Clinical: the eyes have it

12 March 2018

Sticky eye and conjunctivitis are two of the most common conditions affecting children’s eyes, but what causes them, and just how serious are they, asks journalist John Windell.

Our eyes are our windows on the world, particularly when we are young and learning so much from what we see happening around us. This is why it is so important to look after infants’ and children’s eyes. Any problems with their eyes or the normal function of their sight while they are still properly forming can have a profound and lasting impact on a child’s overall physical and cognitive development.

Though not every eye condition that affects babies and young children threatens long-term problems, even routine issues can be uncomfortable and unpleasant for children and a big worry for their parents. Health visitors are in a unique position to advise and reassure parents on conditions such as conjunctivitis and sticky eye, which at first glance are not so easy to tell apart.

A sticky problem

For many babies and young children, sticky eye will be a normal event as they grow up. The routine symptoms are a mucus-like yellow substance sitting in and around the tear duct in the corner of the eye (it’s most often just the one eye). The usual cause is a narrow, underdeveloped tear duct – the tears can’t flow properly, so build up in the corner of the eye, leading to watery eyes and infection.      

‘This is a common condition,’ says Professor Stephen Vernon, vice-president at the Royal College of Ophthalmologists. ‘Children will tend to have a sticky eye when they wake up after sleeping. They won’t necessarily have a red eye, but it may have a slight redness. What I would call “sticky eye” is a non-infected excess of mucus that occurs usually in the first year.’

A case of sticky eye will usually clear up on its own, and generally there’s no need to see a GP. 

The sticky substance that accumulates in the eye can crust over a little, but is easily removed. ‘Clean it with a saline solution,’ says Professor Vernon. ‘Boil some water with half a teaspoon of salt, and let it cool. Then carefully wipe away the mucus with a clean cotton-wool ball, from the corner of the eye outwards. Otherwise, wait for natural resolution, which happens in the majority of cases when children are in their first year.’

But if the sticky discharge persists or gets worse, it may be something a little more serious – possibly conjunctivitis.

Eye-health tips 

Get tested Regular eye tests – at least every two years – can keep children’s eyes healthy, and will detect conditions such as long- or short-sightedness, squint and lazy eye.

Eat healthily A varied diet with lots of fruit and vegetables will provide all the nutrients needed for developing eyes. Try grapes and blueberries (anthocyanins), fish (Omega-3 fatty acids), spinach and kale (carotenoids), papaya (betacarotene), eggs (lutein) and wholegrains (zinc and vitamin B).

Cover up Children’s eyes are sensitive to light and need protecting from the sun’s harmful UV rays. Suitable sunglasses will have a CE, UV 400 or British Standard mark. Children should wear them when the UV index rises to three, even if cloudy. Wide-brimmed hats can help too.

Play a game Children’s eyes continue to develop up to the age of eight and should be stimulated through age-appropriate play: from high-contrast toys, mirrors and ‘peekaboo’ games to throwing and catching activities that promote hand-eye coordination.

Vision Matters, 2018

Conjunctivitis – bacterial, viral or allergic?

Conjunctivitis can be triggered by either bacteria or a virus, and in some cases an allergic reaction. Viral infections are the most common and can be caused by the same virus responsible for the common cold, though both the viral and bacterial versions are highly contagious. Once infected, the clear thin layer that covers the eye begins to swell. As well as the discharge and redness, the eye can feel scratchy and as though it is burning. Vision may become blurred, and there may be some sensitivity to light. Conjunctivitis also affects both eyes.

‘The classic bacterial version of conjunctivitis gives a mucus discharge, comes on quickly but is usually self-limiting,’ says Professor Vernon. ‘Even if untreated, the body tends to fight it off. But because it has the potential to spread, children tend to be given a course of antibiotic drops.’

Dr Imran Rafi, joint medical director at the Royal College of General Practitioners, says that while conjunctivitis is a very common and treatable condition in children, it also requires a degree of management. ‘It’s important that children try not to rub the affected eyes and let them heal. Conjunctivitis can also be infectious, so children should avoid sharing towels, pillows and flannels with other members of the family to prevent it from spreading.’ As with the bacterial version, good eye hygiene can also alleviate the symptoms of viral conjunctivitis.

For most adults, conjunctivitis will clear up on its own within one or two weeks. But a visit to the GP is normally recommended if a child is suspected of having conjunctivitis, and if it’s affecting a young baby, an appointment is more urgent. You don’t need to avoid work or school unless you or your child are feeling very unwell, but if there are a few children with conjunctivitis, schools may ask those infected to stay at home (NHS Choices, 2018).

Professor Vernon goes so far as to recommend that any child with conjunctivitis should be taken to see the family GP, practice nurse or other healthcare professional. ‘Some parents try to treat it themselves, but can get it wrong and then have a mess on their hands. It’s far better to see somebody who is used to examining children and who can give the right advice.’

A third version of the condition is allergic conjunctivitis. This can be triggered by a wide variety of allergies, including hay fever. Itchy and scratchy eyes are the classic symptoms, but they can also become watery, red and swollen. The symptoms of allergic conjunctivitis will normally clear up when the irritant is removed. But, again, Professor Vernon recommends vigilance: ‘If it goes on a long time, especially in a child under 10, get a second opinion from an ophthalmologist, because it could be something more serious.’

Anecdotally, the topical use of breastmilk for conjunctivitis can be effective. Recent randomised clinical studies on its health benefits are inconclusive, but Arnardottir et al (2016) found that breastmilk contained a ‘reservoir’ of biomolecules that heal infection, reduce pain and calm inflammation.

Opthalmia neonatorum

A less common eye condition to look out for in babies is ophthalmia neonatorum (ON). This is a form of conjunctivitis that newborns can pick up in the birth canal during delivery when the mother is infected with chlamydia or gonorrhoeae bacteria. It is usually detected and treated at birth with antibiotic drops or ointment, though the symptoms – swollen and tender eyelids, and discharge from the eyes – can appear up to 28 days after birth. These days, ON is considered a mild condition, though in extreme cases, if left untreated, it can cause blindness.

‘Any potential infection in the first weeks after birth can be serious,’ says Professor Vernon. ‘The signs of conjunctivitis during that time are almost certainly going to have been contracted during the birth process. If the eyelids are obviously inflamed and sticky, that is effectively ON, and the child needs to be seen immediately by an ophthalmologist.’

What is a stye?

Styes appear on the eyelid when the root of an eyelash becomes infected. This creates a build-up of pus, leading to a red spot-like lump that becomes inflamed and painful. The eye itself might also become red and watery. Styes are common among children but tend to clear up on their own within a few days. A warm compress held gently against the eye will stimulate blood flow to the infected area and help it to heal more quickly. Otherwise, drops and ointment are available over the pharmacy counter. Never attempt to burst a stye. If it bursts on its own, carefully clean it and the surrounding area. A trip to the GP is rarely necessary, unless the stye fails to heal or the infection gets worse.


Arnardottir H, Orr SK, Dalli J, Serhan CN. (2016) Human milk proresolving mediators stimulate resolution of acute inflammation. Mucosal Immunology 9: 757-66. See: https://www.nature.com/articles/mi201599 (accessed 26 February 2018).

NHS Choices. (2018) Conjunctivitis. See: https://www.nhs.uk/conditions/conjunctivitis (accessed 13 February 2018).

NICE. (2017) Conjunctivitis – infective. See: https://cks.nice.org.uk/conjunctivitis-infective#!backgroundsub:1 (accessed 13 February 2018).

Vision Matters. (2018) Six ways to keep children’s eyes healthy. See: http://www.visionmatters.org.uk/childrens-eye-health/six-ways-to-keep-childrens-eyes-healthy (accessed 13 February 2018).

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