Eye infections


Most infections are viral and/or self-limiting and do not require antibiotics.

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over-the-counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is conjunctivitis.

Treatments of conjunctivitis are cheap to buy and are readily available OTC along with advice from pharmacies. Please click here for further information, exceptions, and a patient leaflet.

Bacterial conjunctivitis is self-limiting and will normally settle in 5-10 days, it is characterised by red eye with mucopurulent, not watery, discharge. Therefore, avoidance of drug treatment is an option if a patient wishes, for example during pregnancy

Public Health England advises that exclusion of single cases from school / nursery is not generally necessary, but may be required if an outbreak occurs.

Chlamydia conjunctivitis in neonates: oral erythromycin 12.5mg/kg every 6 hours. Additional drops are unnecessary.

MHRA Drug Safety Update (December 2020): Erythromycin: update on known risk of infantile hypertrophic pyloric stenosis

Neonates with severe conjunctivitis should be referred urgently to secondary care.

If treatment with chloramphenicol fails take swabs and consider viral cause or incorrect administration. Fusidic acid has a narrow spectrum of activity and should not be used in cases of chloramphenicol failure or for reasons of convenience. Fusidic acid drops may be used in patients with chloramphenicol intolerance.

Chloramphenicol 0.5% eye drops
  • Apply every 2 hours during day for first 48 hours, then four times a day until 48 hours after resolution
  • There are no links established between chloramphenicol eye drops and aplastic anaemia
Chloramphenicol 1% ointment
  • Apply 3-4 times daily until 48 hours after resolution

Corneal abrasion

  • Ointment 1%
  • Treat in primary care if no stromal whitening/abscess


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