When should I consider referring a patient with bacterial conjunctivitis to an ophthalmologist?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

You should consider referring a patient with bacterial conjunctivitis to an ophthalmologist in several specific situations, particularly if there are signs of severe disease or complications ,.

  • Ophthalmia Neonatorum: All cases of neonatal sticky eye with redness require urgent referral to ophthalmology to prevent serious systemic and local complications ,. Management often involves input from paediatrics ,.
  • Suspected Herpes Infection: Ocular infection with herpes simplex or herpes zoster requires urgent specialist assessment and treatment with oral antivirals ,.
  • Contact Lens Use: If the conjunctivitis is associated with contact lens use and topical fluorescein reveals corneal staining (epithelial defect), urgent referral is required as this can be a sight-threatening condition ,. Bacterial keratitis can also occur in contact lens wearers . Do not give antibiotics in the interim as this may interfere with corneal culture ,.
  • Recurrent and Persistent Conjunctivitis: If symptoms persist after 10 days, it is recommended to stop all drops and refer to ophthalmology . Discussion with ophthalmology is also recommended for recurrent or persistent conjunctivitis .
  • Red Flags for Serious Causes: Arrange urgent assessment by ophthalmology if the person has any red flag indicating a serious cause of red eye, maintaining a low threshold for referral to avoid missing sight-threatening conditions ,.
  • Suspected Gonococcal or Chlamydial Conjunctivitis: Consider this possibility in sexually active individuals or children of any age where sexual abuse is suspected .
  • Suspected Periorbital or Orbital Cellulitis: This requires urgent assessment by ophthalmology ,.
  • Severe Disease: Refer urgently if there is corneal ulceration, significant keratitis, or the presence of a pseudomembrane ,.
  • Recent Intraocular Surgery: Patients with recent intraocular surgery presenting with conjunctivitis should be referred ,.
  • Associated Systemic Conditions or Immunocompromise: Refer if the conjunctivitis is associated with a severe systemic condition such as rheumatoid arthritis or if the patient is immunocompromised ,.
  • Diagnostic Uncertainty: Discuss with or refer to ophthalmology if there is diagnostic uncertainty or if appropriate diagnostic equipment is not available ,.
  • Molluscum Contagiosum: Consider referral if conjunctivitis is thought to be due to molluscum contagiosum .

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