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Eye Infections and Inflammation
Oftentimes, the mother of a newborn calls me about their baby's puffy eyelids and a gluey secretion from the corner of the eye. Usually I am able to guide her through the routine of clearing up what is frequently a blocked nasal lacrimal duct. Tears are produced in sacs under the upper outer eyelids and wash across the eyes to clear away foreign particles and to keep the eye moist and healthy. These tears must drain regularly and they normally do, into a tiny drainage system in the inner corner of the lower eyelids and from there drain into the nose. When we cry of course more tears are produced than ordinarily and so the system cannot handle all the flow and some spill over in what we see as evidence of crying. In newborns, the ducts are so small and so easily clogged that often the lacrimal tears cannot get through to drain and the result is first tearing, then thickening of the tears as mucus and foreign matter (dust, dirt etc.) mix with them giving that gooey look and then as a result of this thick matter the eyelids get inflamed and puffy. Usually this situation can be reversed by simple cleansing of the secretions regularly and gentle massaging beneath the inner corner of the eyes with a clean short-nailed pinky finger. Sometimes the white of the eye has also been affected and has turned pink-red and the secretions may be collecting quickly after each cleansing - at this point your baby has a simple eye infection called conjunctivitis because of the blocked duct and your pediatrician will prescribe an anti-bacterial ointment or drops. Usually this condition is better in 1-3 days.Sometimes a baby can develop conjunctivitis without having a blocked duct and typically this infection is more severe, involving the eyelids and even the skin under the eyes, sometimes along with a cold and fever. Depending upon the baby's age the pediatrician may add oral antibiotics to the ointment treatment plan. There are some eye infections that can spread into the underlying tissue and effect the eye muscles if not treated. There are bacteria that can be introduced into the baby's eyes during the birth process and for that reason babies are routinely treated at birth with an eye ointment to prevent serious eye infections. This is not a common happening any more but it used to be a cause of blindness before antibiotic ointments were the rule in nurseries. That's progress.
Most older children get conjunctivitis at least occasionally, usually with a cold, and simple cleaning and hand washing will control it in most cases. If your child complains of pain in the eye and the whites are pink-red your doctor will probably have to take a look before prescribing. Sometimes the inflamation is not an infection but instead caused by a tiny scratch or some tiny bit of dirt or eyelash caught behind the lid. Flushing and soothing eye drops are often enough to wash out the offender; sometimes the doctor has to "go get it". Be kind, be supportive and hold your child tightly to help the doctor get to it quickly and safely. Afterwards he will probably prescribe drops to prevent infection since anytime you "go get it" you run the chance of leaving something behind of it and it can go on to get inflamed and infected a few days later.
When parents call and tell me their 3 year old has a painless pinkness to one eye and no discharge, maybe some increased tearing, and no history of trauma, I usually tell them to just keep thinks clean and watch for other developments. Most simple eye infections are viral like are colds and will heal soon by the body's own methods and without treatment. This is a common childhood condition and although it is easily transmitted to others (it is contagious) most children end up with only mild infections and little to no treatment needed.
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