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Conjunctivitis: management in children

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This guideline provides a protocol for the management of bacterial conjunctivitis, viral conjunctivitis and ophthalmia neonatorum.


This guidance applies to medical and nursing healthcare professionals.


All clinical staff caring for children, infants and neonates.

Conjunctivitis is a common infection of childhood. Patients will have peripheral injection of their conjunctiva causing a red eye. It can be difficult clinically to differentiate between bacterial and viral aetiology. Conjunctivitis is generally a self limiting condition, however a Cochrane review of adult conjunctivitis demonstrated there is an improvement in symptoms with topical antibiotic therapy in those with suspected bacterial conjunctivitis. All children should have a thorough eye examination. Remember to be vigilant and consider other differential diagnoses of a red eye.


Bacterial Conjunctivitis

There are proven positive predictors:

  • Sticky eyelashes in the morning
  • Purulent discharge on examination
  • Crusting of the eyelashes
Viral conjunctivitis

There are no evidence based predictors but there is often a bilateral watery discharge.

Opthalmia Neonatorum

This is conjunctivitis in infants <1month. The most serious cause is gonococcus and should be suspected if there is a large volume purulent discharge before day 7.


Other Points

There is no evidence to suggest a separate bottle of chloramphenicol is required for each eye.

No exclusion is required from school or nursery (HPA advice April 2010)

Editorial Information

Last reviewed: 01 March 2014

Next review: 31 October 2020

Author(s): Monica Wallace, Fiona Russell

Approved By: Clinical Effectiveness