Executive summary
- Most infective conjunctivitis is self-limiting (often viral). Focus on hygiene + symptom relief.
- Consider antibiotics if marked purulent discharge, significant discomfort, or high-risk features (per CKS/local policy).
- Contact lens wearers: treat as higher risk; stop lenses and have a low threshold for urgent ophthalmology if pain/photophobia/reduced vision.
Red flags (urgent ophthalmology/ED)
- Reduced vision, severe pain, marked photophobia.
- Corneal opacity, ciliary flush, or fixed/irregular pupil (consider keratitis/uveitis/acute glaucoma).
- Contact lens wearer with pain or corneal signs (microbial keratitis risk).
Typical topical regimens (check age/pregnancy/local guidance)
- Chloramphenicol 0.5% drops: commonly 1 drop every 2 hours for 48 hours, then reduce to QDS; continue until 48 hours after resolution (typical CKS-style advice).
- Chloramphenicol 1% ointment: typically 3–4 times daily (useful at night or if drops difficult).
- Fusidic acid 1% gel: commonly BD (convenient dosing), used in some pathways.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.