Synopsis
Distinguish common conjunctival inflammation from corneal and intraocular disease, select proportionate treatment, and recognise neonatal or sexually transmitted infection requiring urgent specialist care.
- Viral, bacterial and allergic conjunctivitis overlap clinically; discharge colour alone does not reliably determine the cause.
- Itching that dominates bilateral watery symptoms supports allergy, particularly with rhinitis and a seasonal or exposure-related pattern.
- Uncomplicated conjunctivitis causes irritation or grittiness with a clear cornea and preserved visual acuity after discharge is removed.
Key red flags
Pain, significant light sensitivity or vision that remains blurred after blinking and clearing discharge suggests disease beyond uncomplicated conjunctivitis.
Investigation priorities
Identify loss of function inconsistent with simple surface inflammation.
Management branches
Examination supports uncomplicated conjunctivitis with preserved vision and no corneal or contact-lens concern.
- Explain that many bacterial and viral episodes settle spontaneously and agree a practical symptom-relief plan.
- Consider immediate or delayed topical antibiotic treatment when bacterial infection is sufficiently likely and clinical circumstances justify it.
Key medicines
Chloramphenicol 1% eye ointmentFor selected uncomplicated bacterial infection, apply a 1 cm ribbon inside the affected lower eyelid three to four times daily, leaving roughly four to six hours between applications, for five days.
Carmellose sodium eye dropsUse one to two drops in the affected eye or eyes as needed for irritation, selecting a suitable formulation and following its opening-expiry instructions.