Infectious Conjunctivitis

Infectious Conjunctivitis

“Infectious Conjunctivitis” by Dr Dick Stockley  /  HEALTH FEATURE

The Eye asked me for an article on conjunctivitis...

so I said Aye Aye, the Eye on the eye.

Apparently it’s been going round. Technically conjunctivitis is an “-itis of the conjunctiva” so describes any inflammation: chemical, allergic, traumatic, autoimmune, or infectious. But most people think “pink eye”: a common epidemic in schools that we can’t avoid, but hope as adults we’re immune to it from our own grubby childhoods. So let’s talk about infectious conjunctivitis. But quick warning: some causes of red eyes are serious.

Even in the middle of an epidemic of adenovirus pink eye, an alert doctor will see an occasional auto immune uveitis or other rare potentially blinding disease. Sometimes treatment is so urgent that making an appointment tomorrow isn’t an option. Most epidemics of conjunctivitis are viral. Usually an adenovirus but who cares: any virus from Covid to measles can cause a red eye. A good GP will have a quick look, shine a torch, check the pupil, make sure the inside of the lower eye lid is redder than the surface of the eye and put in some fluoresceine eye drops to check for ulcer. Herpes is one virus you don’t want to miss.


Pain is important. If it’s more painful then you think it ought to be, go right away. A regular viral pink eye starts suddenly usually in one eye, and then just as it’s getting better starts in the other eye. On what side does conjunctivitis always start? *Answer at the bottom of the page. If conjunctivitis is part of a general viral upper respiratory infection it will start in both eyes along with other signs of a common cold: running nose, cough, sore throat, maybe a bit of a fever. Typically the eyes feel a bit sore, gritty, or itchy. Of course they look pink and usually look a lot worse than they feel. There may be slight tears, or a lot of discharge. There may be pus and even bloody oozing. The conjunctiva can get swollen, even close the eye. As a general rule severe swelling with the whole surface lumpy is more common in allergic conjunctivitis, and swollen with pus is more likely to be bacterial. Pain and blurred vision could be a sign of more severe disease.

Can it be prevented?

We advise everyone with pink eye to wash their hands like lady Macbeth and stay away from other children.

Doctors and nurses wash hands after touching any red infected eye. But to be honest the reason we see epidemics is because it’s so contagious. Realistically if you’re not immune from prior exposure you’re going to get it, never mind how careful you are. My 5-year-old granddaughter woke up with it this weekend and took a day off school: spent half her time over here playing with our new puppy. We found two-thirds of her class had it too, but no adults.

Try and avoid rubbing your eyes: all that discharge is a great culture medium for bacteria and you can easily get a staph or strep infection on top of the initial epidemic virus.

When to see a doctor?

If you’re worried see a doctor: better to feel you’re wasting time than risk missing a serious disease. Although blurred vision, increasing pain, pain on pressing the eye, photophobia can all still be due to a virus, in my opinion any such signs require an urgent visit, even 2 o’clock in the morning. Herpes can cause permanent corneal scars, uveitis can cause blindness. After 42 years in Uganda I’ve seen some horrors, google endogenous endophthalmitis if you like being scared. I’ve seen a case from a simple boil on his neck and the eye turned into a bag of pus in hours.

Spoiler alert: it’s extremely rare: so is iritis, episcleritis, uveitis. I’ve seen them all but I hope you never will.

Hypertension Dick Stockley
Dick and Rosie Stockley

When I was working in Karamoja in the 80’s, trachoma a particular eyelid infection caused by chlamydia was extremely common. It was a chronic disease, untreated it caused scarring of the lids requiring surgery. I operated on about 25,000 cases in 9 years, in the back of a Land Rover under a tree. Tamarind trees were best, they weep like weeping willow and you can back right in like a green cave, with just the right amount of soft light. Hopefully it’s now eradicated and we’ll never see it again. I mean trachoma not tamarind trees. If they were eradicated we’d have no more Worcestershire sauce


A typical viral conjunctivitis gets better whatever you do. I always gave simple antibiotic eye drops for a few days because the drops are soothing and it prevents secondary infection. They only last a few hours so ointment at night is a good idea. Never self prescribe steroid drops or mixtures. Eye drops are officially “prescription only” for a reason. I remember a local healer who recommended omo. I doubt he had many patients come back. If you’re up country and no one to see, then take a selfie, I know The Surgery doctors will be happy to look at it and advise what you can get in a pharmacy.

Viral conjunctivitis Treatments
Viral conjunctivitis Treatments

I don’t think I ever saw a doctor with conjunctivitis when I was a child. My mum used to treat us with cold tea. A dilute solution of tannic acid. She let the pot stew, poured it into an egg cup, we held it to the eye and blinked. Probably useless but made mum feel better and satisfied the need to “do something”. Seemed to work too. When I turned 40 I needed glasses: must have been all that tea.



Conjunctivitis is extremely common, often coming in epidemics among children. Commonly due to adenovirus or other common cold viruses. It gets better but eye drops make it feel better and prevent secondary infection. Other severe diseases can cause a red eye so if in doubt see a doctor, treatment may be extremely urgent.

And the quiz?

*Conjunctivitis always starts on what side?

The outside.

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