What are the appropriate first-line treatments for common causes of acute red eye, such as conjunctivitis or corneal abrasion?

First-line treatments for common causes of acute red eye include:

• Infective conjunctivitis: For acute viral conjunctivitis, no antibiotics are recommended; instead, advise self-care measures such as eyelid hygiene with sterile saline or cooled boiled water, cool compresses, and use of artificial tears or lubricating ointments to relieve symptoms. Emphasize hand hygiene and avoiding spread of infection. Referral to ophthalmology is advised if symptoms persist beyond 7–10 days or if complications arise ³.
• For acute bacterial conjunctivitis, most cases are self-limiting and resolve within 5–7 days without treatment. Topical antibiotics (e.g., chloramphenicol 0.5% drops or 1% ointment, fusidic acid 1% drops) are reserved for severe cases or when rapid resolution is required. A delayed antibiotic prescribing strategy (starting antibiotics if no improvement after 3 days) is recommended to reduce unnecessary antibiotic use ³.
• Corneal abrasion (superficial corneal injury): Routine use of cycloplegics is not recommended as they do not improve healing or pain management. Consider topical broad-spectrum antibiotics such as chloramphenicol to prevent bacterial superinfection, continuing treatment until 24 hours after symptom resolution. Eye patching is not routinely recommended as evidence does not support improved healing or pain reduction; patients may find relief by keeping the eye closed and avoiding bright light. Arrange follow-up within 24 hours and advise patients on red flag symptoms requiring urgent review ².