Eye care of the newborn

Daily eye care is an important part of a newborn's health. Because babies can't tell you if they have eye or vision problems, parents and health care professionals must be aware of the warning signs.


Newborn vision
Newborns tend to keep their eyes shut, but most infants can see and react to lighting changes. Newborns can typically focus on things about 8 to 10 inches away, and they're often interested in faces. In fact, a mother's face is one of the earliest visual cues to which a newborn will respond. Your baby's eyes may cross occasionally during the first two months, and tears may not appear for one to three months, even with crying. Most newborns have vision in the 20/400 range, which improves rapidly over the next six months. By age 2 or 3, vision is often about 20/20.

Physical characteristics
Pressure during delivery, medications dropped into the eyes at birth, and premature birth can all play a role in how your baby's eyes appear while a newborn.
Swollen eyelids
To help prevent infection and potential vision impairment or blindness, newborns often receive antibiotic eyedrops (or, rarely, silver nitrate eyedrops) at birth. These medications may cause swollen eyelids for a short time. For about one of every five babies, silver nitrate may also cause chemical conjunctivitis (inflammation of the membrane that lines the eyelids). This condition causes swelling and yellowish discharge from the eyes. Swollen eyelids may also be related to pressure on the face during delivery.

Blood spots
Blood spots on the white part of the eye, or subconjunctival hemorrhage, are common in newborns. They are caused by pressure that occurs during the birth process and typically disappear on their own within two to three weeks.

Color changes
Some babies are born with and keep dark irises (the colored part of the eye). In other cases, especially for Caucasians, babies are born with blue or gray irises. The permanent color often appears by age 6 months.


Blocked tear ducts
Blocked tear ducts are a common complication for newborns from the time tear production begins, about two weeks after birth. The condition usually clears up on its own by age 1. To treat blocked tear ducts at home, the doctor may show you how to massage the lacrimal sac (the spot where tears collect). Sometimes, tears may overflow from the affected eye. If a blocked tear duct doesn't open on its own or with home treatment by age 6 to 12 months, an ophthalmologist (a doctor who specializes in eye disorders) may open the duct with a special probe. If there's an infection, your baby may need antibiotics.

Infant eye exams
A baby's first eye exam is usually done before discharge from the hospital. Other exams are usually done at well-baby checkups during the first year. The doctor will examine certain reflexes, the shape of the eyes, whether there's any discharge or swelling, and ocular movements. If the doctor detects any problems with your baby's eyes, your baby may be referred to an ophthalmologist for a more extensive evaluation.
The doctor will need to know about any family history of eye disease and any medical problems you may have had during the pregnancy or delivery that may place your child at risk for visual disorders. If your child was born very premature, a specialist may check for a condition called retinopathy of prematurity (changes in the retina due to prematurity).


Signs of eye problems
Call your baby's doctor if you notice any of the following warning signs in your newborn:
uncoordinated eye movement after age 3 months (eyes that don't move together)
whites of the eyes that are pink or red all over
dark yellow eye discharge
eye swelling or discharge that begins 24 hours or more after an eye medication is given
daily tearing
a continuously watery eye
tears that run down your baby's face without crying
red and swollen eyelids
a red lump at the inner corner of the eyelid
pus that sticks the eyelids together
eyelids that are matted shut after sleeping
a cloudy cornea (the clear surface covering the eye)
a protruding eyeball
"sun-setting" eyes (child appears to be gazing downwards)

Prevention
Routine eye care can help you detect problems early and preserve your child's vision. When washing your baby's face, first clean the eyelids by carefully wiping from the inner to outer part of each lid. There's no need to use soap -- a clean, wet washcloth or cotton ball soaked with plain water is fine. Also, use this time to check your baby's eyes and eyelids for abnormalities. Finally, make sure your baby receives regular eye exams.