Self care is the recommended first line treatment for conjunctivitis.  Bathe clean eyelids with cotton wool dipped in sterile saline or boiled and cooled water to remove crusting.

Where antimicrobial is required/prescribed take a bacterial swab for culture and sensitivities. Consider the need for viral swabs and STI testing - see Notes below.

Antimicrobial recommendation

Recommended total duration: up to 7 days or for 48 hours after resolution whichever is shorter.

Chloramphenicol 0.5% eye drops: 1 drop every 2 hours for 2 days then 4 times daily

OR

Chloramphenicol 1% eye ointment applied 3-4 times daily, or once daily at night (with drops during the day).

OR

ONLY if swab identifies that isolate is susceptible AND chloramphenicol is contraindicated:

Fusidic acid 1% modified release eye drops: one drop twice daily

 

Notes

Likely organisms: Viruses, Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae.

Consider:

Chlamydia, Neisseria gonorrhoeae - send eye swab using recommendations from STI testing

Herpes simplex keratitis and ophthalmic zoster send a swab using viral transport medium.

Consult ophthalmologist if infection is severe or fails to respond, or in contact lens wearers.

See also NICE CKS guidance on infective conjunctivitis for further advice.

For confirmed Chlamydia conjunctivitis see here.

If meningococcal disease suspected see here.