3.6 Conjunctivitis, Chlamydial, Adult Inclusion Conjunctivitis

eyes.nhs.scot/
Eyecare Guidelines/
Section 3 - Conjunctiva/
3.6 Conjunctivitis, Chlamydial, Adult Inclusion Conjunctivitis

Date of last review:

22/6/2026

Date of next review:

22/6/2028

Date of publication:

17/8/2026

Differential diagnosis ⁽¹⁾

The clinical signs associated with adult chlamydial conjunctivitis may resemble other forms of conjunctivitis. This can result in delayed recognition and diagnosis.

Possible management by Optometrist

Advice ⁽¹⁾ 

Advise the patient not to wear contact lenses until the condition has fully resolved

Treatment  

Even where the diagnosis appears likely, topical or systemic antimicrobial treatment should not be commenced in primary eye care ⁽¹⁾. This is because: 
- Co‑existing sexually transmitted infections may be present 
- Definitive diagnosis and treatment require specialist assessment and investigation

Provide symptomatic relief only, including:  
- Ocular lubricants (drops for use during the day, unmedicated ointment for use at bedtime)⁽¹⁾. Refer to local formularies for suitable options ⁽⁶⁾

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

Typical dosage/duration

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

Not applicable for this condition ⁽⁷⁾

Further management options 

First‑aid measures only ⁽¹⁾ 
Urgent referral to ophthalmology and GP with instruction for onward referral to a Genito‑Urinary Medicine (Sexual Health) Clinic, ^(1,7)

Possible management in secondary care or local/community pathways where available ⁽¹⁾

Laboratory investigations to confirm the diagnosis (typically PCR testing)
Liaison with Sexual Health services to:  
- Exclude other sexually transmitted infections 
- Arrange treatment for the patient and sexual partner(s) 
Systemic antibiotic therapy (e.g. azithromycin or doxycycline), as indicated
Treatment of sexual partners is essential to prevent reinfection

College of Optometrists Clinical Management Guideline⁽¹⁾  

Conjunctivitis, chlamydial - 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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Accordingly, to the maximum extent permitted by law, the Eyecare Guidelines area of the Website is made available by PSD Scotland on the basis that PSD Scotland excludes all representations, warranties, conditions and other terms (including, without limitation, the conditions implied by law of satisfactory quality, fitness for purpose and the use of reasonable care and skill) which, but for this disclaimer, might have effect in relation to the Website. 