When should I consider referring a patient with viral conjunctivitis for specialist evaluation?

Consider referring a patient with viral conjunctivitis for specialist evaluation if:

• They are a neonate with red sticky eye (ophthalmia neonatorum), which requires urgent referral to prevent serious complications.
• There is suspicion or confirmation of herpes simplex or herpes zoster ocular infection, as these require urgent specialist assessment and oral antiviral treatment.
• Symptoms persist for more than 7 to 10 days after initiating treatment, especially if recurrent or persistent conjunctivitis is present.
• There is any corneal involvement, such as corneal staining or epithelial defects detected by fluorescein, particularly in contact lens wearers, due to the risk of sight-threatening conditions like bacterial keratitis.
• There is diagnostic uncertainty or lack of appropriate diagnostic equipment in primary care.

In these cases, referral to ophthalmology is recommended to ensure timely specialist management and to prevent sight-threatening complications.

For isolated uncomplicated viral conjunctivitis without these features, referral is generally not required, but follow-up should be arranged to confirm resolution.

Patient education on red flags and symptom monitoring is important to identify when urgent review is needed.

References: ¹, ²