Eye health in newborns: physiology, hygiene, and management of eye secretions

The eyes are among the most delicate structures of the human body, and this is particularly evident in the first months of life. In the neonatal period, the tear drainage system is still immature, a condition that can lead to temporary difficulty in the natural cleansing of the ocular surface.

Eye secretions in the first months of life

In newborns, dense and adherent mucus around the eyelids may be observed, without redness or signs of irritation. This phenomenon is physiological and linked to the temporary inefficiency of the nasolacrimal duct. Tear drainage generally begins to function effectively around the second or third week of life but may take up to two months to fully stabilize.

Neonatal conjunctivitis: characteristics and management

In some cases, during the days following birth, a more marked eye discharge may appear, hindering eyelid opening. This is known as neonatal conjunctivitis, a condition that may affect one or both eyes and often originates from a partial blockage of the nasolacrimal duct or mild nasal mucosa congestion.
Symptoms tend to be more evident upon waking and resolve spontaneously in most cases. Management includes proper eye hygiene and, if necessary, localized massage of the lacrimal sac to promote drainage.

Neonatal eye hygiene: operational procedures

Daily cleaning of the eyes aims to remove secretions and crusts that may accumulate around the eyelids or in the tear lake. The recommended procedure includes:

• Careful handwashing before contact with the periocular area.
• Use of sterile disposable gauze or ophthalmic wipes moistened with saline solution.
• Gentle eye cleaning from the inner corner (near the nose) outward, without applying pressure.
• Use of a different gauze for each eye to prevent cross-contamination.
• Softening of crusts with saline compresses before removal.
• Avoidance of cotton balls, which may release potentially irritating microfibers.

Persistent tearing and nasolacrimal duct obstruction

Tear production begins around the third or fourth week of life. In some newborns, however, excessive tearing (epiphora) may occur due to partial or complete obstruction of the nasolacrimal duct. The result is a constantly moist eye, which may promote irritation or inflammation.
In most cases, the nasolacrimal duct opens spontaneously within the first year of life. While awaiting this physiological resolution, the process can be aided by specific massage techniques.

Lacrimal sac massage techniques

Method 1: localized circular pressure

• Lay the baby in a supine position.
• After washing hands, apply light circular pressure just below the inner corner of the eye using a fingertip.
• Stabilize the head with the opposite hand.
• Repeat the procedure 3–5 times a day.

Method 2: vertical drainage movement

• Slide the fingertip from the inner corner of the eye toward the nostril, along the side of the nose.
• Apply minimal and constant pressure, without causing discomfort.
• Repeat 3–5 times a day, preferably during routine moments (e.g., diaper changes).

Method 3: localized warm compress

• Apply a warm (not hot) cloth over the upper area of the tear duct.
• Leave in place for 3–5 minutes.
• The moisture and heat help remove the blockage and promote drainage.
• Repeat up to five times a day.

All massage techniques aim to generate slight local overpressure to open the valve of Hasner and allow the stagnant contents to drain from the nasolacrimal canal. This also facilitates the removal of potentially present bacteria and restores normal tear flow.

Ocular hygiene in the first months of life is essential for preventing irritation, infections, and complications due to nasolacrimal duct obstruction. Early recognition of physiological signs, the application of non-invasive cleansing and massage techniques, and monitoring of tear evolution ensure optimal eye health in newborns.
In cases of persistent discharge or associated symptoms (redness, swelling, fever), consultation with a pediatrician or healthcare provider is advised for further evaluation.