Conjunctivitis (red, sticky eye): a case-based approach

The presentation

A 9-year-old we will call "Ben" (an illustrative example) wakes with his right eyelids gummed shut by yellow crusting. Once bathed clean, the white of the eye is pink-red, the eye waters and feels gritty, "like sand", but he can see normally and the light does not hurt him. By afternoon the other eye is starting too. This is a typical picture of infective conjunctivitis: redness, discharge and a gritty feeling, usually starting in one eye and spreading to the other, with normal vision and no true pain. The clinician's key task is to confirm it is conjunctivitis and not one of the more serious causes of a red eye that need urgent attention.

The main types

Conjunctivitis comes in three broad types, and the clues differ. Bacterial conjunctivitis tends to produce more yellow or green sticky discharge and glued-together lids. Viral conjunctivitis, often alongside a cold, causes watery discharge and is very infectious. Allergic conjunctivitis, from pollen or dust, affects both eyes together with intense itching, watering and puffy lids, and often comes with sneezing or a runny nose. Sorting these helps guide advice: infective types are usually self-limiting and settle within a week or two, while allergic conjunctivitis responds to antihistamine or anti-allergy eye drops and avoiding the trigger. Crucially, in all types the vision stays normal and the eye is gritty rather than truly painful.

Self-care and Pharmacy First

Most conjunctivitis needs no antibiotics and gets better on its own. Self-care is the mainstay: gently bathing the lids with cooled boiled water and cotton wool to clear the crusting, not sharing towels or pillows, and washing hands often to avoid spreading it. People who wear contact lenses should stop wearing them until the eye is completely better. Lubricating (artificial tear) drops from the pharmacy can ease the grittiness. Under the NHS Pharmacy First scheme in England, a community pharmacist can assess an acutely red, sticky eye and, where appropriate, supply treatment without a GP appointment — a quick route for straightforward cases and for ruling out anything more worrying.

When a red eye is not simple conjunctivitis

Some red eyes are warning signs of a serious, potentially sight-threatening condition, and these need urgent assessment rather than pharmacy self-care. The alarm features are moderate or severe eye pain rather than mere grittiness, changes or loss of vision, marked sensitivity to light, a red eye with a headache and haloes around lights, or an eye that is red because of an injury or a chemical splash. Contact lens wearers with a painful red eye need prompt attention because of the risk of a corneal infection. A red eye in a newborn baby also needs urgent medical advice. In these situations conjunctivitis is a diagnosis of exclusion — the dangerous causes must be ruled out first.

Management and safety-netting

For ordinary infective conjunctivitis the clinician reassures that it usually clears within one to two weeks, advises the self-care measures above, and explains it can be passed on until the discharge stops, so hand hygiene matters. Children do not automatically need to stay off school unless they are unwell. The safety-netting message is clear: come back or seek help if the eye becomes painful rather than gritty, if vision changes, if light becomes very uncomfortable, or if it is no better after a couple of weeks. This is general education, not a diagnosis — a sudden loss of vision, a chemical splash to the eye, or severe eye pain needs urgent same-day eye care, and severe injury warrants calling 999 or attending A&E.