What are the red flags for red eye & conjunctivitis in urgent care?

Reduced visual acuity → Not simple conjunctivitis — same-day eye service; Significant eye pain or photophobia → Keratitis, iritis, scleritis or acute glaucoma; Contact lens wearer with a red painful eye → Microbial keratitis — same-day eye service; Fixed mid-dilated pupil, haloes, headache, vomiting → Acute angle-closure glaucoma — emergency; Neonate (under 28 days) with conjunctivitis → Ophthalmia neonatorum — same day; Fluorescein uptake (dendritic ulcer) → Herpes simplex keratitis — eye service

Which decision rule is used for red eye & conjunctivitis?

Is it safe to call it conjunctivitis?: Normal acuity; No significant pain or photophobia; Normal pupils; No fluorescein uptake; Not a contact lens wearer with pain. All five true → conjunctivitis managed in clinic. Any false → same-day eye service.

What should I prescribe for red eye & conjunctivitis?

Chloramphenicol 0.5% eye drops (if treating bacterial): 1 drop every 2 hours for 2 days, then reduce to 4 times a day (Continue for 48 h after symptoms settle (max 5 days)); Chloramphenicol 1% eye ointment (alternative / at night): Apply 3–4 times a day, or at night if using drops by day (As above); Fusidic acid 1% eye drops (e.g. pregnancy): 1 drop twice a day (7 days)

Home
Urgent care
Ear, nose, throat & eyes
Red eye & conjunctivitis

● Urgent care clinic · 30-minute consult

Red eye & conjunctivitis

Q: What safety-netting advice should I give for red eye & conjunctivitis?

Advise the patient to return or seek help if: Your eyesight gets worse or blurred; The eye becomes painful or sensitive to light; Not improving after a week.

Conjunctivitis is a diagnosis of exclusion — check acuity and pain first.

Typical consult⏱ 15 min

Investigations🔬 None (acuity + fluorescein)

Usual outcome💊 Self-care ± chloramphenicol

0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document

1Rule out first — red flags

If you find…	…then
Reduced visual acuity	Not simple conjunctivitis — same-day eye service
Significant eye pain or photophobia	Keratitis, iritis, scleritis or acute glaucoma
Contact lens wearer with a red painful eye	Microbial keratitis — same-day eye service
Fixed mid-dilated pupil, haloes, headache, vomiting	Acute angle-closure glaucoma — emergency
Neonate (under 28 days) with conjunctivitis	Ophthalmia neonatorum — same day
Fluorescein uptake (dendritic ulcer)	Herpes simplex keratitis — eye service

4Decide — investigate only if it changes the plan

Is it safe to call it conjunctivitis?

Normal acuity
No significant pain or photophobia
Normal pupils
No fluorescein uptake
Not a contact lens wearer with pain

All five true → conjunctivitis managed in clinic. Any false → same-day eye service.

Investigation	Only if…
None	Swabs only if severe, neonatal or not responding

5Treat & send home

Management & advice

Most infective conjunctivitis settles in 7–14 days without treatment
Clean lids with cooled boiled water; don’t share towels; no contact lenses until resolved
School/work exclusion not needed
Allergic: antihistamine drops / oral antihistamine

Refer / follow-up

Any red flag → same-day eye service / ophthalmology

℞

Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.

Drug	Dose	Duration / notes
Chloramphenicol 0.5% eye drops (if treating bacterial)	1 drop every 2 hours for 2 days, then reduce to 4 times a day	Continue for 48 h after symptoms settle (max 5 days)
Chloramphenicol 1% eye ointment (alternative / at night)	Apply 3–4 times a day, or at night if using drops by day	As above
Fusidic acid 1% eye drops (e.g. pregnancy)	1 drop twice a day	7 days

6Safety-net

Say it like this

This is conjunctivitis, an infection on the surface of the eye. Your eyesight is normal, which is reassuring. It usually clears in 1 to 2 weeks, and the drops may help it settle a little faster. Don’t share towels and leave contact lenses out. Come back the same day if your vision gets worse or the eye becomes painful or sensitive to light.

Come back / call 111 — or 999 if severe — if:

Your eyesight gets worse or blurred
The eye becomes painful or sensitive to light
Not improving after a week

7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Conjunctivitisnhs.uk/conditions/conjunctivitis

Red eyenhs.uk/conditions/red-eye

8Document

Red eye & conjunctivitis — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — RED EYE & CONJUNCTIVITIS PRESENTING COMPLAINT: HISTORY One or both eyes; onset: Pain vs grittiness; itch (allergic); discharge type: Vision change, photophobia, haloes: Contact lenses, trauma, chemicals: Recent cold, atopy, sexual history if neonatal or hyperacute: RED FLAGS (record present / absent) [ ] Reduced visual acuity [ ] Significant eye pain or photophobia [ ] Contact lens wearer with a red painful eye [ ] Fixed mid-dilated pupil, haloes, headache, vomiting [ ] Neonate (under 28 days) with conjunctivitis [ ] Fluorescein uptake (dendritic ulcer) PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Visual acuity (Snellen) each eye — always document: Pupils, redness pattern (diffuse vs circumcorneal): Discharge, lids, lashes: Fluorescein staining: Pre-auricular node (viral): DECISION RULE — Is it safe to call it conjunctivitis?: result ______ INVESTIGATIONS: none required / None — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Conjunctivitis, Red eye Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Your eyesight gets worse or blurred - The eye becomes painful or sensitive to light - Not improving after a week Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More ear, nose, throat & eyes

Sore throat & tonsillitisFeverPAIN decides — and don’t miss the quinsy or epiglottitis.Earache: otitis media & externaMostly no antibiotics — but spot mastoiditis and malignant otitis externa.SinusitisViral until day 10 — and don’t miss the orbit.Nosebleed (epistaxis)Proper first aid, cautery if you can see it, and who needs ENT.