Young Parents, especially first timers are often concerned about watering, discharge or stickiness of one or both eyes of a newborn.  Their lack of confidence in handling a newborn baby often adds to the anxiety.  

Complete systemic examination of a newborn is a part of standard protocol at all the hospitals nowadays.  In fact with advances in "Foetal Medicine" well-being of a baby is ensured starting in mother's womb itself.  Birthing may be normal, assisted or through a C-Section.  There may be contamination from sac fluids, meconium, maternal faecal matter, assistance devices or even hospital equipment and instruments.  Contaminants are generally cleaned thoroughly after collection of delivery and baby kept in a clean warm bassinet.  After resuscitation and stabilisation exclusion of gross structural anomalies is carried out.

No eye drops are suggested if there is no evidence of infection in the eyes of a baby.  Eyes are cleaned by gently running clean water with open lids during the process of giving a bath.

Caregivers who are not very confident of cleansing the eyes can do so with boiled, moist cotton swabs.  A bowl full of water is taken in a pan and wisps of cotton are put in it to soak.  After complete soaking water is put to boil for a minute.  Cover the pan with a lid and after cooling down you have sterile wisps of cotton and water.  Moist swabs of cotton are then used for cleaning the lid margins. Some water is used for cleaning the eye surface by just squeezing the moist cotton swabs.

If stickiness of lids and matting of eyes persists opinion of an eye specialist should be sought.  Antibiotic drops should not be started empirically.  It may be a good practice to continue cleaning the eyes while culture sensitivity results are awaited.  However, in the case of clear cut infection, broad-spectrum antibiotics may be started immediately after taking a swab for culture.  It is important that the swab is moistened with sterile water or culture medium to prevent any abrasion to the delicate eye tissues.

Tear production starts around 6 weeks of age and is generally at this time that profuse watering may be reported by parents in one or both the eyes.  Blockage in the tear ducts is a possibility that one has to keep in mind.

Watering increases whenever a baby gets a cough and cold as there is swelling of the mucous membrane of the nose which blocks the internal opening of the tear duct inside the nose.

Tear duct block can occur anywhere from the opening at the lid margin to the end point in the nose. There is a sac in the middle that frequently gets blocked and inflamed a condition termed as "dacryocystitis".  Blocks can be soft as a membrane or hard as a bone.  They can be overcome by simple massage of the sac or by probing with graduated silver wires.  In the case of major structural anomalies, a new passage needs to be constructed at a later age.

The take home message is:

1) Keep the eyes clean by running clean water over them 

2) Use sterile moist cotton swabs for cleaning lid margins in case there is discharge and stickiness of lids

3) Do not put antibiotic drops till the "culture sensitivity" reports are available unless the treating doctor thinks it is imperative and prescribes.

4) Learn an effective way to massage the sac (when suggested by the doctor).  Use the little finger, clip nails and sanitise your hands.

5) Do not massage when there is a cough or cold

6) Time for "Syringing and Probing" is a prerogative of the treating doctor.  Do not insist on early probing.