Conjunctivitis (viral)

Eye & Ear

Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.

Clinical features

Itchy eyes, redness, watery discharge and possible light sensitivity

Can be unilateral or bilateral

Commonly caused by adenovirus; therefore pharyngitis and fever may be present

Allergic and bacterial conjunctivitis are discussed separately under the headings 'conjunctivitis (allergic)' and 'conjunctivitis (bacterial)'. [Allergic conjunctivitis both eyes usually affected, are red and itchy and gritty. There may be other allergy symptoms and a positive personal or family history of allergic disease. Bacterial conjunctivitis may affect one eye first, then spread to the other and has a mucopurulent/purulent discharge]

Referral criteria

General point: if complications affect vision (potentially resulting in a loss of vision), it is vital that such referrals are urgent/prompt and possibly to hospital rather than the GP

Vision is affected (double or blurred vision, peripheral vision)

Moderate-to-severe eye pain (not grittiness or a burning sensation)

Irregularly shaped pupils, issues with dilation (unreactive/fixed pupils)

Photophobia

Marked redness of the whole eye or redness/signs of damage specifically around pupil (particularly in a contact lens wearer)

Severe swelling of the eye/face

Unsure if straightforward/uncomplicated (for example, if patient has an existing eye condition or recent injury or surgery in the last 6 months)

Irritant conjunctivitis (acid or alkali burns or exposure to irritating substance)

Neonatal conjunctivitis

Primary angle closure glaucoma (eye pain; headache, nausea and vomiting caused by pain, red eye, impaired vision, lights seen with surrounding halos, pupil dilation impaired)

Uveitis (eye pain, impaired/blurred vision, watering, photophobia, floaters, unreactive or irregular-shaped pupil, possible red eye)

Keratitis or corneal ulcer (unilateral, painful, photophobia, contact lens wearer). Be mindful that contact lens wearers are at risk of developing giant papillary conjunctivitis (GPC) which can present with conjunctivitis-type symptoms but requires referral to an optometrist for further investigation

Scleritis (pain, headache, association with other inflammatory diseases, vision reduced)

Herpes simplex infection

Adverse reaction to medicine (or excipient of prescribed eye product)

Time frame to resolution

Should resolve within 1-2 weeks (medical attention should be sought after this time if not)

Management strategy

Non-pharmacological advice

Hygiene measures: bathe the eyelids with tepid water to remove discharge. The Royal Pharmaceutical Society recommend wiping the eye from the bridge of the nose to the outer corner with a fresh piece of cotton wool/gauze

Discuss ways to minimise the spread of infection: wash hands regularly, particularly after touching eyes/discharge, avoid sharing towels and pillows, facecloths, discard contaminated make up etc

According to NHS "patients don't need to stay away from work or school unless they are feeling particularly unwell. If there are a number of conjunctivitis cases at your child's school or nursery, you may be advised to keep them away until their infection has cleared up. Generally, adults who work in close contact with others, or share equipment such as phones and computers, shouldn't return to work until the discharge has cleared up."

Cold compress may be helpful

Contact lenses wearers should be instructed to discontinue use until symptoms have resolved

Pharmacological advice

There are no OTC ocular products licensed to treat viral conjunctivitis; non pharmacological advice is key for all patients