Usually yes, sometimes no.

Just minutes after I delivered my first child a nurse squirted antibiotic ointment into his eyes. My husband asked what it was for, and I called from bed, “It’s in case I have an STD.” The nurse laughed at my frank answer, but my husband was quite horrified. So what is that antibiotic eye ointment newborns get and what is it for? Do all new babies really need it? Is it safe to decline this medicine for my newborn?

Ilotycin is an antibiotic ointment is routinely put in the eyes of all newborns to prevent neonatal conjunctivitis (pink eye). While Chlamydia and Gonorrhea are the most serious pathogens that are treated with ilotycin, this treatment also prevents less severe infection with other common bacteria such as e. coli. These common bacteria are found in everyone’s genital/rectal area. The medical term for newborn eye infections is “ophthalmia neonatorum.” These infections are obtained during passage through the vagina. Neonatal conjunctivitis can cause blindness, yet is easily prevented by antibiotic eye medications shortly after birth. Babies born by c-section are still at risk for neonatal conjunctivitis if there was any vaginal rupture of membranes prior to delivery.

The state of Missouri, like many states, actually mandates prophylactic treatment for newborn eye infections, although parents do have the right to decline treatment.

I get a lot of questions about antibiotic eye ointment for newborns. Here are the most common:

“I have zero risk of having an STD. My baby doesn’t need eye antibiotics.”

Answer: The antibiotic ointment also protects against other common bacteria that can be found the vagina and rectal area.

“My baby is being born by c-section, so she doesn’t need eye antibitoics.”

Answer: As long as there was no vaginal rupture prior to c-section, risk of ophthalmia neonatorum is essentially zero. You are fine to decline eye antibiotics.

“If my baby gets an eye infection, we can treat it then.”

Answer: Ophthalmia neonaturm can be rapidly progressive and cause permanent damage to the cornea. Treatment is complicated and usually involves IV antibiotics and hospitalization. Preventative medicine is best. Risks of eye antibiotic are limited to rare eye irritation, which is much less since switching from the older treatment of silver nitrate to the ilotycin antibiotic ointment that we now use. The benefits of preventative treatment outweigh the risks.

“I want to delay eye antiobitics so that my baby can see me.”

It is absolutely fine to delay for a few hours or until mom and baby have bonded and/or breastfed for the first time. In fact, there is some evidence that giving eye antibiotics before a baby has nursed for the first time impedes the baby’s ability to see and latch onto mom’s breast. We’ve changed our procedures at Barnes Jewish Hospital so that baby and mom spend their first few minutes together and eye ointment and other newborn care comes later (as long as baby is healthy).

A growing number of parents decline antibiotic eye ointment for their newborns. You are welcome too, also. Just discuss it with your pediatrician before delivery. Babies used to go blind from eye infections. Now we almost never see it— I’ve seen one case in my career. I’ve never seen any side effect from the antibiotic eye ointment, either.

As for me, I do let all my own babies get antibiotic eye ointment shortly after birth, even though I have no personal concerns for STDs. I do wait until after they have breastfed for the first time. As for my husband, he recovered from his initial shock, and he’s fine with the antibiotic eye ointment, too.