Quick answer: Gunky eyes in babies are extremely common — and the two most frequent causes (blocked tear duct and conjunctivitis) look similar but require different management.
Gunky eyes in babies are extremely common — and the two most frequent causes (blocked tear duct and conjunctivitis) look similar but require different management. Here’s how to tell them apart and what to do.
Blocked Nasolacrimal Duct (Blocked Tear Duct)
The nasolacrimal duct drains tears from the inner corner of the eye into the nasal cavity. In approximately 6–20% of newborns, this duct is partially blocked or has a membrane that hasn’t fully opened. The result: persistent watering and mucosal discharge from the affected eye (often one eye only). The eye itself is not red or inflamed — there’s no conjunctival injection. The discharge is typically clear to yellowish-white, accumulating in the inner corner. This is not an infection — it’s a drainage problem. Management: Nasolacrimal massage — press firmly with a clean finger at the inner corner of the eye and massage downward toward the nose, 5–10 times before each feed. This applies pressure to the duct and can open the membrane over weeks. Clean with cooled boiled water — wipe discharge from inner to outer corner with a clean cotton ball. Most blocked ducts resolve spontaneously by 12 months. If persistent at 12 months, referral to ophthalmology for probing (a brief procedure under sedation or anaesthesia to open the duct) is warranted.
Conjunctivitis (Pink Eye)
Conjunctivitis is inflammation of the conjunctiva — the clear membrane covering the white of the eye. In babies, it can be: Chemical conjunctivitis: From the erythromycin eye ointment given at birth (US practice) — resolves within 24–48 hours. Bacterial conjunctivitis: Thick yellow-green discharge, red/pink conjunctiva, sticky eyelids. Can be caused by various bacteria; Neisseria gonorrhoeae (gonococcal) and Chlamydia trachomatis (chlamydial) are the most serious neonatal forms and require specific treatment. In older infants, most bacterial conjunctivitis is caused by Staphylococcus aureus or Haemophilus influenzae. Viral conjunctivitis: Watery discharge, may accompany a cold. Usually self-limiting.
Neonatal Conjunctivitis: A Special Case
Conjunctivitis in the first 28 days of life (neonatal conjunctivitis or ophthalmia neonatorum) always requires evaluation. Gonococcal conjunctivitis (from maternal gonorrhoea) presents in the first 2–5 days with profuse purulent discharge and significant eyelid swelling — can cause blindness without urgent treatment. Chlamydial conjunctivitis presents at 5–14 days with mucopurulent discharge. Both require specific antibiotic treatment (topical and systemic). Any significant conjunctivitis in the first month needs same-day assessment.
Treatment by Type
Blocked tear duct: Massage and cleaning only — no antibiotics needed unless secondary infection develops. Bacterial conjunctivitis: Topical antibiotic eye drops (chloramphenicol is first-line in the UK and most of Europe; most cases respond within 5 days). Clean discharge with cooled boiled water. Wash hands thoroughly. Viral conjunctivitis: Supportive care — cooling eye and cleaning discharge. Antibiotics don’t help viral conjunctivitis.
Frequently Asked Questions
How do I tell if it’s a blocked duct or conjunctivitis?
Key distinction: in blocked duct, the white of the eye is white — no redness. Discharge is in the inner corner, typically clear to whitish. One eye is usually affected. In conjunctivitis, the conjunctiva is visibly pink or red. Discharge may be thicker and yellower. Both eyes may be affected. When in doubt with a young baby, have it assessed — particularly in the first month.
Is conjunctivitis contagious?
Bacterial and viral conjunctivitis are both contagious through direct contact (touching the eye then a surface; sharing towels). Blocked tear duct discharge is not contagious. Good hand hygiene is the primary prevention. Children with bacterial conjunctivitis are generally excluded from nursery until 24 hours after antibiotic treatment started; viral conjunctivitis until discharge has resolved.
My baby has been treated for conjunctivitis twice in a month — what’s going on?
Recurrent conjunctivitis in the same eye may indicate an underlying blocked tear duct (the stagnant tears become infected repeatedly). Assessment by an ophthalmologist to evaluate the drainage system is worthwhile if infections keep recurring.
Related Reading
- Newborn crying: decoding the 5 different cries
- Baby fever: temperature chart and when to seek help
- Safe sleep for newborns: the complete ABCs guide
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