EYE WATERING AND DISCHARGE IN NEWBORNS

Eye watering in newborns is one of the most common issues we encounter in our outpatient practice. Therefore, it is important to educate families about this condition.

The underlying causes of eye watering in newborns can be identified through an ophthalmologist’s examination. I will try to explain the most common conditions causing eye watering, in order of their frequency.

The most common cause of intense discharge and crusting in newborns is the colonization of pathogens from the mother’s birth canal, leading to a severe eye infection. This condition is medically known as neonatal conjunctivitis. The discharge can be so thick that it sticks the eyelids together, and it often has a greenish-yellow appearance. It can occur in one or both eyes. The color and consistency of the discharge vary depending on the causative microorganism. The spectrum ranges from simple bacterial infections to more severe infections caused by Chlamydia or Neisseria. Chlamydia and Neisseria infections produce a thicker, stickier discharge and respond more slowly to treatment. In such cases, collaboration with pediatricians is essential. Another important point is the evaluation of the mother’s birth canal. Since the infection is thought to be transmitted from the mother’s birth canal, it is crucial to ensure the mother receives appropriate treatment as well.

The second most common condition we see in the clinic is nasolacrimal duct obstruction (tear duct blockage). The nasolacrimal duct is a thin canal that carries tears from the eye to the nose. Congenital underdevelopment or the presence of a membrane within the duct can obstruct the natural flow of tears, causing them to accumulate and overflow. Initially, the tears are clear, but over time, the stagnant tears can become infected, leading to a more purulent discharge and crusting. This developmental issue is usually seen in one eye, though it can occasionally affect both eyes.

A much rarer cause of eye watering is congenital glaucoma. In this case, there is no discharge, but rather intense sensitivity to light and excessive tearing. Babies with congenital glaucoma cannot establish natural eye contact with their mothers due to this sensitivity. These infants typically have unusually large eye diameters and often have other congenital eye anomalies. Congenital glaucoma is an emergency condition in newborns, making accurate diagnosis crucial.