What management strategies are effective for children diagnosed with conjunctivitis, and when should I consider referral?

Effective management strategies for children diagnosed with conjunctivitis primarily involve supportive care and symptom relief, as most cases are self-limiting and viral in origin. Parents and carers should be advised on good hygiene practices to prevent spread, such as frequent handwashing and avoiding sharing towels or pillows. Warm or cool compresses can help alleviate discomfort. In cases suspected to be bacterial, topical antibiotics may be considered, especially if symptoms persist beyond a week or worsen, but routine antibiotic use is generally not recommended due to the typically self-limiting nature of the condition and concerns about resistance.

For allergic conjunctivitis, management includes avoidance of known allergens and the use of lubricating eye drops or antihistamine eye drops to reduce symptoms Berger et al. 2017.

Referral should be considered under certain circumstances: if the child presents with severe pain, photophobia, reduced vision, or if there is suspicion of a more serious ocular condition such as keratitis or uveitis, urgent referral to ophthalmology is warranted. Additionally, if conjunctivitis is recurrent or associated with systemic symptoms, or if there is no improvement with initial management, referral for specialist assessment is appropriate. Children with signs of neurological involvement (e.g., new-onset squint, neurological symptoms) or systemic illness should be referred urgently as per broader paediatric guidelines NICE NG127,NICE NG143.

In summary, management focuses on supportive care and symptom control, with antibiotics reserved for bacterial cases, and referral is indicated for severe, atypical, or complicated presentations to ensure timely specialist intervention and prevent complications.