The American Academy of Pediatrics (AAP) recommends that all infants get treated with ocular prophylaxis (preventative eye infection treatment), usually a 0.5% erythromycin ointment. This ointment prevents ophthalmia neonatorum, commonly referred to as newborn conjunctivitis or pinkeye (Franco & Hammerschlag, 2023; Nolt et al., 2022).
Most states in the U.S. require eye drops at birth by law to prevent newborn pinkeye (Frenck, 2025). For GHT families or other families in California, prophylaxis for newborn pinkeye is required to be administered within two hours of birth with use of silver nitrate or ophthalmic ointments or drops containing tetracycline or erythromycin. Any newborn who develops newborn pinkeye must be isolated until negative lab tests are obtained (Cal. Code Regs., Tit. 17, § 2560).
Eye drops and ointments have been used to prevent newborn pinkeye since the late 1880s (Franco & Hammerschlag, 2023). Silver nitrate was the common treatment in a pre-antibiotic era, though we now commonly use erythromycin (Moore & MacDonald, 2015). Silver nitrate and tetracycline are no longer commonly used or available (American Academy of Ophthalmology, 2025; Moore & MacDonald, 2015).
Newborn Pinkeye
Newborn pinkeye can cause vision issues or even blindness, if untreated. It can be caused by several things, including allergies, chemical irritation, or bacterial or viral infections, which can be passed to newborns during pregnancy or birth (Frenck, 2025).
Newborn pinkeye can be caused by gonorrhea, which damages your baby’s eyes or even infect the bloodstream (Frenck, 2025). 30-50% of infants born of people with gonorrhea infections that are not treated with eye drops at birth contract gonorrhea infections (Nolt et al., 2022). Newborn pinkeye due to gonorrhea is known to progress aggressively and has a high risk of scarring and vision loss (American Academy of Ophthalmology, 2025).
Newborn pinkeye can also be caused by chlamydia, staph, strep, E. coli, herpes simplex, and flu (Frenck, 2025). It is possible to have co-infection, like contracting both gonorrhea and chlamydia at the same time (American Academy of Ophthalmology, 2025).
Signs/Symptoms of Newborn Pinkeye
- Red or pink color of the white of the eye
- Swollen, puffy eyelids
- Watery discharge to progresses quickly to thicker, pus-like discharge
- Crusty eyelashes that sometimes seal the eyes shut during sleep
Keep your eye out 😉 for symptoms because newborn pinkeye presents during the first four weeks of life (Asiamah et al., 2025; Nolt et al., 2022).
Newborn pinkeye caused by gonorrhea or chlamydia infection are uncommon in high-income countries because of the introduction of prenatal screening and treatment (Asiamah et al., 2025; Franco & Hammerschlag, 2023). So, why is it still recommended for all newborns?
Criticism of Eye Drops at Birth
Newborn pinkeye occurs in about 10,000 cases annually worldwide, with the burden of cases in mostly low-income countries (Asiamah et al., 2025). Though, while the use of erythromycin ointment is not associated with any serious harm (Nolt et al., 2022), some parents question its necessity.
Some parents prefer not to use eye drops at birth because they believe it hinders bonding in the first few hours of life due to mild eye irritation (Moore & MacDonald, 2015). Furthermore, eye drops at birth prevent infections due to some pathogens like gonorrhea, but not others, like chlamydia (Nolt et al., 2022). Many families think that since eye drops at birth don’t protect against all infections, then the benefits aren’t worth the risks. And it’s true that if your infant does later contract newborn pinkeye due to gonorrhea, they can be treated (Nolt et al., 2022).
There is also an increasing resistance to erythromycin among some infections (Asiamah et al., 2025; Nolt et al., 2022). And in some cases, eye drops at birth can cause chemical conjunctivitis, or pinkeye due to a reaction to treatment, which can complicate diagnosis and treatment (Asiamah et al., 2025). However, the AAP continues to recommend erythromycin ointment at birth until other strategies for preventing newborn pinkeye have been enacted, like screening pregnant people. Eye drops at birth provide substantial benefit and are not associated with serious harm (Nolt et al., 2022).
We at GHT also recommend eye drops at birth. Untreated ophthalmia neonatorum can cause blindness or fatal blood or brain infections. Your California providers will follow the law and not risk infection.
Other Ways to Protect Against Eye Infections at Birth
- Treat any infections or issues during pregnancy, before your baby is born.
- Get screened for infections like gonorrhea before your baby is born.
- You may need to be retested after treatment. For example, you need to be tested three months after gonorrhea treatment to ensure you don’t need retreatment.
- Get vaccinated during pregnancy to help your baby build the immunity they need to stay safe and healthy during the first few months of life.
- Keep an eye out for signs and symptoms of infection within the first four weeks of life
References
American Academy of Ophthalmology. (2025). Use of Erythromycin in the Prevention of Ophthalmia Neonatorum—2025. American Academy of Ophthalmology. https://www.aao.org/education/clinical-statement/use-of-erythromycin-in-prevention-of-neonatal-opht
Asiamah, R., Owusu, G., Amoako, P. T., Amponsah, R., Adator, E., & Kyei, S. (2025). Epidemiology of ophthalmia neonatorum: A systematic review and meta-analysis. BMC Pediatrics, 25(1), 31. https://doi.org/10.1186/s12887-024-05382-x
California Code Regs. Title 17, § 2560 – Conjunctivitis, Acute Infectious of the Newborn. https://www.law.cornell.edu/regulations/california/17-CCR-2560
Franco, S., & Hammerschlag, M. R. (2023). Neonatal ocular prophylaxis in the United States: Is it still necessary? Expert Review of Anti-Infective Therapy, 21(5), 503–511. https://doi.org/10.1080/14787210.2023.2172401
Frenck, R. W. (2025). Erythromycin Eye Ointment for Newborn Pinkeye (Conjunctivitis). American Academy of Pediatrics. HealthyChildren.Org. https://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Erythromycin-Ointment.aspx
Moore, D. L., & MacDonald, N. E. (2015). Preventing ophthalmia neonatorum. The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien Des Maladies Infectieuses et de La Microbiologie Médicale, 26(3), 122–125. https://doi.org/10.1155/2015/720726
Nolt, D., O’Leary, S. T., & Aucott, S. W. (2022). Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices. Pediatrics, 149(2), e2021055554. https://doi.org/10.1542/peds.2021-055554
