Erythromycin Eye Ointment: What’s the Deal with That Shiny Goop?
One of the most common questions I get from parents-to-be: “Do I have to get that shiny goop in my baby’s eyes after they’re born?”
Erythromycin 101: What to know before it hits baby’s eyes
Let’s do a quick, clear-eyed review so you can feel informed (and stunningly confident!) in whatever decision feels right for your family.
So, after birth, babies are often offered a trio of routine medications:
✔️ Hepatitis B vaccine
✔️ Vitamin K
✔️ And… erythromycin eye ointment
And if you're expecting a baby, chances are you're wondering: Does my baby actually need this? Fair question.
Erythromycin is an antibiotic, and in this case, it comes in the form of a thick, jelly-like ointment that’s placed into and around your baby’s eyes, usually within the first 24 hours of life. It’s meant to prevent newborn pink eye, also known as ophthalmia neonatorum (ON) or neonatal conjunctivitis. In plain terms, it’s an eye infection that causes swelling, redness, and sometimes drainage in those fresh little peepers.
Why Do We Do This?
This is the one you’ve seen in every movie, every medical drama - the one where the doctor is front and center like a catcher at the World Series. And while this position is an option and works great for some people, it’s not always the best one.
Pros? It gives your provider a clear view and easy access, which allows them to assist in the birthing process. But the big con is that lying flat reduces the space in your pelvis and puts pressure on your sacrum (which CAN move freely if given the space to do so!). Not to mention, it can also restrict blood flow to you and your baby.
And let’s be real - birthing on your back is not instinctive. If you watch unmedicated births, home births, or births in other cultures, you’ll notice that most people naturally avoid lying flat. Why? Because the birth canal isn’t a straight drop - it’s shaped like a J, meaning babies have to move down and then up again when you’re on your back. That’s the opposite of what we want.
The most serious cause of ON is gonorrhea, a sexually transmitted infection. While rare today, gonorrhea ON can cause corneal scarring and even blindness. So, erythromycin became a go-to routine intervention to lower that risk.
The most common cause, though? Chlamydia—also sexually transmitted, and another possible cause of ON. Other, less serious bacteria can lead to eye infections, and erythromycin may or may not be effective for those (research is limited).
At this point, you might be thinking:
"But I don’t have any STIs, my partner and I are monogamous… why is this being recommended for my baby?"
Good question—and you’re not alone in asking it.
The reality is that erythromycin is given prophylactically, meaning it’s used to prevent problems before there’s any sign of infection. Because sometimes screening doesn’t catch everything. Sometimes exposure happens late in pregnancy. Sometimes one partner isn’t honest. Sometimes infections are asymptomatic. It’s complex.
But the truth is, not all countries continue this practice. Denmark, Sweden, Norway, Belgium, Australia, and the UK have all moved away from routine administration. Here in Canada, the Canadian Pediatric Society doesn't recommend it universally either, but some provinces still do make it mandatory by law. The same goes for many states in the U.S.
So, what are the actual pros and cons?
Benefits of Erythromycin Eye Ointment:
Helps reduce the risk of blindness from gonorrheal ON
Might reduce complications from chlamydial ON
Offers protection where prenatal care or screening is limited
Inexpensive and widely available
It may help against certain non-STI bacteria
Can act as a safety net if STI testing was negative early on, but exposure happened later
Useful where treatment for ON isn’t readily available
Risks and Considerations:
Contributes to antibiotic resistance
Can cause mild chemical conjunctivitis (yep, it can irritate the eyes it’s supposed to protect)
Might temporarily blur the baby’s vision, possibly affecting early bonding
Only about 80% effective for gonorrheal ON, and resistance is growing
If You're Considering Opting Out:
It starts with screening. Every pregnant person should be screened for chlamydia and gonorrhea early in pregnancy. If there’s a positive result, treatment for both the pregnant person and their partner is essential.
Follow-up testing in the third trimester is also recommended to make sure the treatment worked. If that's not available, screening at labour and birth can be a fallback. And if testing hasn’t been done during pregnancy? Then, rapid testing during labour is key.
In places like the UK where erythromycin isn’t used, there’s a "watchful waiting" approach. That means babies are closely monitored, and if signs of ON appear, they’re treated immediately with appropriate injectable antibiotics, but this only works if you’ve got timely access to healthcare services.
So much happens in those first few hours of life, and every intervention offered should be one you feel good about. That includes erythromycin.
If you’re unsure what’s right for your family, talk with your care provider. Ask about the laws in your area. Ask what alternatives exist. Weigh the benefits and risks. And most of all, ask questions until you feel confident.
