The recommended treatment for conjunctivitis will depend on whether it's caused by infection, an allergic reaction or an irritant, such as a stray eyelash.
Most cases of infective conjunctivitis don't need medical treatment and clear up in 1 to 2 weeks.
There are several ways you can treat infective conjunctivitis at home:
- remove your contact lenses – if you wear contact lenses, take them out until all the symptoms of the infection have gone; don't re-use old lenses after the infection has gone because they could be a potential source of re-infection; always use new lenses, solutions and cases after an infection
- use lubricant eye drops – these are available over the counter at pharmacies or they may be prescribed for you; they may help ease any soreness and stickiness in your eyes; always follow the manufacturer’s instructions
- gently clean away sticky discharge from your eyelids and lashes using cotton wool soaked in water
- wash your hands regularly – this is particularly important after touching your eyes and will stop the infection spreading to others
Antibiotics aren't usually prescribed for infective conjunctivitis because it usually clears up by itself and there's a very low risk of complications for untreated conjunctivitis.
However, if the infection is particularly severe or it has lasted for more than 2 weeks, you may be prescribed antibiotics. Some schools or playgroups may insist that a child is treated with antibiotics before they can return, although this is rare.
Chloramphenicol and fusidic acid are the two main types of antibiotics that may be prescribed.
Chloramphenicol is usually the first choice of antibiotic and comes in the form of eye drops. It's available without a prescription from pharmacies to treat bacterial conjunctivitis.
Chloramphenicol needs to be used carefully to get the best results, so make sure you follow the advice of your pharmacist about how and when to use it, or check the patient information leaflet that comes with the medication so you know how to use it properly.
If eye drops aren't suitable for you, you may be prescribed the antibiotic as an eye ointment instead.
Fusidic acid may be prescribed if chloramphenicol isn't suitable for you. It's often better for children and elderly people because it doesn't need to be used as often. It's also the preferred treatment for pregnant women.
Like chloramphenicol, fusidic acid comes in the form of eye drops and should be used as advised by your doctor or as described in the instructions that come with the medication.
Eye drops can briefly cause blurred vision. Avoid driving or operating machinery straight after using eye drops.
Chloramphenicol and fusidic acid can also cause other side effects, such as a slight stinging or burning sensation in your eye, although this shouldn't last long.
It's very important to go back to your optician if you still have symptoms after 2 weeks. You should also contact your optician immediately if you experience any of the following symptoms:
- eye pain
- sensitivity to light (photophobia)
- loss of vision
- intense redness in one eye or both eyes
Your optician may recommend that you're tested for sexually transmitted infections (STIs). Some STIs, such as chlamydia, can cause infective conjunctivitis. If this is the case, your symptoms may last for several months.
Your treatment will depend on the type of allergic conjunctivitis you have.
The 4 main types of allergic conjunctivitis are:
- seasonal conjunctivitis – typically caused by an allergy to pollen
- perennial conjunctivitis – usually caused by an allergy to dust mites or pets
- contact dermatoconjunctivitis – usually caused by an allergy to eye drops or cosmetics
- giant papillary conjunctivitis – usually caused by an allergy to contact lenses
Whatever the cause, you'll find that some self-help methods can ease your symptoms.
If you have allergic conjunctivitis, you can follow the guidelines below to treat your condition at home:
- if you wear contact lenses, take them out until all the signs and symptoms of the conjunctivitis have gone
- don't rub your eyes, even though they may be itchy – rubbing your eyes can make your symptoms worse
- place a cool compress over your eyes – wetting a flannel with cool water and holding it over your eyes will help ease your symptoms
- avoid exposure to the allergen, if possible
Seasonal and perennial allergic conjunctivitis
If you have seasonal or perennial conjunctivitis, you may be prescribed the following medicines:
If allergic conjunctivitis needs rapid relief, your optician will probably prescribe a medicine known as an antihistamine.
Antihistamines work by blocking the action of the chemical histamine, which the body releases when it thinks it's under attack from an allergen. This prevents the symptoms of the allergic reaction occurring.
Antihistamine eye drops
You may be prescribed antihistamine eye drops, such as:
- azelastine (not suitable for children under four years of age)
- emedastine (not suitable for children under three years of age)
- ketotifen (not suitable for children under three years of age)
- antazoline with xylometazoline (Otrivine-Antistin, not suitable for children under 12 years of age)
Antazoline with xylometazoline (Otrivine-Antistin) is also available over the counter from pharmacies without prescription. Always follow the manufacturer’s instructions.
If you're pregnant or breastfeeding, some antihistamine eye drops may not be suitable. Speak to your optician for advice.
You may be prescribed an antihistamine such as:
You'll usually only have to take an antihistamine once a day.
If possible, oral antihistamines shouldn't be taken if you're pregnant or breastfeeding. Speak to your optician for advice.
Although new antihistamines shouldn't make you drowsy, they may still have a sedating effect. This is more likely if you take high doses or drink alcohol while you're taking antihistamines.
Mast cell stabilisers
Mast cell stabilisers are an alternative type of medicine. Unlike antihistamines, they won't provide rapid symptom relief, but they are better at controlling your symptoms over a longer period of time.
It may take several weeks to feel the effects of a mast cell stabiliser, so you may also be prescribed an antihistamine to take at the same time.
Mast cell stabilisers that are commonly prescribed in the form of eye drops include:
- nedocromil sodium
- sodium cromoglicate
If your symptoms of allergic conjunctivitis are particularly severe, you may be prescribed a short course of topical corticosteroids (a cream, gel or ointment). However, these aren't usually prescribed unless absolutely necessary.
Giant papillary conjunctivitis
As giant papillary conjunctivitis is usually caused by contact lenses, the symptoms often clear up after you stop wearing them. The spots that form on the inside of your upper eyelid may last slightly longer.
If you develop giant papillary conjunctivitis as a result of recent eye surgery, you'll be immediately referred to an ophthalmologist. This is so that your eyes can be carefully monitored and the most effective treatment given.
Most cases of irritant conjunctivitis don't need any treatment, as the condition should clear up once the irritant is removed from the eye.
An exception to this is if your eyes were exposed to harmful substances such as bleach or acid. This is usually regarded as a medical emergency and you'll need to be admitted to hospital so your eyes can be washed out with saline solution.