Conjunctivitis Treatment in Children: A Practical Guide

You've worked out it's conjunctivitis. Now what? The treatment differs depending on which type you're dealing with, and a surprising amount of conjunctivitis needs no treatment at all — just patience and a clean cotton pad.

This guide covers what actually works at home, when antibiotic drops add value, and the things to watch for that mean it's time to stop self-managing.

Healthbooq covers everyday childhood illnesses with the practical detail that helps you decide what to do. For broader context, see our complete guide to child health.

First, Identify Which Kind

Treatment depends on the cause. The honest truth is that distinguishing viral from bacterial conjunctivitis on appearance alone is unreliable — a 2004 BMJ systematic review by Rietveld and colleagues confirmed that discharge character is a poor diagnostic tool. But some patterns help:

• Watery discharge, both eyes, runny nose, recent cold → most likely viral.
• Thick yellow-green pus, eyelashes glued shut after sleep → more likely bacterial, though viruses can do this too.
• Itchy more than sore, both eyes equally, seasonal, hay fever symptoms → allergic.
• Newborn under 28 days with significant pus or eyelid swelling → urgent — see GP/A&E today.

In the absence of a clear pattern, "watch and clean" for a few days, then escalate if not improving, is reasonable for older children.

Cleaning the Eye: The Foundation

The single most useful thing you can do at home, for any kind of conjunctivitis, is keep the eye clean.

Method:

1. Wash your hands.
2. Boil fresh water and let it cool to room temperature. (Don't use it warm — too hot risks the cornea.)
3. Take a clean cotton wool ball or pad. Soak it.
4. Wipe gently from the inner corner of the eye outward, in one stroke. Don't go back and forth.
5. Use a fresh piece for each wipe. Don't reuse.
6. Use entirely separate pieces for each eye. Never one for both.
7. Repeat as often as needed — every couple of hours initially, less often as the discharge reduces.
8. Wash your hands again afterwards.

For very young children who fight cleaning, distract with a song, a toy, or do it while they're nursing or feeding. A warm-then-cooled wet flannel against the closed eye for 30 seconds first softens crust and makes wiping easier.

Treating Viral Conjunctivitis

There is no specific treatment. The job is supportive:

• Clean the discharge as above, several times a day.
• Cool damp cloth over closed eyes for 5–10 minutes, twice a day, for soothing.
• Lubricating eye drops (artificial tears, available over the counter — preservative-free single-dose vials are best for children) can ease grit and dryness. Suitable from infancy if needed.
• Pain relief with paracetamol or ibuprofen is rarely needed for the eye itself, but useful for the cold symptoms accompanying it.
• Time. 7–14 days is the typical course. The second eye usually catches up with the first about 24–48 hours later.

What doesn't help:

• Antibiotic drops. No effect on viruses.
• Warm compresses beyond comfort. They don't shorten viral conjunctivitis.

If your child is older and using contact lenses, switch to glasses for the duration of the infection and replace any contaminated lenses afterwards.

Treating Bacterial Conjunctivitis

The decision tree:

Mild cases. Many resolve in 5–7 days with cleaning alone. NICE supports a watch-and-treat approach: try hygiene measures for 2–3 days, treat if not improving.

Moderate to severe cases, or not improving with cleaning. Add chloramphenicol.

Chloramphenicol — the standard NHS treatment:

• Eye drops: 1 drop into the affected eye every 2 hours while awake for the first 48 hours, then 4 times a day. Continue for 48 hours after the eye looks normal. Total course usually 5–7 days.
• Eye ointment: apply 1 cm into the lower lid 4 times a day, or apply just at night alongside daytime drops in older children. Ointment blurs vision briefly but is easier to use in younger children.
• Suitability: chloramphenicol drops and ointment are available over the counter from pharmacies for children aged 2 and over. For children under 2, prescription only — see GP.
• Storage: drops need to be refrigerated; ointment doesn't.
• Allergy is rare. If a rash or worsening swelling develops after starting drops, stop and see the GP.

Pharmacy First (England) allows community pharmacists to assess and supply chloramphenicol for children 2+ with conjunctivitis without a GP appointment. Worth knowing — saves the GP appointment and gets the drops faster.

If chloramphenicol isn't working after 48 hours of correct use, see the GP. Resistant organisms exist; alternatives like fusidic acid eye drops or, more rarely, ciprofloxacin drops may be used.

Treating Allergic Conjunctivitis

The aim is to dampen the immune reaction.

First-line:

• Cool damp cloths on the eyes — soothing.
• Lubricant artificial tears — flush allergens out.
• Avoid the trigger where possible. Keep windows closed during pollen peaks. Wash hair before bed in pollen season. Keep pets out of bedrooms in dust mite or pet allergy.

Eye drops:

• Sodium cromoglicate (Opticrom). Mast cell stabiliser. Over the counter from age 6 in some products. Works as prevention more than rescue — start before pollen season if possible.
• Olopatadine, ketotifen. Antihistamine eye drops; also OTC age limits vary by product.
• Combination antihistamine/mast cell drops are increasingly used and given once or twice daily.

Oral antihistamines:

• Cetirizine, loratadine, fexofenadine. Once daily, age-appropriate doses. If the child has a runny nose and sneezing alongside the eye symptoms, oral antihistamines often manage everything.

More severe cases — refer to GP. Short courses of topical steroid drops are sometimes used under specialist guidance, but not first-line because of the risk of raised intraocular pressure.

Newborns: Different Treatment Pathway

Conjunctivitis in babies under 28 days requires medical assessment, not over-the-counter treatment.

• Sticky eye from blocked tear duct (white-yellow discharge, eye not red, no swelling) is treated with cleaning and gentle massage at home. See the conjunctivitis in babies article for the technique.
• Mild bacterial conjunctivitis in a young baby is treated with prescribed chloramphenicol or fusidic acid drops/ointment by the GP.
• Significant pus or eyelid swelling in the first 2 weeks of life can mean gonococcal conjunctivitis (days 2–5, dramatic and rapid) or chlamydial conjunctivitis (days 5–14, less acute). Both need systemic antibiotic treatment, not just drops, because chlamydia can also cause pneumonia and gonorrhoea can cause widespread infection. These cases are managed by the paediatric or neonatal team in hospital.

Red Flags: When to Stop Self-Managing

See a doctor or 111 promptly for any of:

• Newborn (under 28 days) with any conjunctivitis.
• Significant pain in the eye, not just gritty discomfort.
• Photophobia — child distressed by normal light.
• Reduced or blurred vision that doesn't clear when crust is wiped away.
• Cloudy cornea (the clear front of the eye).
• Eyelid hot, very swollen, or red — could be peri-orbital or orbital cellulitis.
• Eye looks bulging or movement is reduced.
• Recent contact with a herpes cold sore — herpes simplex keratitis can scar the cornea and cause permanent visual loss.
• Contact lens wearer developing a red painful eye — bacterial keratitis around lenses needs urgent ophthalmology assessment.
• Child seems generally unwell — fever, lethargy, off feeds.
• No improvement after 5 days of correctly used antibiotic drops, or rapid worsening.

These can indicate keratitis, iritis, peri-orbital cellulitis, or other conditions that need specific assessment and treatment.

School and Nursery

Current NHS and Public Health Agency advice: conjunctivitis is not a reason to keep a child off school or nursery. The condition is mild and infection control through hand hygiene is more useful than exclusion.

That said, individual settings often have policies — particularly nurseries with under-twos and reception classes — that exclude until the discharge has cleared. Check yours.

While the eye is actively discharging:

• Hand wash for child and family.
• Don't share towels, flannels, pillowcases.
• Wash bedding and used cloths at high temperature.
• Discard mascara and other eye make-up that may be contaminated (older children).

A Note on Things People Try That Don't Help

• Breast milk in the eye. Despite social media enthusiasm, no good evidence. Risk of contamination.
• Chamomile tea, salt water, herbal washes. Variable sterility, can sting, no evidence of benefit over plain cooled boiled water.
• Antibiotic drops "just in case" for viral conjunctivitis. No effect on viruses.
• Steroid drops. Should never be self-purchased or used for general conjunctivitis without specialist supervision — can worsen herpes infection and cause raised pressure.

Most conjunctivitis in children resolves on its own — viral cases in 7–14 days, most bacterial cases within 7–10 days even without treatment. Cleaning the eye with cooled boiled water on a clean cotton pad is the foundation. Chloramphenicol drops or ointment shave a day or two off bacterial cases and are available over the counter for children 2 and older. Two situations need urgent assessment: any conjunctivitis in the first 28 days of life, and any case with eye pain, photophobia, vision change, or a cloudy cornea.