Paeds · ophthalmology
Conjunctivitis and red eye
Also known as Pink eye · Acute conjunctivitis · Bacterial conjunctivitis · Viral conjunctivitis · Adenoviral conjunctivitis · Allergic conjunctivitis · Ophthalmia neonatorum · Neonatal conjunctivitis · Red eye
Fellowship topic on conjunctivitis and the red eye in children: the bacterial, viral and allergic forms of conjunctivitis and ophthalmia neonatorum in the newborn; the adenoviral and IgE pathophysiology alongside the pyogenic bacterial response; the differential diagnosis of the red eye and the red-flag features that point away from simple conjunctivitis toward keratitis, iritis and trauma; a clinical diagnosis built on discharge type, laterality and the presence of pain and photophobia; stepwise management from supportive care and topical chloramphenicol to antihistamine-mast-cell-stabiliser drops and the neonatal chlamydia and gonococcal pathways; and ANZ, UK, US and Canadian guidance on school exclusion, neonatal prophylaxis and the moderate antibiotic benefit.
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Target exams
Red flags
- A unilateral red eye with pain, photophobia, reduced vision or a foreign-body sensation — keratitis, iritis (uveitis), corneal abrasion or a retained foreign body, not conjunctivitis; refer urgently to ophthalmology
- A contact-lens wearer with a painful red eye and discharge — bacterial keratitis with sight-threatening corneal ulcer until proven otherwise; remove the lens, do not patch, refer same day
- A newborn with purulent conjunctivitis in the first 24 to 48 hours — gonococcal ophthalmia neonatorum that can perforate the cornea within hours; treat as an emergency and screen the mother
- A neonate with conjunctivitis between day 5 and 14 — chlamydia ophthalmia neonatorum, which can progress to chlamydial pneumonia and needs systemic treatment, not topical drops alone
- Copious, hyperacute, profuse purulent discharge with marked eyelid oedema in any infant — gonococcal or other severe bacterial infection; admit, culture and treat systemically
Life stages
Care settings
Clinical exam formats
Board mappings
- General Paediatrics and Ophthalmology: bacterial, viral and allergic conjunctivitis — recognition, topical treatment and exclusion advice
- Neonatology: ophthalmia neonatorum — chemical, gonococcal and chlamydial causes, prophylaxis and systemic treatment
- Renewed curriculum — Infectious diseases and neonatology: neonatal chlamydia and gonococcal conjunctivitis, maternal screening and prophylaxis
- Allergy: allergic conjunctivitis and its stepwise treatment including mast-cell stabilisers
- General Paediatrics: diagnosis and management of the red eye, recognising the features that mandate ophthalmology referral
- Public health: school and childcare exclusion, neonatal prophylaxis and maternal sexually-transmitted-infection screening
- Long Case / Structured discussion: a neonate with ophthalmia neonatorum — cause, treatment, maternal screening and complications
- Communication station: explaining the self-limiting nature of viral conjunctivitis, the modest benefit of topical antibiotics and the prevention of household spread
- Level 2 / 3 — Ophthalmology and Infection: conjunctivitis by cause, the red-eye red flags, and neonatal conjunctivitis
- Public health and health improvement: neonatal prophylaxis and maternal infection control
- Foundation of Practice (FOP): the forms of conjunctivitis, the red-eye differential and ophthalmia neonatorum
- Applied Knowledge in Practice (AKP): topical and systemic treatment choice, chlamydia versus gonococcal neonatal conjunctivitis
- History-taking and management: the child with a sticky or red eye, and the newborn with conjunctivitis
- Communication: explaining the self-limiting course of viral conjunctivitis and when exclusion is needed
- General Pediatrics Content Outline — conjunctivitis: bacterial, viral, allergic and neonatal forms, diagnosis and management
- Neonatology: ophthalmia neonatorum — causes, prophylaxis and the chlamydia and gonococcal treatment pathways
- Ophthalmology: the red-eye red flags and the features that mandate urgent referral
- Patient Care: diagnosis and cause-matched management of conjunctivitis and the red eye across ages, with antibiotic stewardship
- Systems-Based Practice and Population Health: neonatal prophylaxis, maternal screening and school exclusion guidance
- Medical Knowledge: adenoviral and IgE pathophysiology, the chlamydia and gonococcal neonatal mechanisms, and the red-eye differential
- Medical Expert: conjunctivitis and the red eye diagnosis, treatment and complications, including ophthalmia neonatorum
- Health Advocate and Collaborator: neonatal prophylaxis, maternal sexually-transmitted-infection screening and Indigenous and remote-community eye health
- Communicator: explaining the self-limiting course, hygiene and exclusion advice to families
The three common forms of conjunctivitis
Bacterial
Allergic
Overview & Definition
Picture a three-year-old brought in with both eyes red and gritty for two days, the lashes stuck together in the morning with yellow crust, and a runny nose. The child is afebrile, playing between wiping the eyes, and the vision is normal when you coax a look at a toy. This is the everyday face of conjunctivitis in childhood — common, contagious in its infective forms, almost always benign, and the single commonest reason a child presents with a red eye. The skill is not in treating the conjunctivitis; it is in not missing the cause of a red eye that threatens sight. [1] [5]
Conjunctivitis is inflammation of the conjunctiva — the thin, transparent membrane lining the anterior sclera and the inner eyelids — caused most often by infection or allergy, and less often by irritants or trauma. It produces redness, discharge and discomfort, and it sits at the benign end of the red-eye spectrum. The dangerous end holds keratitis, iritis, acute angle-closure glaucoma, corneal abrasion and the retained foreign body, each of which asks a different question and needs a different response. The clinician's first task is therefore triage, not treatment: decide whether this is conjunctivitis at all, and only then decide which form it is. [5] [1]
The task has three layers. The first is recognition of the red-flag features — pain, photophobia, reduced vision, a foreign-body sensation, contact-lens use, trauma or a unilateral painful eye — that move the child out of the conjunctivitis basket and into urgent ophthalmology. The second is cause-matched management of the common, benign forms: supportive care and hygiene for viral disease, a short topical antibiotic course for severe or persistent bacterial disease, and antihistamine with mast-cell stabiliser for allergic disease. The third layer is the newborn, where the same red eye is ophthalmia neonatorum and the response is culture, systemic therapy and maternal screening rather than a topical cream. [1] [9]
References11ShowHide
- [1]Azari AA; Barney NP Conjunctivitis: a systematic review of diagnosis and treatment. JAMA, 2013.PMID 24150468
- [2]Mahoney MJ; Bekibele R; Notermann SL; et al Pediatric Conjunctivitis: A Review of Clinical Manifestations, Diagnosis, and Management. Children (Basel), 2023.PMID 37238356
- [3]Chen YY; Liu SH; Nurmatov U; et al Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev, 2023.PMID 36912752
- [4]Liu SH; Chen YY; Nurmatov U; et al Antibiotics Versus Placebo for Acute Bacterial Conjunctivitis: Findings From a Cochrane Systematic Review. Am J Ophthalmol, 2024.PMID 37482371
- [5]Cronau H; Kankanala RR; Mauger T Diagnosis and management of red eye in primary care. Am Fam Physician, 2010.PMID 20082509
- [6]Muto T; Imaizumi S; Kamoi K Viral Conjunctivitis. Viruses, 2023.PMID 36992385
- [7]Jhanji V; Chan TC; Li EY; Agarwal K; Vajpayee RB Adenoviral keratoconjunctivitis. Surv Ophthalmol, 2015.PMID 26077630
- [8]Vazirani J; Shukla S; Chhawchharia R; et al Allergic conjunctivitis in children: current understanding and future perspectives. Curr Opin Allergy Clin Immunol, 2020.PMID 32739978
- [9]Moore DL; MacDonald NE; Canadian Paediatric Society Preventing ophthalmia neonatorum. Paediatr Child Health, 2015.PMID 25838784
- [10]Castro Ochoa KJ; Gurnani B Ophthalmia Neonatorum (Neonatal Conjunctivitis). StatPearls, 2026.PMID 31855399
- [11]Zar HJ Neonatal chlamydial infections: prevention and treatment. Paediatr Drugs, 2005.PMID 15871630