyes with a clean cotton pad and cooled boiled water, wiping from the inner corner of the eye outward. Each wipe should use a fresh piece of cotton wool or a clean area of pad to avoid spreading infection from one eye to the other.
Bacterial conjunctivitis in children over two can often be assessed and treated at a pharmacy without needing a GP appointment. Chloramphenicol eye drops or ointment are available over the counter and are effective. The ointment is easier to apply in young children who will not hold still for drops. The drops need to be applied every two hours while awake for two days, then four times a day until the course is complete.
Most cases of bacterial conjunctivitis would resolve without antibiotics within seven to ten days. The argument for treating is speed of resolution and reduction in contagiousness.
Allergic conjunctivitis is managed by avoiding triggers where possible and using antihistamine eye drops. If the child has hay fever more broadly, systemic antihistamines often help the eye symptoms alongside nasal symptoms.
Sticky Eyes in Newborns
Newborns commonly have sticky eyes in the first few weeks of life. In most cases this is not infection but the result of a blocked or narrow nasolacrimal duct, the channel that normally drains tears from the eye into the nose. The excess tears pool and become sticky.
Cleaning with cooled boiled water on a clean cotton pad is the management. Gentle massage of the inner corner of the eye (over the nasolacrimal duct) may help the duct open. Most blocked ducts open spontaneously by 12 months.
If the eye is becoming red, if the discharge is profuse or yellow-green in a young baby, or if there is any swelling around the eye, medical assessment is needed.
When to See a Doctor
Any conjunctivitis in the first 28 days of life needs medical assessment on the same day. Neonatal conjunctivitis can be caused by gonorrhoea or chlamydia (from the birth canal) and requires specific antibiotic treatment; it can threaten vision if untreated.
At any age, see a doctor promptly if the child has significant eye pain or headache behind the eye, marked photophobia (aversion to light), reduced vision, a cloudy or hazy cornea (the clear part of the front of the eye looks milky), a very swollen or red eyelid, or if the eye is not improving after five days of antibiotic drops.
These features can indicate herpes simplex keratitis, iritis, or periorbital cellulitis, which are more serious conditions that require specific assessment and treatment.
Conjunctivitis is contagious, particularly the viral and bacterial forms. Children with active conjunctivitis should be kept away from nursery or school according to local guidance. NHS guidance is that antibiotic treatment is not required for school exclusion purposes, and that children are generally safe to return once the discharge has resolved.
Key Takeaways
Conjunctivitis is inflammation of the conjunctiva, the clear membrane covering the white of the eye and lining the eyelid. In children it is most commonly viral (associated with a cold), bacterial (producing yellow-green discharge), or allergic. Viral conjunctivitis resolves without treatment; bacterial conjunctivitis usually responds to antibiotic drops or ointment, though evidence suggests most cases also resolve without treatment. Sticky eyes in newborns are common and usually caused by blocked tear ducts rather than infection. Any conjunctivitis with significant pain, photophobia, reduced vision, or in the first 28 days of life requires prompt medical assessment.
