Conjunctivitis in children

Conjunctivitis ("red eye" or "pink eye") is common eye condition that affects children, especially under 5 years of age. It can either be caused by an infection or by an allergy. Infectious conjunctivitis is contagious and may spread to other household members. Allergic conjunctivitis is more common in children with allergies such as hay fever.

Symptoms of conjunctivitis include:

  • a red or pink eye (or both eyes)
  • redness behind the eyelid
  • swelling of the eyelids, making them appear puffy
  • excessive tears
  • either a watery discharge or a yellow-green discharge from the eye which dries when your child sleeps, causing crusting around the eyelids
  • a dislike of bright lights (photophobia)
  • a gritty feeling (like there is sand in the eye)
  • itchiness of the eyes and eye rubbing
  • children with allergic conjunctivitis almost always rub their eyes excessively. They may also have an itchy or runny nose and sneezing
When should you worry?
If your child has any of the following:
  • Eyeball is bulging out
  • Vision loss
  • Severe pain in eye
  • Severe headache
  • Severe vomiting
  • Breathing very fast, too breathless to talk, eat or drink
  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
  • Is pale, blue, mottled or feels unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched cry or can’t be settled
  • Has a fit (seizure)
  • Has a rash that does not go away with pressure (the ‘Glass Test’)
  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:
  • Eye so swollen it cannot be opened
  • Changes in vision (blurred or very sensitive to light)
  • Headache
  • Vomiting
  • Blisters develop on the skin next to the eye
  • Breathing a bit faster than normal or working a bit harder to breathe
  • Dry skin, lips or tongue
  • Not had a wee or wet nappy in last 8 hours
  • Poor feeding in babies (less than half of their usual amount)
  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
  • Is 3 to 6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
  • Temperature less than 36°C in those over 3 months
  • Getting worse and I am still worried

You need to contact a doctor or nurse today.

Please ring your GP surgery or call NHS 111 - dial 111

  • Watch them closely for any change and look out for any red or amber symptoms
  • Additional advice is also available to young families for coping with crying of well babies – click here.
  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

Sticky eye in a baby/blocked tear duct - no treatment required (green)

Mild conjunctivitis - no treatment required (green)


Peri-orbital cellulitis - needs same day review (amber)

Causes of conjunctivitis

Most cases of conjunctivitis in children are caused by an infection; your child may also have a runny nose, cough or earache.

Treatment

most children with conjunctivitis do not need treatment with antibiotics - it takes the same amount of time to get better whether an antibiotic is used or not.

If your child has any features of severe infection (amber or red features above), they will need to be urgently seen by a healthcare professional who may decide that your child may benefit from antibiotic treatment. If your child is under 28 days of age and has a red eye(s) or large amounts of pus discharging from their eye(s), they need to be seen by a healthcare professional.

You can help relieve symptoms by gently cleaning the eye(s) with cotton balls soaked in warm water.

  • Clean in one direction only, outwards from the inside (nose side) of the eye. This prevents the other eye becoming infected if only one eye is affected.
  • Discard the cotton ball each time to prevent reinfection.
  • Do not try to clean inside the eyelids as this may cause damage to the inside of the eye. Lubricating eye drops such as 'artificial tears' may give some relief.
  • If your child wears contact lenses, make sure they stop using them until their symptoms have completely gone.

It can take up to 2 weeks for a child to fully recover from conjunctivitis . If your child is not improving after 2 weeks, you should take your child to see their GP.

Prevention

  • To avoid conjunctivitis spreading to other family members, make sure all family member (and your children) wash hands regularly with warm soapy water and wash your child's pillows and face cloths in hot water and detergent. Avoid sharing towels and pillows.

Your child does not need to be excluded from school or childcare if they have conjunctivitis.

This guidance is written by healthcare professionals from across Hampshire, Dorset and the Isle of Wight.

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