Conjunctivitis in Children: Types, Treatment, and Red Flags

A child wakes up with one eye sealed shut by yellow crust. By lunchtime the other eye is going the same way. Their eye is bright pink and watering. This is usually conjunctivitis, and most of the time it's straightforward — uncomfortable, contagious, and self-limiting.

What matters is being able to spot the small minority of cases where something more serious is going on, and knowing the rules for newborns, who play by a different set.

Healthbooq covers common childhood illnesses with the practical context that helps you decide what to do.

What Conjunctivitis Is

The conjunctiva is the thin transparent membrane covering the white of the eye and the inside of the eyelid. When it gets inflamed — for any reason — the eye looks pink or red, weeps, and feels gritty. That's conjunctivitis.

The most useful thing to know is which kind you're dealing with, because the management differs.

Viral Conjunctivitis

The most common kind in children, especially during cold and flu season. Usually caused by adenovirus or one of the common cold viruses.

What it looks like:

• Watery discharge, not thick pus.
• Red or pink whites of the eye.
• Often starts in one eye and spreads to the other within a day or two.
• Comes alongside cold symptoms — runny nose, mild cough, sore throat.
• Eye feels gritty, sometimes itchy. Mild discomfort, not severe pain.
• Sometimes a swollen tender lymph node in front of the ear (preauricular node) — a useful pointer to viral cause.

What helps:

• Clean the eyes with cooled boiled water on cotton wool. Inner corner outward, fresh piece of cotton wool for each wipe.
• Cool damp cloth on closed eyes can soothe.
• Time. Self-resolves in 7–14 days.
• Antibiotic drops do nothing for viral conjunctivitis. Don't bother.
• Hand hygiene matters a lot — viral conjunctivitis is highly contagious, particularly adenovirus, which can survive on surfaces for days.

Bacterial Conjunctivitis

Common in young children. Usual culprits are Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae.

What it looks like:

• Thick yellow or green pus. Crusts over the lashes, especially after sleep.
• Eyelids stuck together in the morning.
• Red eye, often with eyelid swelling.
• Often both eyes, sometimes worse on one side.
• Spreads easily in nurseries and reception classes.

What to do:

• Clean the eyes with cooled boiled water — gently soak the crust to soften it before wiping.
• Chloramphenicol eye drops or ointment is the standard NHS treatment. Drops every 2 hours for the first 2 days, then four times a day for a total of 5 days, or as directed. Ointment is applied four times a day; it's easier in younger children who won't tolerate drops, but it makes vision blurry briefly.
• Available over the counter for children aged 2 and over; prescription only for under-2s.
• Continue treatment for 48 hours after the eye looks normal.

A note on the evidence: trials in older children and adults find that most bacterial conjunctivitis resolves on its own within 7–10 days. The benefit of antibiotic drops is modest — about a day or two faster recovery, and reduced contagiousness. NICE guidance allows watchful waiting in mild cases. In practice, most parents appreciate having something to do, and the drops are safe and cheap.

If symptoms haven't clearly improved after 5 days, see the GP. If they're worsening, sooner.

Allergic Conjunctivitis

Common from school age onward, often peaks in spring and summer with hay fever season.

What it looks like:

• Itchy eyes — itching is the dominant symptom, more than pain.
• Watery discharge, clear, no pus.
• Both eyes, equally affected.
• Eyelids puffy.
• Linked allergic symptoms — sneezing, blocked nose, sometimes asthma.
• Triggered by pollen, dust mites, pet dander, or specific allergens.

What helps:

• Avoid triggers where possible. Keep windows closed during peak pollen, change clothes after coming in from outside.
• Cool damp cloth on the eyes.
• Antihistamine eye drops — sodium cromoglicate (over the counter, suitable from age 6 in some products), olopatadine, or ketotifen are commonly used; check age suitability on the box.
• Systemic antihistamines (cetirizine, loratadine, fexofenadine) help if the child also has nasal allergic symptoms; one of these often manages everything.
• GP referral for severe persistent symptoms — sometimes mast cell stabiliser drops or short courses of steroid eye drops are used under specialist supervision.

Sticky Eye in Newborns: Different Rules

In babies under about 6 weeks, most sticky eyes are blocked tear ducts, not infection. The white of the eye is not red, the eyelid isn't swollen, and the discharge is more sticky than purulent. See the conjunctivitis in babies article for full management — clean with cooled boiled water, gentle massage, and patience.

But the first 28 days of life is the period where you take significant pus or eyelid swelling seriously. Two specific infections — gonorrhoeal and chlamydial conjunctivitis — can be acquired during birth and can damage vision if untreated. Same-day assessment for any newborn with significant eye discharge.

When to See a Doctor

For most viral and mild bacterial conjunctivitis at home, you don't need a GP. The NHS pharmacy First scheme means you can often access chloramphenicol drops for children over 2 directly through a community pharmacy.

See a doctor (GP or 111) if:

• The child is under 28 days old with any conjunctivitis.
• The child is under 2 and the GP needs to prescribe drops.
• Significant pain in the eye (not just gritty discomfort).
• Light sensitivity (photophobia) — child holding the eye closed and uncomfortable in normal lighting.
• Vision is reduced or blurred and not just because of crust.
• Cloudy or hazy area on the cornea (the clear front of the eye).
• Eyelid is hot, swollen, and red — could be peri-orbital or orbital cellulitis, which needs IV antibiotics in hospital.
• The eye is bulging or the child can't move the eye normally.
• Child seems generally unwell — fever, lethargy.
• Symptoms not better after 5 days of treatment, or rapidly worsening.
• Recent contact with a cold sore or active herpes — herpes simplex keratitis can scar the cornea.
• Contact lenses in older children — bacterial keratitis around lenses needs urgent ophthalmology assessment.

These red flags can indicate keratitis, iritis, glaucoma, or peri-orbital infection, which need specific treatment.

Returning to Nursery or School

Current NHS and Public Health England guidance: conjunctivitis is not a reason to stay off school or nursery routinely. That said, individual nurseries and schools often have policies requiring exclusion until the discharge has cleared, particularly for under-fives. Check yours.

Practical infection control:

• Hand washing for child and family.
• Don't share towels, flannels, or pillowcases.
• Discard mascara and other eye make-up that may be contaminated (relevant for older children).
• Clean glasses frames.
• Don't reuse contact lenses worn during an infection.

Most schools and nurseries take a pragmatic view: if the child is well enough to participate and the discharge is being managed, they can usually return.

A Word on Pink Eye Without Conjunctivitis

A red eye is not always conjunctivitis. Other causes:

• Subconjunctival haemorrhage — bright red bleed under the conjunctiva, looks dramatic, painless, no discharge. Resolves over 1–2 weeks.
• Foreign body — speck of dust, eyelash, or grit. Pain, watering, often unilateral.
• Stye or chalazion — focal lump on or in the eyelid, not generalised redness.
• Blocked tear duct in older children — watering, sticky lashes, but no inflammation.
• Dry eye — gritty, mild redness, no discharge, related to screen use or environmental factors.
• Iritis (anterior uveitis) — deep eye pain, photophobia, blurred vision; rare in children but seen in juvenile idiopathic arthritis. Needs urgent ophthalmology.
• Glaucoma — very rare in children but can present with red eye, photophobia, and a cloudy cornea.

When the picture doesn't fit conjunctivitis, see the GP rather than reaching for the chloramphenicol.

Conjunctivitis is the umbrella term for a red, discharging eye, and in children it is almost always viral, bacterial, or allergic. Most cases — viral or bacterial — resolve in 1–2 weeks with or without treatment. Antibiotic drops are commonly used for the bacterial form but speed recovery only modestly. The newborn period is different: any conjunctivitis in the first 28 days needs same-day assessment. Red flags at any age — eye pain, light sensitivity, vision change, cloudy cornea, swollen red eyelid — mean stop and see a doctor today.