Signs and Symptoms

• Redness of the conjunctiva, including the tarsal conjunctiva (unlike uveitis, episcleritis/scleritis which predominantly affects the globe)
• Purulent discharge suggests bacterial origin
• Small white corneal changes may occur in viral or chlamydia infection
• Chemosis is suggestive of allergic conjunctivitis
• Patients often report a gritty or foreign body sensation
• Bacterial conjunctivitis usually has a mucopurulent discharge or lashes may be stuck together
• Viral conjunctivitis- patients often report watering, often sequential and bilateral, associated with an upper respiratory tract infection and pre-auricular lymph nodes
• Allergic conjunctivitis is usually seasonal, bilateral and itchiness is characteristic

History and Examination

• Visual acuity is not usually significantly affected
• Examine conjunctiva- globe and tarsus for injection
• Cornea may show fine white spots in viral conjunctivitis but significant corneal staining or clouding may suggest corneal ulcer
• Red Flag- any contact lens wearer with corneal staining suggests corneal ulcer

Significant reduction in vision, pain, lid swelling and membrane formation.

Most infections are viral and/or self-limiting and do not require antibiotics.

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.

Treatments of conjunctivitis are cheap to buy and are readily available over the counter along with advice from pharmacies.

Associated dry eye can be treated with lubricants (Tear deficiency, ocular lubricants, and astringents)

If bacterial conjunctivitis is not controlled by eye cleansing alone, consider anti-infective eye preparations, see Eye infections (conjunctivitis)

Consider oral antihistamines and other anti-inflammatory eye preparations for allergic conjunctivitis, see Antihistamines and Other anti-inflammatory preparations.

Refer if there are no improvement following treatment after 2 weeks - Routine OPD

Refer Urgently if the patient is experiencing any significant reduction in vision, pain, lid swelling and membrane formation.

Referral Instructions

e-Referral Service Selection:

Specialty: Ophthalmology

Clinic Type: Not Otherwise Specified

Service: DRSS-Western-Ophthalmology--Optom Only-(PCT)-Devon ICB-15N

Referral Form

DRSS referral form

Pathway Group

This guideline has been signed off by NHS Devon

Publication date: May 2022