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Most infections are viral and/or self-limiting and do not require antibiotics.
NHS England (NHSE) has published new prescribing guidance for various common conditions for which over-the-counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is conjunctivitis.
Treatments of conjunctivitis are cheap to buy and are readily available OTC along with advice from pharmacies. Please click here for further information, exceptions, and a patient leaflet.
Bacterial conjunctivitis is usually bilateral, one eye may be affected before the other (by one or two days), and is characterised by red eye with mucopurulent, not watery, discharge. The condition is self-limiting and will normally settle in 5-10 days. Therefore, avoidance of drug treatment is an option if a patient wishes, for example during pregnancy.
Patients should be encouraged to use self-care including the following measures: cleansing the eye lids with a cotton wool ball moistened with boiled and cooled water, paying attention to hand hygiene, and avoiding sharing towels. Patients should be aware of the red flag symptoms and be advised to seek medical advice if they emerge.
Red flag symptoms: eye pain or photophobia, marked redness in one eye, reduced visual acuity or purulent conjunctivitis in a new-born infant (see below)
Conjunctivitis in neonates: Neonates with severe conjunctivitis should be referred urgently to secondary care
Public Health England advises that exclusion of single cases from school/nursery is not generally necessary but may be required if an outbreak occurs. Some institutions may apply their own exclusion policies.
If treatment with chloramphenicol fails take swabs and consider viral cause or incorrect administration. Fusidic acid eye drops have a narrow spectrum of activity and should not be used for reasons of convenience. Fusidic acid eye drops should only be used if indicated by antimicrobial sensitivity or on specialist recommendation for an individual patient.
Last updated: 24-09-2021