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Conjunctivitis - infective - Management
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Definition
- Acute infective conjunctivitis is inflammation of the conjunctiva due to infection lasting less than 3 weeks.
- For the purpose of this CKS topic we distinguish the management of people with symptoms lasting less than 2 weeks from people with symptoms that persist longer than 2 weeks.
What self-care advice can I give a person with acute infectious conjunctivitis?
- Infective conjunctivitis is a self-limiting illness that usually settles without treatment within 1–2 weeks. People should reconsult if their symptoms persist for longer than 2 weeks.
- Urgently seek medical attention if marked eye pain or photophobia, loss of visual acuity, or marked redness of the eye develop.
- Remove contact lenses until all symptoms and signs of infection have completely resolved, and any treatment has been completed for 24 hours.
- Lubricant eye drops may reduce eye discomfort; these are available over the counter, as well as on prescription.
- Clean away infected secretions from eyelids and lashes with cotton wool soaked in water.
- Wash hands regularly, particularly after touching infected secretions, and avoid sharing pillows and towels.
Should I prescribe a topical ocular antibiotic to someone with infective conjunctivitis?
- Advise people with clinical features of infective conjunctivitis that:
- Most people with infective conjunctivitis get better, without treatment, within 1–2 weeks.
- For most people, use of a topical ocular antibiotic make little difference to recovery from infective conjunctivitis.
- Up to 10% of people treated with topical ocular antibiotics complain of adverse reactions to treatment.
- The risk of a serious complication from untreated infective conjunctivitis is low.
- Consider offering a topical ocular antibiotic to a person with infective conjunctivitis when:
- Infective conjunctivitis is severe, or likely to become severe, providing serious causes of a red eye can be confidently excluded.
- Schools and childcare organizations require treatment before allowing a child to return.
- They understand the limitations of treatment but still prefer treatment.
- When a topical ocular antibiotic is prescribed because of the person's preference for treatment, consider advising them to delay starting treatment for 7 days to see if the condition will resolve spontaneously.
In depth
If a topical ocular antibiotic is thought necessary which antibiotic should I prescribe for someone with infective conjunctivitis?
- Prescribe chloramphenicol first-line for empirical treatment of infective conjunctivitis.
- Fusidic acid is an alternative. It is preferred for people who:
- Are pregnant.
- Have a personal or family history of blood dyscrasias, such as aplastic anaemia.
- Are intolerant of chloramphenicol.
- Prefer a twice-a-day treatment for infective conjunctivitis.
In depth
What advice should I give about excluding children with infective conjunctivitis from school and childcare centres?
- It is not necessary to exclude a child from school or childcare if they have infective conjunctivitis, unless there is an outbreak of infective conjunctivitis. In the event of an outbreak of infective conjunctivitis, advice should be sought from the Health Protection Agency by the school or childcare centre.
- Provide written information from the Health Protection Agency to support this advice.
In depth
Prescriptions
Chloramphenicol eye drops or ointment
Age from 1 month onwards
Chloramphenicol 0.5% eye drops
Chloramphenicol 0.5% eye drops
Put one drop into the affected eye(s) every 2 hours for 2 days, and then every 4 hours for 5 days. You only need to use the drops while you are awake.
Supply 10 ml.
Chloramphenicol 1% eye ointment
Chloramphenicol 1% eye ointment
Put a small amount into the affected eye(s) four times a day for 2 days, and then twice a day for 5 days.
Supply 4 grams.
Multi-therapy: Chloramphenicol 0.5% eye drops + 1% eye ointment
Chloramphenicol 0.5% eye drops
Chloramphenicol 0.5% eye drops
Put one drop into the affected eye(s) every 2 hours for 2 days, and then every 4 hours for 5 days. You only need to use the drops while you are awake.
Supply 10 ml.
Chloramphenicol 1% eye ointment
Chloramphenicol 1% eye ointment
Put a small amount into the affected eye(s) at bedtime for 7 days.
Supply 4 grams.
Fusidic acid eye drops
Age from 1 month onwards
Fusidic acid 1% eye drops
Fusidic acid 1% modified-release eye drops
Put one drop into the affected eye(s) twice a day for 7 days.
Supply 5 grams.
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