A red, watering, gummy eye is one of the most common reasons people walk into a community pharmacy without appointment. It is usually conjunctivitis — an inflammation of the thin membrane covering the white of the eye and the inside of the eyelids — and it is usually self-limiting. Your pharmacist can often identify which type you have, recommend or supply treatment, and tell you whether you need to be seen urgently.

This guide explains the three main types of conjunctivitis, what your pharmacist can do without a GP appointment, and the small number of red-eye cases that need immediate referral.

The three types

The NHS and NICE Clinical Knowledge Summaries divide conjunctivitis into three main categories. The treatment path depends on which you have.

Viral conjunctivitis

The most common type in adults. Usually accompanies or follows a cold or upper respiratory infection. Both eyes are typically affected within a day or two of each other, with watery discharge, redness, a gritty feeling, and often mild light sensitivity.

Viral conjunctivitis is highly contagious but needs no specific treatment. It clears within 1 to 2 weeks on its own.

Bacterial conjunctivitis

More common in children. Typically starts in one eye and spreads to the other. The discharge is thicker, yellow or green, and the eyelids often stick together overnight. It is usually mildly uncomfortable rather than painful.

Most mild bacterial cases clear within a week without antibiotics. A Cochrane review of topical antibiotics for acute bacterial conjunctivitis found that they modestly shorten the duration but the condition is self-limiting in most people.

Allergic conjunctivitis

Almost always bilateral, intensely itchy, and often accompanied by a runny nose, sneezing, or the familiar pattern of hay fever. The discharge is watery rather than purulent, and the eyelids may be puffy.

What the pharmacist can supply

This is where community pharmacy earns its reputation. The pharmacist can assess the eye, ask a targeted set of questions about the pattern of symptoms, and recommend from a range of products that are all available without a prescription.

For viral conjunctivitis

• lubricating drops (hypromellose, polyvinyl alcohol, carmellose) to ease the gritty feeling
• cool compresses
• strict handwashing and separate towels to prevent spread
• reassurance about the typical course

Antibiotic drops do not help viral conjunctivitis and will not be recommended.

For mild bacterial conjunctivitis

The NHS advice for most adults with mild, uncomplicated bacterial conjunctivitis is to wait and see. For cases where treatment is warranted:

• chloramphenicol 0.5% eye drops (Optrex Infected Eyes, Brochlor, Golden Eye)
• chloramphenicol 1% eye ointment

Chloramphenicol is available over the counter in most UK pharmacies for people aged 2 and over. Drops are applied every 2 hours for the first 48 hours, then four-hourly, usually for a total of five days. Ointment is used two to four times daily.

The pharmacist will not supply chloramphenicol if the patient:

• is under 2 years old
• wears contact lenses (refer to GP or optometrist)
• has a suspected injury or foreign body in the eye
• has had recent eye surgery
• has light sensitivity, severe pain or reduced vision

For allergic conjunctivitis

• sodium cromoglicate 2% eye drops (Opticrom, Optrex Allergy) — taken regularly during the allergy season
• an oral antihistamine such as cetirizine or loratadine
• cool compresses

Sodium cromoglicate takes a few days to reach full effect; it is not a rescue drop. For immediate relief, pharmacists may also recommend olopatadine or azelastine drops where suitable.

When a pharmacist will refer you urgently

Not every red eye is conjunctivitis. The pharmacist will refer to a GP, eye casualty, or optometrist if:

• you have significant eye pain rather than just irritation
• your vision is reduced or blurred and does not clear with a blink
• there is intense light sensitivity
• the white of the eye is deep red around the iris (a "ciliary flush" pattern)
• there is a history of eye injury or foreign body
• a newborn has a sticky eye — neonatal conjunctivitis needs specialist assessment
• contact lens wearers have any red, painful eye — always referred, because the risks of a contact-lens-related keratitis are serious
• symptoms have not improved after a week of appropriate treatment

These exclusions exist because red-eye is one of the main presentations of more serious eye conditions — corneal ulcer, uveitis, acute glaucoma. The pharmacist's job is to spot the minority of cases that are not conjunctivitis.

How to avoid spreading it

Viral and bacterial conjunctivitis both spread easily. The NHS recommends:

• washing hands frequently with soap and water, especially after touching the eye or face
• not sharing towels, pillows or eye make-up
• throwing away old eye make-up
• not wearing contact lenses until the eye has fully cleared
• cleaning eyelashes with cool water and cotton wool to remove crusted discharge

Children with conjunctivitis do not usually need to stay off school unless they are particularly unwell. UK Health Security Agency guidance aligns with this.

What about "pink eye"?

"Pink eye" is the common American term for the same conditions. It does not describe a specific type. If a UK school letter refers to pink eye, it almost always means viral or bacterial conjunctivitis.

When to ask your pharmacist today

Drop in if:

• you have had a red, watering eye for more than 48 hours
• there is yellow or green discharge and you want treatment
• you wake up with eyelids stuck together
• you have seasonal eye itching and want advice on drops

For anything that feels more serious than a mild irritation — pain, vision change, photosensitivity — treat it as a refer-up case rather than a self-select one. Your pharmacist will make that call with you. Find a pharmacy near you in the PharmSee directory.

Sources

• NHS — Conjunctivitis (nhs.uk)
• NICE Clinical Knowledge Summary — Conjunctivitis (infective) and Conjunctivitis (allergic)
• British National Formulary — Chloramphenicol, sodium cromoglicate eye products
• Cochrane Review — Topical antibiotics for acute bacterial conjunctivitis

PharmSee publishes UK pharmacy consumer health guides grounded in NHS clinical guidance.