Infective conjunctivitis is an infection of the thin skin, called the conjunctiva, on the front of the eye. It is very common. One or both eyes become red or pink, they may be sticky or watery and they may have surface irritation. Most cases clear in a few days without any treatment. Antibiotic drops or ointments may be advised if the infection is severe or does not settle. Marked eye pain, light hurting your eyes and reduced vision are not typical in infective conjunctivitis. Tell your doctor if these or other worrying symptoms develop. Conjunctivitis in a newborn baby is different to the common 'sticky eye' of newborn babies, and needs urgent attention from a doctor.
What is conjunctivitis?
Conjunctivitis means inflammation of the conjunctiva. The conjunctiva is the thin covering (like a very thin skin) that covers the white part of the eyes and the inside of the eyelids.
What causes conjunctivitis?
Infection is the most common cause.
Allergy is another common cause. Many people with hay fever (pollen allergy) have a red and inflamed conjunctiva - the thin, clear covering over the white part of the eyes and inside of the eyelids. See the separate leaflet called Allergic Conjunctivitis for more details.
Irritant conjunctivitis sometimes occurs. For example, your conjunctiva may become inflamed after getting some shampoo in your eyes. Chlorine in swimming pools is a common cause of mild irritant conjunctivitis.
The rest of this leaflet is about conjunctivitis caused by infection.
Types of infective conjunctivitis
Common infective conjunctivitis
Most cases of infective conjunctivitis are caused by common germs (bacteria and viruses). These are often the same ones that cause coughs and colds. Conjunctivitis commonly develops when you have a cold or cough. although sometimes it occurs alone. In the vast majority of cases, infective conjunctivitis is not serious. It clears within a week or so without leaving any permanent damage to the eye.
More serious types of infective conjunctivitis
Rarely, infective conjunctivitis is more serious. For example:
- Conjunctivitis may develop in addition to infection of the cornea (keratitis). The cornea is the transparent front part of the eye. This is most commonly due to an infection with the cold sore virus (the herpes virus). If you have keratitis you are likely to get eye pain rather than just surface irritation. Blurring of vision is also common.
- A virus called adenovirus can cause a very red and prolonged conjunctivitis.
- Conjunctivitis in newborn babies can be caused by germs called chlamydia or gonorrhoea. These are sexually transmitted infections in adults; however, babies can acquire them from the birth canal. They need urgent treatment if they affect the eyes of babies. (If a mother has one of these infections in her vagina, it can be passed on to the eye of her baby during childbirth.) Note: this is different to the very common sticky eye of newborn babies, caused by a blocked tear duct. A blocked tear duct with sticky eye does not cause redness and inflammation of the conjunctiva. See separate leaflet called Tear Duct Blockage in Babies for more details.
- Some adults develop conjunctivitis due to chlamydia.
- Conjunctivitis can sometimes be just one part of a more serious infection of deeper structures of the eye. This may be indicated by eye pain, reduced vision, or swelling around the eye.
What are the symptoms of common infective conjunctivitis?
- Infective conjunctivitis usually spreads to both eyes. The whites of the eyes look inflamed and may be red or pink.
- The eyes may feel gritty and may water more than usual.
- Some mild soreness may develop; however, the condition is not usually very painful.
- The eyelids may become swollen. They are often stuck together with gluey material (discharge) after a sleep.
- Vision is not normally affected. You may develop some blurring of vision, due to discharge at the front of the eye. However, this clears with blinking.
What is the treatment for common infective conjunctivitis?
- Not treating - this is a common option for mild or moderate infections. Your tears contain chemicals that fight off germs (bacteria). Without treatment, most cases of infective conjunctivitis clear on their own within 1-2 weeks. Often they clear within 2-5 days. If symptoms become worse then see a doctor to check your eye and to see if you need treatment.
- Bathing the eyes - using cool clean water, this may be soothing.
- Lubricant eye drops - these may reduce eye discomfort. They are available over the counter, as well as on prescription.
These may be prescribed and might be:
- Eye drops such as chloramphenicol.
- Eye ointment such as chloramphenicol or fusidic acid (actually an oily drop, halfway between an ointment and a drop).
Note: treatment using antibiotic preparations tends to be for more severe cases, as they make very little difference in mild cases, which get better anyway. It is also used for those cases not clearing on their own. (Tell your doctor if you are pregnant, as some eye drops may not be suitable.)
Other general advice
- Do not wear contact lenses until symptoms have completely gone, and for 24 hours after the last dose of any eye drops or ointment.
- You can clean secretions from eyelids and lashes with cotton wool soaked in water.
- Infective conjunctivitis is contagious, which means it can be passed on by touching. The likelihood of passing on the infection is not high unless you are in close contact with others. Washing your hands regularly, particularly after touching your eyes, and not sharing towels or pillows, will help avoid it.
What should I look out for?
See a doctor if symptoms change, or do not settle within a few days, or if you are concerned that you have anything other than a common conjunctivitis. In particular, see a doctor urgently if:
- You develop marked eye pain.
- Light starts to hurt your eyes (photophobia).
- Spots or blisters develop on the skin next to the eye.
- Your vision becomes affected.
- Your newborn or very young baby develops conjunctivitis.
Most conjunctival infections are not serious, do not harm the eye, and clear in a few days. However, some infections such as herpes or chlamydia persist for longer than usual, are more serious and need special treatment. Most serious eye infections feel different to simple conjunctivitis because they cause significant pain. Many also affect vision. Some other conditions, including allergic conjunctivitis, can appear similar to infective conjunctivitis initially. This makes it particularly important that you go back to your doctor if things become worse or if they do not settle as expected.
Does a child with conjunctivitis need to stay off school?
Guidance from Public Health England (PHE) states that it is not necessary to exclude a child from school or from childcare if they have infective conjunctivitis, unless there is an outbreak of several cases. This is because it is a mild condition which represents no danger to others, whilst breaks in school attendance affect your child's learning. However, if an outbreak occurs, with many cases, the school or childcare centre should seek advice from the PHE or other health professional.
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Further reading & references
- Guidance on infection control in schools and other childcare settings; Public Health England (September 2014)
- Sheikh A, Hurwitz B, van Schayck CP, et al; Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2012 Sep 12 (9):CD001211. doi: 10.1002/14651858.CD001211.pub3.
- Conjunctivitis - infective; NICE CKS, August 2015 (UK access only)
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.