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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Inflammation of the conjunctiva is commonly infective or allergic. It is usually unilateral.

  • it is the commonest cause of red eye (1)
  • conjunctivitis in children is predominantly bacterial, with nontypeable H. influenzae being the most common organism (2)

Clinical features depend on the underlying cause

  • however, the eyes often feel gritty or in allergic conjunctivitis, itchy
  • discharge is a constant finding and may be purulent, mucoid or watery; typically, the eyelashes are stuck together on waking
  • may be transient blurring as a consequence of discharge smearing the cornea but this is easily cleared by blinking
  • photophobia and pain indicate corneal involvement - keratoconjunctivitis - which is not infrequent
  • diffuse hyperaemia overlying the sclera and the inner surface of the eyelids.
  • viral infection is associated with follicles; allergies, with chemosis.

Itching suggests an allergic cause (3).

Infective conjunctivitis is treated with topical antibiotics; non-infective with anti-inflammatory agents.

  • a meta-analysis concluded that '..acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics...' (4)
  • in randomized clinical trial and systematic review and meta-analysis (5)
    • topical antibiotics were associated with significantly shorter durations of conjunctival symptoms in children with acute infective conjunctivitis
      • RCT (n=88), moxifloxacin eye drops reduced time to clinical cure vs placebo (3.8 vs 5.7 days; p=0.04) & in meta-analysis (4 studies;n=584), topical antibiotics reduced proportion of children with symptoms of conjunctivitis on days 3 to 6 vs placebo (OR 0.59;95% CI,0.39-0.91)
      • study authors concluded that
        • findings suggest that topical antibiotic therapy should be considered for acute infective conjunctivitis in children because antibiotics were associated with significantly shorter recovery times


  1. Leibowitz HM. The Red Eye Leibowitz HM. NEJM 2000; 343:345.
  2. Patel PB et al. Clinical features of bacterial conjunctivitis in children. Acad Emerg Med. 2007 Jan;14(1):1-5.
  3. Rietveld RP et al. Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms. BMJ 2004 329: 206-210.
  4. Jefferis Jet al. Acute infective conjunctivitis in primary care: who needs antibiotics? An individual patient data meta-analysis. Br J Gen Pract. 2011 Sep;61(590):e542-8. doi: 10.3399/bjgp11X593811.
  5. Honkila M, Koskela U, Kontiokari T, et al. Effect of Topical Antibiotics on Duration of Acute Infective Conjunctivitis in Children: A Randomized Clinical Trial and a Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(10):e2234459. doi:10.1001/jamanetworkopen.2022.34459

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