What causes a goopy eye in an infant?

Causes of Goopy Eye in Infants

A goopy eye in an infant is most commonly caused by bacterial conjunctivitis, viral conjunctivitis, blocked tear ducts, or allergic reactions, with bacterial conjunctivitis and nasolacrimal duct obstruction being the most frequent causes requiring different management approaches. 1, 2

Common Causes of Goopy Eyes in Infants

1. Nasolacrimal Duct Obstruction (Blocked Tear Duct)

• Most common cause in infants
• Presents with:
  • Persistent tearing
  • Mucoid discharge (especially after sleep)
  • Usually unilateral
  • No significant redness or inflammation
• Management:
  • Gentle massage of the tear duct area
  • Warm compresses
  • Observation (most resolve spontaneously by 12 months)

2. Bacterial Conjunctivitis

• Presents with:
  • Purulent or mucopurulent discharge
  • Eyelid mattering/crusting
  • Conjunctival redness
  • May be unilateral or bilateral
• Common pathogens in infants:
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Staphylococcus aureus
• Management:
  • Topical antibiotics may shorten duration
  • Cleaning crusts with warm water

3. Viral Conjunctivitis

• Presents with:
  • Watery discharge
  • Redness
  • Often bilateral
  • May have associated URI symptoms
• Management:
  • Supportive care
  • Warm compresses
  • Self-limiting condition

4. Allergic Conjunctivitis

• Less common in infants
• Presents with:
  • Bilateral itching
  • Watery discharge
  • Redness
• Management:
  • Identify and remove allergens
  • Topical antihistamines if severe

Special Considerations for Neonates (0-28 days)

Ophthalmia Neonatorum

• Presents within first month of life
• Potential serious pathogens:
  • Gonococcal: Severe purulent discharge 1-7 days after birth 1
  • Chlamydial: Presents 5-19 days after birth 1
• Management:
  • Urgent referral to ophthalmologist
  • Systemic antibiotics often required
  • Hospitalization may be necessary for gonococcal conjunctivitis 1

When to Refer to an Ophthalmologist

Immediate referral is required for any infant with:

• Visual loss
• Moderate or severe pain
• Severe purulent discharge
• Corneal involvement
• Lack of response to therapy within 2-3 days
• Recurrent episodes
• Symptoms in first month of life (ophthalmia neonatorum) 1

Management Algorithm

1. Assess severity and age:

   • Neonates (0-28 days): Consider ophthalmia neonatorum → refer to ophthalmologist
   • Older infants: Proceed with assessment

2. Evaluate discharge characteristics:

   • Purulent/yellow-green: Likely bacterial
   • Clear/watery: Consider viral or blocked tear duct
   • Mucoid/white: Consider blocked tear duct

3. Check for associated symptoms:

   • Fever, significant redness → Consider bacterial infection
   • Upper respiratory symptoms → Consider viral cause
   • Persistent tearing without significant redness → Consider blocked tear duct

4. Initial management for mild cases in infants >28 days:

   • Clean discharge with warm water
   • For suspected bacterial: Consider topical antibiotics
   • For suspected blocked tear duct: Gentle massage and warm compresses

5. Follow-up and referral:

   • Improvement within 48-72 hours → Continue treatment
   • No improvement or worsening → Refer to ophthalmologist

Important Caveats

• Never ignore eye discharge in neonates - could be ophthalmia neonatorum requiring urgent treatment 1
• Bilateral severe purulent discharge requires immediate evaluation for gonococcal infection 1
• Persistent discharge beyond 2-3 weeks in older infants warrants ophthalmology referral 1
• Blocked tear ducts typically resolve spontaneously by 12 months of age; persistent cases may require probing
• Avoid steroid-containing eye drops unless specifically prescribed by an ophthalmologist

Remember that proper hand hygiene is essential when treating an infant with conjunctivitis to prevent spread to the other eye or to other family members 1.