• Watery discharge (and less than bacterial conjunctivitis)
• Erythema of the conjunctiva, follicles on eyelid eversion
• Lid oedema
• Subconjunctival haemorrhage

• Purulent / mucopurulent discharge
• Cursting of the eyelids 
• Eyelids stuck together on waking

Avoid antibiotic prescription

Advise self-care measures

• Cold compress around the eye area
• Bathing / cleaning the eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge
• Use of lubricating agents or artificial tears

Advise on the prevention of spread:

• Washing hands frequently with soap and water
• USe separate towels and flannels
• Avoid close contact with others 

But there is NO NEED for exclusion from school / nursery / childminders unless an outbreak or cluster of cases occurs.

Advise the person that most cases of bacterial conjunctivitis are self-limiting and resolve within 5–7 days without treatment

If severe / require rapid solution / symptoms not resolved within 3 days: offer topical antibiotics

• Chloramphenicol, or
• Fusidic acid (safe in pregnancy)

There is NO NEED for exclusion from school / nursery / childminders unless an outbreak or cluster of cases occurs.

If no corneal staining with topical fluorescein and no red flags:

• Stop contact lens use immediately and avoid until all symptoms have resolved
• Bathing / cleaning the eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge

 

• Consider topical antibiotic effective against gram –ve organisms
  • Aminoglycoside (e.g. gentamycin)
  • Fluoroquinolone (e.g. levofloxacin, moxifloxacin)