Conjunctivitis - infective
Questionnaire/history:
Onset?
Unilateral or bilateral?
Conjunctival reddening?
Discomfort (eg 'grittiness', 'foreign body' or 'burning' sensation)?
Itching?
Discharge (eg watery, purulent or mucopurulent, when worst)?
Changes in vision (eg transient blurring caused by discharge)?
Eyelid changes (eg swelling, flaking, vesicles)?
Recent exposure to an infected person?
Red flags which indicate the need for urgent ophthalmological assessment such as:
- Reduced visual acuity?
- Marked eye pain?
- Headache?
- Photophobia?
- Red sticky eye in a neonate (within 30 days of birth)?
- Questionnaire/history of trauma (mechanical, chemical or ultraviolet) or possible foreign body?
- Copious rapidly progressive discharge (may indicate gonococcal infection)?
- Infection with a herpes virus?
- Soft contact lens use with corneal symptoms (such as photophobia and watering)? Associated symptoms?
- Upper respiratory tract infection?
- Enlarged tender lymph nodes?
PMH?
Current medication?
Drug allergies?
Examination:
Conjunctiva?
Sclera?
Cornea?
Pupils?
Eyelids?
Periorbital area?
Regional lymph nodes?
Visual acuity?
Management:
Acute (non-herpetic) viral conjunctivitis
Advised:
- Most cases of acute, infectious conjunctivitis are self-limiting and do not require antimicrobial treatment and that viral (non-herpetic) conjunctivitis usually resolves within 1-2 weeks without treatment
- Symptoms may be eased with self-care measures, such as bathing/cleaning eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge, cool compresses applied gently around the eye area, use of lubricating drops or artificial tears
- Contagious, advised to try to prevent spread of infection to the other eye and other people by washing hands frequently with soap and water, using separate towels and flannels, avoiding close contact with others especially if they are a healthcare professional or child care provider, patient may be infectious for up to 14 days from onset
- Public Health England (PHE) does not recommend an exclusion period from school, nursery or childminders except if an outbreak or cluster of cases - Red flags (as above) for urgent review
- To return/seek further help if symptoms persist beyond 7 days
- To read Patient UK info 'Infective Conjunctivits'
Acute bacterial conjunctivitis
Advised:
- Most cases of bacterial conjunctivitis are self-limiting and resolve within 5-7 days without treatment
- Chloramphenicol 0.5% drops 1 drop 2 hourly for 2 days then 4 times daily for 5 days or chloramphenicol 1% ointment qds for 2 days, then twice daily for 5 days (NICE CKS 2021)
- Alternative: if no contact lens: dexamethasone with tobramycin (Tobradex eye drops) to be considered if appropriate
- Exclusion period from school, nursery or childminers not recommended for isolated cases, but many nursery and primary schools may nevertheless have an exclusion policy
- Red flags (as above) for urgent review
- To return/seek further help if symptoms persist beyond 7 days
- To read Patient UK info 'Infective Conjunctivitis'
Reference(s):
NICE CKS: Conjunctivitis - infective
Information for patient/carer(s):