Sticky, gunky eyes are a familiar parenting experience. Conjunctivitis – sometimes called pink eye – is among the most common reasons for GP consultations in the first year of life and throughout early childhood. Most cases are mild and self-limiting, but a few features distinguish the straightforward from the ones that need prompt attention.
This guide covers the different types of conjunctivitis in children, how to manage them at home, and the warning signs that require clinical assessment.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers common childhood illnesses and when to seek help.
What Conjunctivitis Is
The conjunctiva is the clear membrane lining the inside of the eyelids and covering the white of the eye. When it becomes inflamed – from infection, allergy, or irritation – the eye appears red or pink, and discharge may form. The discharge ranges from watery (more typical of viral cause) to thick yellow or green pus (more typical of bacterial cause). Gluing of the eyelids together after sleep is very common.
Types and Causes
Viral conjunctivitis is the most common form in children. It is often associated with a cold or upper respiratory infection, caused by adenovirus most often. Both eyes are usually affected (though sometimes one eye starts before the other). The discharge is watery or mucoid rather than thick. Viral conjunctivitis is highly contagious and spreads readily through direct contact and contaminated hands. It resolves without antibiotic treatment.
Bacterial conjunctivitis typically causes more profuse, thicker yellow or green discharge. The commonest organisms are Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus. The distinction between viral and bacterial conjunctivitis based on discharge character alone is unreliable; a 2004 systematic review by Rietveld and colleagues in the BMJ found that clinical features could not reliably differentiate viral from bacterial cause. However, bacterial conjunctivitis does respond to topical antibiotics, and evidence suggests that antibiotics modestly shorten the duration and improve early resolution. NHS and NICE guidance supports a "delayed antibiotic" strategy for uncomplicated conjunctivitis: manage with hygiene measures initially, prescribe antibiotics if not improving within a few days or if symptoms are severe.
Allergic conjunctivitis is associated with hay fever or other allergies. Both eyes are affected, discharge is watery, and itching is the predominant symptom rather than pain. It is often seasonal and associated with a runny nose and sneezing. Antihistamine eye drops or oral antihistamines provide the most relevant relief.
Neonatal conjunctivitis (ophthalmia neonatorum). Conjunctivitis in a baby aged under 28 days is classified differently and managed more urgently. The most significant causes are Neisseria gonorrhoeae and Chlamydia trachomatis, both transmitted from the birth canal during delivery. Gonococcal conjunctivitis presents within the first 2-5 days with severe, rapidly progressive purulent discharge and carries a risk of corneal perforation if untreated. Chlamydial conjunctivitis presents at 5-14 days. Both require systemic antibiotic treatment, not just eye drops. Any conjunctivitis in the neonatal period warrants prompt clinical assessment for this reason.
Home Management
For conjunctivitis in children beyond the newborn period without red flag features:
Cleaning the discharge. Gently wipe discharge from the inner corner outward using cooled boiled water and a clean cotton pad or gauze. Use a separate piece for each eye; wash hands before and after. This is the most important step and is sufficient for many mild cases.
Hygiene. Avoid sharing towels or face cloths. Encourage hand washing. Children with conjunctivitis can return to nursery or school as NHS guidance no longer recommends exclusion for conjunctivitis alone, though many settings have their own policies.
Contact lenses. Children who wear contact lenses should switch to glasses until the conjunctivitis has resolved.
Red Flags and When to See a Doctor
Most conjunctivitis in children does not require urgent assessment. However, immediate assessment is needed for: significant eye pain (not just mild discomfort); reduced vision or blurred vision; photophobia (discomfort in bright light); redness of the white of the eye that is severe or does not appear to be in the conjunctiva; cloudiness of the cornea; or any conjunctivitis in a baby under 28 days. These features can indicate a more serious condition such as keratitis (corneal infection), uveitis, or – in the case of neonatal conjunctivitis – systemic infection.
Key Takeaways
Conjunctivitis (inflammation of the clear membrane covering the eye) is very common in children and has several causes: viral, bacterial, allergic, and in newborns, chemical or infective. Most cases of viral and bacterial conjunctivitis in children older than a few weeks resolve without antibiotic treatment. Cleaning sticky discharge with cooled boiled water and a clean cotton pad is effective first-line management. Antibiotic eye drops are prescribed when there is significant discharge and the child is not improving, or in neonates where conjunctivitis carries a greater risk. Urgent assessment is needed if there is associated eye pain, reduced vision, photophobia, or redness of the white of the eye that does not move with the eyelid.
