3.5 Conjunctivitis, Bacterial

eyes.nhs.scot/
Eyecare Guidelines/
Section 3 - Conjunctiva/
3.5 Conjunctivitis, Bacterial

Date of last review:

19/12/2025

Date of next review:

19/12/2027

Date of publication:

19/1/2026

This is a GOS Specialist Supplementary condition and should be managed by community optometrists in line with national guidance⁽⁸⁾. This guideline should be read in conjunction with ‘Supporting information’ guidance [link to Supporting Information page]

Differential diagnosis ⁽¹⁾

Viral conjunctivitis (adenovirus)
Herpes simplex or zoster
Chlamydial conjunctivitis
Allergic conjunctivitis

Possible management by optometrist

Advice ⁽¹⁾

Clean lids/lashes using sterile wipes or cooled boiled water to remove discharge or crusting.
Advise on contagious nature: avoid towel sharing, frequent handwashing, etc.
Children: exclusion from school/nursery not required under UK public health guidance.
Condition usually self-limiting (resolves in ~5–7 days).
Contact lens wearers with a diagnosis of bacterial conjunctivitis should be treated (where appropriate ⁽⁷⁾) with a topical antibiotic effective against Gram –ve organisms, such as an aminoglycoside or a fluoroquinolone. Contact lenses should not be worn until the condition has resolved.

Treatment ⁽¹⁾

Topical antibiotics may slightly hasten recovery and reduce infectivity, but benefits are modest; consider risks of allergy and antimicrobial resistance.
- No proven superiority among agents.

Typical adult dosage/duration

(Blue text = IP, black text = non-IP)

NB. The supply of Chloramphenicol 0.5% and 1.0% is available via Pharmacy First for non-IP optometrists, where it is specifically for use in cases of bacterial conjunctivitis (NHS Pharmacy First Scotland)

Chloramphenicol 0.5% eye drops ^(1,5) (POM generic): One drop every 2 waking hours for 48 hours. After this period, treatment should be every 4 hours during waking hours. Eye drops may be supplemented by ointment at night. The course of treatment should be 5 days (even if symptoms improve) ^(2,3,6)
Chloramphenicol 1% eye ointment ^(1,5) (POM generic): Apply at night (if eye drops used during the day), alternatively apply 3–4 times daily if ointment used alone. The course of treatment should be 5 days (even if symptoms improve) ^(2,3,6).

If chloramphenicol contraindicated, then consider:

Fusidic acid 1% eye drops ^(1,5) (POM): One drop twice daily. Treatment should be continued for at least 48 hours after the eye returns to normal ^(2,3).

Alternative treatment options for contact lens wearers:

Gentamicin 0.3% eye drops ^(1,5,7) (POM generic): One drop ⁽⁷⁾at least every 2 waking hours, reduce frequency as infection is controlled and continue for 48 hours after healing. Frequency of eye drops depends on the severity of the infection and the potential for irreversible ocular damage; for less severe infection 3–4 times daily is generally sufficient ^(2,3).
Ofloxacin 3mg/ml eye drops ^(1,5) (POM generic): One drop ⁽⁷⁾in the affected eye(s) every 2-4 waking hours for the first 2 days then four times daily. Treatment should not exceed 10 days ^(2,3).

Regimens should be adjusted according to severity and patient factors (e.g. age, weight, pregnancy, renal function). Prescribing should follow local formulary and local/national guidance where available ⁽⁷⁾.

In cases of known sensitivities, please consult local formularies for alternative options ⁽⁷⁾.

Further management options

Normally no referral ⁽¹⁾. GOS Specialist Supplementary Stage 1 where appropriate* ⁽⁸⁾
If required, GOS Specialist Supplementary Stage 2* treatment should be provided by a local IP optometrist/OMP who is registered and qualified to carry out GOS Specialist Supplementary Stage 2 management; intra-referral (practice to practice) should take place to facilitate this ⁽⁸⁾
Treatment may be provided within available locally enhanced schemes, or by community IP optometrists/OMPs, as appropriate (outwith GOS Specialist Supplementary) ⁽⁷⁾
Refer if condition fails to resolve, or if there is corneal involvement, urgent referral to ophthalmologist ⁽¹⁾
Same day referral to ophthalmologist if suspect gonococcal infection ⁽¹⁾

*Treatment should be provided in line with “Annex C of the Statement” ⁽⁸⁾https://www.eyes.nhs.scot/for-professionals/legislation/

Possible management in secondary care or local/community pathways where available

See Further management options

College of Optometrists Clinical Management Guideline⁽¹⁾

Conjunctivitis (bacterial) - College of Optometrists*

*With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists
Advisory alignment with the BNF BNF (British National Formulary) | NICE
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above
Advisory alignment with expert consensus (CEGG)
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

Disclaimers

CEG disclaimer for guidelines awaiting update:

The Eyecare Guidelines area of the eyes.nhs.scot website (“Website”) is intended as a reference source for education and clinical decision support and is intended for use by ophthalmic healthcare professionals working in Scotland.

As such, the Eyecare Guidelines are not intended for use by the general public and do not replace the advice of a healthcare professional. Members of the public should seek advice directly from their optometrist.

Before reading the Eyecare Guidelines or making any management decisions based upon them, all users should read the ‘supporting information’ page which gives more detail around the content of the Guidelines and useful website links [link to Supporting Information page].

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Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways. 

Updating the Eyecare Guidelines requires a continuous process; the date of the last review for each guideline will be clearly noted on each guideline. Users must consider these dates before using the guidance.

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