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Infectious conjunctivitis in adults and children

AAO-aligned differentiation of viral, bacterial and high-risk conjunctivitis, antibiotic stewardship and urgent corneal referral.

JurisdictionUnited States
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceUnited States healthcare professionals
This is an iatroX educational summary of named United States sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use the named authority, current FDA labeling, applicable state law, payer rules and local protocol where relevant.

Scope of this summary

Adults and children with conjunctival redness or discharge suspected to be infectious. The AAO Preferred Practice Pattern covers a broader red-eye differential; this page focuses on infection and deliberately does not duplicate the general red-eye triage topic. Neonates, contact-lens keratitis, ocular trauma, chemical exposure and postoperative eyes need dedicated urgent assessment.
sources for this section:AAO conjunctivitis 2024

The Bottom Line

  • Differentiate viral, bacterial, allergic, toxic, dry-eye and eyelid causes from corneal or intraocular disease; discharge color alone does not reliably identify a bacterial pathogen.
  • Most uncomplicated viral conjunctivitis is self-limited and should not receive an antibiotic; many mild bacterial cases also resolve without routine broad-spectrum topical treatment.
  • Use hand hygiene, avoidance of shared towels and careful cleaning of reusable items to reduce spread, while giving realistic advice about school or work based on symptoms and local policy.
  • Treat suspected gonococcal, chlamydial or neonatal infection as a separate systemic-care question: this AAO-only summary does not establish a regimen, so retrieve the exact current CDC organism-specific and age-specific authority rather than extrapolating from an unrelated STI chapter.
sources for this section:AAO conjunctivitis 2024

Practical clinical workflow

1
Ask about onset, unilateral-to-bilateral spread, pain, photophobia, vision, discharge, itch, upper-respiratory illness, sexual exposure, contact lenses, trauma, drops, surgery and immune status.
2
Measure visual acuity when possible and examine pupils, corneal clarity, fluorescein staining, anterior chamber, lids and preauricular nodes; compare both eyes and remove contact lenses.
3
Use supportive care for likely viral disease, choose a narrow source-supported topical option only when bacterial treatment is justified, and stop unnecessary irritant or shared eye products.
4
Reassess persistent, recurrent or atypical disease for keratitis, uveitis, nasolacrimal obstruction, dry eye, blepharitis, molluscum, toxic exposure, chlamydia or an ocular-surface disorder.
sources for this section:AAO conjunctivitis 2024

Safety boundaries and escalation

  • Moderate or severe pain, photophobia, reduced vision, corneal opacity or staining, irregular pupil, proptosis, restricted eye movement or elevated-pressure symptoms requires urgent ophthalmic evaluation.
  • A contact-lens wearer with a painful red eye should be managed as possible microbial keratitis, with lenses and case retained for specialist-directed culture when appropriate.
  • Hyperpurulent discharge with rapid progression suggests gonococcal infection and requires immediate systemic treatment and ophthalmic assessment because corneal perforation can occur.
  • Conjunctivitis in a neonate is an urgent age-specific infection, obstetric and safeguarding problem; do not use routine adult or older-child topical advice.
sources for this section:AAO conjunctivitis 2024

Localization

Use the AAO 2024 Preferred Practice Pattern and local ophthalmology access. If gonococcal or chlamydial infection is suspected, retrieve the exact current CDC organism-specific STI page before selecting a systemic regimen. Apply current state and district school-exclusion policy without allowing it to drive unnecessary antibiotics.
sources for this section:AAO conjunctivitis 2024

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease PanelConjunctivitis Preferred Practice PatternDOI 10.1016/j.ophtha.2023.12.037 路 published 2024-02-12 路 accessed 2026-08-20
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