How to treat conjunctivitis?

Treating different types of conjunctivitis:

Treating conjunctivitis 

The recommended treatment for conjunctivitis will depend on whether it is caused by infection, an allergic reaction or an irritant such as a stray eyelash.

Each treatment option is discussed in more detail below.

Infective conjunctivitis

Most cases of infective conjunctivitis do not require medical treatment and will clear up in one to two weeks.

Self-care

There are several ways that you can treat infective conjunctivitis at home. The following advice should help ease your symptoms:

• Remove your contact lenses. If you wear contact lenses, take them out until all the signs and symptoms of the infection have gone. Avoid using contact lenses until 24 hours after you have finished a course of treatment. Do not re-use the lenses after the infection has passed as the old lens could be a potential source of re-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 you have touched your infected eyes and will stop the infection spreading to other people.

Antibiotics

Antibiotics are not usually prescribed for infective conjunctivitis as it usually clears up by itself and there is a very low risk of complications for untreated conjunctivitis.

However, if the infection is particularly severe or it has lasted for more than two 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 rarely necessary.

The two main types of antibiotics that may be prescribed are:

• chloramphenicol
• fusidic acid

Chloramphenicol

Chloramphenicol is usually the first choice and comes in the form of eye drops.

Make sure you follow your doctor's advice about how and when to use the eye drops, or check the instructions that come with the medication so you know how to use them properly.

If eye drops are not suitable for you, you may be prescribed the antibiotic as an eye ointment instead.

Fusidic acid

Fusidic acid may be prescribed if chloramphenicol is not suitable for you. It's often better for children and elderly people as it doesn't need to be used as often. It is 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.

Side effects

Eye drops can briefly cause blurred vision. Avoid driving or operating machinery straight after using eye drops.

Chloramphenicol and fusidic acid can also cause some other side effects, such as a slight stinging or burning sensation in your eye. This feeling should not last long.

Further treatment

If you still have symptoms after two weeks, it is very important to go back to your GP. Also contact your GP immediately if you experience any of the following symptoms:

• eye pain
• sensitivity to light (photophobia)
• loss of vision
• intense redness in one or both of your eyes

Your GP may suggest that you are tested for sexually transmitted infections (STIs). Some STIs, such as chlamydia, can cause infective conjunctivitis. In this case, your symptoms may last for several months.

Allergic conjunctivitis

Your treatment will depend on which type of allergic conjunctivitis you have.

The four 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 will find that some self-help methods can ease your symptoms.

Self-help

If you have allergic conjunctivitis, you can follow the guidelines below to treat your condition at home:

• Remove your contact lenses. If you wear contact lenses, take them out until all the signs and symptoms of the conjunctivitis have gone.
• Do not rub your eyes, even though your eyes may be itchy. Rubbing them 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:

• antihistamines
• mast cell stabilisers
• corticosteroids

These are described in more detail below.

Antihistamines

If your allergic conjunctivitis requires rapid relief, your GP 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 is under attack from an allergen. This prevents the symptoms of the allergic reaction from 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 are pregnant or breastfeeding, some antihistamine eye drops may not be suitable. Speak to your GP for advice.  

Oral antihistamines

You may be prescribed an antihistamine such as:

• cetirizine
• fexofenadine
• loratadine

You will usually only have to take an antihistamine once a day.

If possible, oral antihistamines should not be taken if you are pregnant or breastfeeding. Speak to your GP for advice.

Although new antihistamines should not make you drowsy, they may still have a sedating effect. This is more likely if you take high doses or drink alcohol while you are taking antihistamines.

Mast cell stabilisers

Mast cell stabilisers are an alternative type of medicine. Unlike antihistamines, they will not provide rapid relief from your symptoms, but they are more effective at controlling your symptoms over a longer period of time.

It may take several weeks to feel the effects 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:

• lodoxamide
• nedocromil sodium
• sodium cromoglicate

Corticosteroids

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 are not usually prescribed unless absolutely necessary.

Read more about corticosteroids.

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 will be immediately referred to an ophthalmologist. This is to ensure that your eyes can be carefully monitored and the most effective treatment given.

Irritant conjunctivitis

Most cases of irritant conjunctivitis do not require 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 medical emergency and you will need to be admitted to hospital so your eyes can be washed out with saline solution.