Infective conjunctivitis provides a clear illustration of how community pharmacy practice is evolving. From reassurance and over-the-counter advice through patient group directions (PGDs) and independent prescribing, community pharmacies are increasingly at the centre of delivering accessible, evidence-based eye care.

Experience from Wales and Scotland demonstrates what can be achieved when commissioning, governance and professional capability align – positioning conjunctivitis as a practical and credible example of ‘pharmacy-first’ care in action.

Types of conjunctivitis

People may present because of discomfort, anxiety about infectivity, pressure from employers or schools, or uncertainty about whether treatment is needed.

Most cases of conjunctivitis are self-limiting, and accurate assessment is central to avoiding unnecessary treatment.

Viral conjunctivitis is the most common cause overall, particularly in adults. Bacterial conjunctivitis accounts for a smaller proportion of cases and is seen more frequently in children.

Allergic conjunctivitis is highly prevalent, often seasonal and frequently misinterpreted as infection. At a pathophysiological level, these conditions differ in ways that translate clearly into recognisable clinical features:

• Bacterial conjunctivitis is commonly associated with Haemophilus influenzae, Streptococcus pneumoniae and Staphylococcus aureus. It produces a neutrophil-driven inflammatory response and is typically associated with purulent discharge and lid crusting
• Viral conjunctivitis is most often caused by adenovirus and presents with watery discharge, redness and irritation, and is highly contagious
• Allergic conjunctivitis is mediated by IgE-driven mast cell activation, resulting in itching, tearing and conjunctival swelling.