Publication Date: January 1, 2019
Last Updated: March 14, 2022


Conjunctivitis rarely causes permanent visual loss or structural damage, but the economic impact of conjunctivitis is considerable and largely due to lost work or school time and the cost of medical visits, testing and treatment.

Chronic and/or recalcitrant conjunctivitis may be indicative of an underlying malignancy, such as sebaceous or squamous cell carcinoma.

The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic adenoviral conjunctivitis, primarily by educating the patient and family about proper hygiene. Infected individuals should be counseled to wash hands frequently and use separate towels, and to avoid close contact with others during the period of contagion.

Dilute bleach soak (sodium hypochlorite) at 1:10 concentration is an effective disinfectant for tonometers. Notably, 70% isopropyl alcohol (e.g., alcohol wipes), 3% hydrogen peroxide, and ethyl alcohol are no longer recommended for tonometer disinfection.

Surfaces should be disinfected with an EPA-registered hospital disinfectant in accordance with the directions and safety precautions on the label. (, , )

Indiscriminate use of topical antibiotics or corticosteroids should be avoided. Viral conjunctivitis will not respond to anti-bacterial agents, and mild bacterial conjunctivitis is likely to be self-limited. No evidence exists demonstrating the superiority of any topical antibiotic agent.

In adults, conjunctivitis caused by ocular mucous membrane pemphigoid (OMMP), graft-versus-host disease (GVHD), gonococcus, and chlamydia are important to detect early because it is necessary to treat the concomitant systemic disorder. Diagnosis of superior limbic keratoconjunctivitis (SLK) may lead to further investigations that reveal a thyroid disorder. Early detection of conjunctivitis associated with neoplasms may be lifesaving.

Herpes Zoster vaccination should be strongly recommended in patients 50 years or older.

Recommendation Grading





Authoring Organization

Publication Month/Year

January 1, 2019

Last Updated Month/Year

June 9, 2022

Document Type


External Publication Status


Country of Publication


Document Objectives

Establish the diagnosis of conjunctivitis, differentiating it from other causes of red eye, Identify the cause(s) of conjunctivitis, istablish appropriate therapy, relieve discomfort and pain, prevent complications, prevent the spread of communicable diseases, educate and engage both the patient and the referring healthcare providers in conjunctivitis management

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital

Intended Users

Optometrist, nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D003231 - Conjunctivitis, D003229 - Conjunctival Diseases, D003234 - Conjunctivitis, Bacterial, D003236 - Conjunctivitis, Viral


conjunctivitis, opthalmology, red eyes

Source Citation

Varu, D. M., Rhee, M. K., Akpek, E. K., Amescua, G., Farid, M., Garcia-Ferrer, F. J., … Dunn, S. P. (2018). Conjunctivitis Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2018.10.020


Number of Source Documents
Literature Search Start Date
March 1, 2017
Literature Search End Date
June 1, 2018