Purulent or mucoid eye drainage without conjunctival erythema or swelling is usually treated with which of the following?

• A. Bacitracin ointment
• B. Erythromycin ointment, 0.5%
• C. Lacrimal massage and cleansing with water
• D. Oral antibiotics

Answer: (C)

Purulent or mucoid eye drainage in a newborn without conjunctival redness or swelling points to nasolacrimal duct obstruction rather than conjunctivitis. The tear drainage tract is blocked, so discharge accumulates. The best management is conservative: gently massage the lacrimal sac (often called lacrimal sac massage) to help open the blocked duct, and cleanse the eyelids with water to remove crusts and reduce bacterial buildup. This approach directly addresses the drainage problem and avoids unnecessary antibiotics. Topical or oral antibiotics are reserved for signs of conjunctivitis (red, swollen conjunctiva) or infection, which aren’t present here. If symptoms persist or worsen, reassess and consider ophthalmology referral.