What is conjunctivitis?

Conjunctivitis is an eye condition involving inflammation of the conjunctiva. It is usually caused by an infection (bacterial or viral) or allergy.

What are the symptoms?

Conjunctivitis can affect both eyes making them:

• Red

• Itchy

• Feel gritty or burn

• Water

What are the red flag symptoms (needs referral)?

Symptoms which require urgent referral include:

• pain in eyes

• light sensitivity

• changes in vision e.g., wavy lines or flashing

• very red eyes (one eye/both eyes)

• a baby less than 30 days old with red, sticky eyes

Symptoms requiring referral to GP:

• a baby with red, sticky eyes (urgent appointment if the baby is less than 30 days old)

• wear contact lenses and have conjunctivitis symptoms as well as spots on your eyelids – possibly allergic to the lenses

• conjunctivitis and symptoms that have not cleared up within 7 days

What is the OTC treatment for allergic conjunctivitis?

Non-pharmacological advice:

• Avoid causative allergy (if possible)

• Wear (sun)glasses to shield eyes from pollen

• Wash hands regularly with soapy water and avoid touching eyes

• Bathe eyes with a facecloth soaked in cold water or OTC “eye bath”

• Don’t wear eye makeup

• Don’t wear contact lenses

Pharmacological treatment:

• Oral antihistamines - treat all allergy symptoms such as conjunctivitis, runny nose, sneezing

• Antihistamine eye drops - provide a more immediate effect than oral antihistamines locally treating allergy symptoms

• Mast cell stabiliser eye drops e.g., sodium cromoglicate eye drops - these block mast cell degranulation, stabilising the cell and as a result preventing the release of histamine and related mediators. However, these don’t work immediately like antihistamine eye drops and may take a few days to start to work.

What is the OTC treatment for bacterial conjunctivitis?

Non-pharmacological advice:

• wash eyelids with clean water - boil water and allow to cool, then gently wipe eyelashes with a clean cotton wool pad to clean off crusts (use a different piece for each eye)

• cool eyes using a cold facecloth

• don’t use contact lenses until eyes are better

• wash hands regularly with warm soapy water and avoiding rubbing eyes

• wash pillowcases and face clothes in hot water and detergent

• cover mouth and nose when sneezing and put used tissues in the bin

• don’t share towels and pillows

Pharmacological treatment:

Antibiotic eye drops/eye ointment can be purchased OTC in a community pharmacy and used to treat bacterial conjunctivitis.

E.g., optrex infected eyes (chloramphenicol 0.5% w/v eye drops)

How to apply:

NOTE: These should be applied to the eyes only.

1. Check the seal is intact before using the eye drops.

2. Wash & dry hands.

3. Remove plastic cap from the tip of the eye drop bottle.

4. Tilt your head back while seated or lie down on your back.

5. Gently pull the lower eyelid down and look up.

6. Place the tip of the bottle close to the eye. Squeeze the bottle and let one drop fall into the space between the lower eyelid and eye. Take care the tip of the bottle doesn’t touch the eye, surrounding skin or fingers.

7. Close eye for a moment.

8. When both eyes are to be treated, repeat for the other eye.

9. Replace the cap straight away afterwards.

Don’t:

• Breathe on/touch the dropper

• Touch the eyes/eyelids with the dropper

• Share eyedrops with anyone else

Dosage (children over 2 years old, adults & elderly):

Apply eye drops every TWO hours for the first TWO days then every FOUR hours thereafter for FIVE days. Continue using these eye drops until the 5 day course is finished.

Consult a doctor if symptoms don’t improve within 48 hours and seek medical advice if symptoms get worse. Don’t use these eye drops more than 5 days without consulting a doctor. Discard remaining eye drops after 5 day course of treatment.

Storage:

It is important to advise patients buying chloramphenicol eye drops and eye ointment that they should be stored in the fridge.

Symptoms of overusing these eyedrops (local overdose):

• eye irritation

• pain

• swelling

• tears in the eye

• sensitivity to light

Forgotten dose:

If the patient has forgotten to take a dose and it is a considerable time until the next dose, apply the missed dose of eye drops immediately.

If the next dose is soon and you missed the previous dose, take the next scheduled dose. Never double up on a dose to compensate for a missed dose.

Contraindications:

Don’t use this product in the following:

• chloramphenicol allergy

• blood problems (very low numbers of blood cells) during previous chloramphenicol treatment

Don’t use this product and seek GP advice in the following:

• eyesight affected (loss of sight, reduced vision, blurred vision or haloes around lights)

• pain within eye

• eye blow or injury

• inflamed eye and rash on scalp/face

• pupil looks unusual or eye looks cloudy

• light sensitivity

• foreign body within eye that hasn’t been removed

• recently had an eye infection

• glaucoma or dry eye syndrome

• contact lenses

• using any other eye drops/eye ointment

• eye surgery/laser treatment within last 6 months

Driving & operating machinery:

After application of these eye drops, blurred vision may be experienced. Don't drive or operate machinery until this has resolved.

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