When to refer
When to refer
Certain features fall outside of uncomplicated conjunctivitis, and these should be actively checked for when a patient presents. Being able to recognise these red flags clearly is essential for safe practice:
- Moderate or severe eye pain
- Photophobia
- Reduced or blurred vision
- Corneal opacity
- Neonatal conjunctivitis
- Suspected herpetic eye disease
- Eye trauma or chemical exposure
- Contact lens use – this significantly alters risk and lowers the threshold for referral because of the possibility of keratitis (inflammation or infection of the cornea).
Learning from Wales and Scotland
- Wales: bacterial conjunctivitis is included within the nationally commissioned Common Ailments Service. This enables community pharmacists to undertake structured assessment and, when PGD criteria are met, supply chloramphenicol eye drops. The service is funded, standardised and embedded within NHS pathways, demonstrating how pharmacy can manage conjunctivitis at scale
- Scotland: NHS Pharmacy First Plus is a pharmacist independent prescriber-led service that allows community pharmacists to treat common clinical conditions beyond the scope of the standard Pharmacy First service. Pharmacy First Plus includes managing eye infections in conjunction with local optometry services, and there is a two-way pathway between community pharmacies and optometrists.