What's the diagnosis? Newborn with eye discharge
March 4, 2025
The nurse calls asking you to come look at a baby who has eye discharge. She reports the baby is well other than this issue.
You review the chart before going into see the infant. The infant is now 42 hours old. She is a 38.3-week female infant born by a vaginal birth to a 29-year-old G3 now P2-3. The birth was complicated by a triple nuchal cord and meconium stained amnionic fluid. For these issues the NICU team was present for the birth, but the infant did well with APGARS of 6 and 9. The mother arrived in the United States from abroad 2 weeks prior to birth. Prenatal care was limited - records from the other country were not available.
The admission physical noted:
Birthweight 2.920 kg (24%)
Length 50.8 cm (81%)
Head circumference 31 cm (1%) - the head was noted to be molded with overriding sutures
The rest of the exam was wnl
All vital signs since admission have been in the normal range and the infant is exclusively breastfed with a good latch.
On your exam you observe copious purulent discharge coming from the left eye. The discharge is dramatic. You wipe the eye and within 5 minutes it returns.
Differential diagnosis
You run through a differential diagnosis in your mind:
Blocked tear duct
Chemical irritation
Infectious