• Scenario: Acute infective conjunctivitis: covers advice on the management of infectious conjunctivitis of less than 2 weeks' duration
• Scenario: Persistent infective conjunctivitis: covers advice on the management of infectious conjunctivitis of more than 2 weeks' duration
• Scenario: Neonatal conjunctivitis: covers advice on the management of an infant with conjunctivitis in the first 28 days of life

• 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.

• 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.

• 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

• 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

• 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

• For the purposes of this CKS topic, persistent infective conjunctivitis is defined as infective conjunctivitis lasting 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, if worn, 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 to avoid sharing pillows and towels to avoid spreading infection.

In depth

• Reassess the diagnosis — see Diagnosing infective conjunctivitis.
• Assess features suggestive of blepharitis. If present, see the CKS topic on Blepharitis. Features include:
• Swollen eyelids: the defining sign of staphylococcal blepharitis, but unusual when it is less severe.
• Inflamed lid margins: usually present.
• Altered eyelash appearance: including misdirection, crusting, and eyelash loss.
• Altered eyelid surfaces: may be scaly, oily, or greasy. Ulceration of the anterior lid indicates infection.
• Take swabs for bacteria and chlamydia.
• Consider prescribing a topical ocular antibiotic while awaiting results of swabs.

In depth

For people with:

• Blepharitis associated with chronic conjunctivitis — see the CKS topic on Blepharitis.
• A positive bacterial culture — prescribe a topical ocular antibiotic directed by sensitivity results if they are still symptomatic.
• A positive chlamydial culture — refer for testing of sexual contacts and systemic treatment.
• A negative bacterial and chlamydial culture — consider repeating the test if symptoms persist for longer than 3 weeks.

In depth

• Neonatal conjunctivitis is defined as conjunctivitis in a newborn infant within the first 28 days of life.

• Urgently refer all infants in the first 28 days of life with conjunctivitis for same-day assessment and management of their conjunctivitis.
• It is important to distinguish neonatal conjunctivitis, when the conjunctiva is inflamed and red, from a simple sticky eye (when there are no signs of conjunctival inflammation). A simple sticky eye does not usually require specialist assessment.

In depth