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Conjunctivitis

Dr Roger Henderson
Reviewed by Dr Roger HendersonReviewed on 13.10.2023 | 4 minutes read
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Conjunctivitis is an infection of the eye by either a virus or bacteria. The conjunctiva is the pink rim that you can see if you pull down your lower lid, and it extends onto the white of your eye. It’s an area that often gets infected in children and is usually linked to a common viral cold. Children may get a bacterial infection on its own, usually starting in one eye then spreading.

Conjunctivitis has a number of possible symptoms, but one eye normally starts to become affected before the other. The eye looks red and swollen and this redness extends onto the eyelids as well as the white of the eye. There is often a discharge (sometimes greenish in colour) around the eyelids and this is worse on waking – the eyes may seem to be ‘stuck down’ with matter. Itching and pain on rubbing the eyes is also common, with sufferers often saying their eyes feel ‘gritty’, and occasionally bright light may make all these symptoms worse.

Allergic conjunctivitis is in response to an allergen – commonly pollen alongside other hay fever symptoms – but also any face creams, hair dyes, nail varnish, pet dander or anything in the environment that your eyes have become sensitive to. The eyes are usually profusely watery, puffy around them and they may feel a bit gritty. You may also get a runny nose or hives on other parts of the body. Treatment may help, such as antihistamine eye drops or tablets, but it’s usually mild and improves on its own within a day or two – quicker if you remove the suspected allergen.

Is it contagious?

Viral conjunctivitis is very easily spread between people, so it’s important to keep good hand hygiene, avoid rubbing your eyes then touching anything or anyone, and keep your distance from people if you are coughing or sneezing. Bacterial conjunctivitis can also spread by direct contact, and from one eye to the other. Allergic conjunctivitis is not contagious.

What is the treatment of conjunctivitis?

The treatment of conjunctivitis has three main goals:

  1. To reduce eye discomfort.
  2. To reduce or lessen the course of the infection or inflammation.
  3. To prevent the spread of the infection in contagious forms of conjunctivitis.

The appropriate treatment for conjunctivitis depends on its cause:

In bacterial conjunctivitis, this is usually treated with antibiotic eye drops or ointments. Improvement can occur after three or four days of treatment, but the entire course of antibiotics needs to be used to prevent recurrence.

With viral conjunctivitis there are no available drops or ointments to treat the virus for this type of conjunctivitis and antibiotics will not cure a viral infection. Like a common cold, the virus just has to run its course, which may take up to two or three weeks in some cases. The symptoms can often be relieved with cool compresses and artificial tear solutions. For the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation, but do not shorten the course of the infection. Fortunately, most cases of viral conjunctivitis clear quite quickly by themselves.

In allergic conjunctivitis, the first step should be to remove or avoid the irritant, if possible. Cool compresses and artificial tears sometimes relieve discomfort in mild cases and in more severe cases, antihistamines may be prescribed. Cases of persistent allergic conjunctivitis may also require topical steroid eye drops.

Healthwords pharmacists' top tips

For most cases, gentle thorough cleansing is enough to clear an eye infection. For children under the age of 2 years or for mild cases in adults, you may want to first try using freshly boiled and cooled water and a clean flannel.

Gently wipe over the eyelids starting from the outer edge of the lashline with eyelid closed and sweep inwards and downwards towards the inner corner near the nose. This can help clear crusting and debris in the eyes and eyelashes safely. Repeat every two to four hours, for up to 48 hours, and a cool flannel may also be useful to soothe itchy or irritated eyes.

Antibiotic eye drops or ointments are available to buy for adults and children over 2 years old to treat bacterial conjunctivitis, but should be reserved for more severe or prolonged cases. Those under 2 years old need a prescription from their doctor.

When should I see my doctor?

Conjunctivitis usually clears up without any medication. See you doctor if symptoms haven’t improved after a couple of weeks. Antibiotics are not usually required for conjunctivitis, but your doctor may consider them under certain circumstances, including if a sexually transmitted infection such as chlamydia could be the cause.

If you suspect an allergy is to blame, keep a symptom diary to identify the trigger and try antihistamine drops from the pharmacy.

If your vision is affected such as if it's consistently reduced in one eye, you feel very sensitive to light, lights look hazy, or you see wavy lines or flashing lights, you should seek urgent attention from your doctor, 111 or an Emergency Department. Similarly, if the pain is deep and intense, especially if you wear contact lenses, this is another reason to seek urgent attention.

If your baby is less than 28 days old and experiencing a red eye or discharge, see your doctor urgently for assessment.

Am I fit for work or school if I have an eye infection?

If you feel well and your work does not require close contact with others, you can go to work with conjunctivitis. Your child can go to school or nursery if they are well. If you have reason to believe something more serious is going on with your eyes, you should seek urgent medical attention.

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Dr Roger Henderson
Reviewed by Dr Roger Henderson
Reviewed on 13.10.2023
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