How many days should a student with bacterial or viral conjunctivitis stay out of school?

Duration of School Exclusion for Bacterial or Viral Conjunctivitis

Students with bacterial conjunctivitis should stay home until 24 hours after starting antibiotic treatment, while those with viral conjunctivitis should remain home until symptoms resolve, which typically takes 5-7 days. 1

Evidence-Based Recommendations by Type of Conjunctivitis

Bacterial Conjunctivitis

• Return to school criteria: 24 hours after starting appropriate antibiotic treatment 1
• Signs of improvement include reduced discharge and decreased eye redness
• Bacterial conjunctivitis is typically self-limiting, with 41% of cases resolving without antibiotics by days 6-10, but treatment speeds resolution and reduces transmission 1

Viral Conjunctivitis

• Return to school criteria: Should remain home until symptoms resolve (typically 5-7 days)
• Viral conjunctivitis is highly contagious and has no specific treatment
• Supportive care with artificial tears and cold compresses is recommended 1

Rationale for School Exclusion Policies

The American Academy of Ophthalmology guidelines support excluding children with conjunctivitis until they are no longer contagious to prevent outbreaks in school settings 1. This approach balances:

1. Public health concerns about transmission
2. Individual educational needs
3. Practical considerations for families

Current State Policies (For Context)

State policies vary significantly regarding school exclusion for conjunctivitis 2:

• 10 states allow students to remain in school
• 5 states allow return 24 hours after initiating antibiotics
• 5 states require physician approval for return
• 17 states have inconsistent or unclear recommendations
• 15 states have no formal policies

Prevention of Transmission in School Settings

To minimize spread when returning to school:

• Hand hygiene: Frequent handwashing is essential
• Avoid sharing: Personal items like towels, pillowcases, and eye makeup
• Surface disinfection: Toys and commonly touched surfaces should be cleaned regularly
• Contact lens care: Discontinue lens wear until infection resolves 1

Important Considerations

• Antibiotic resistance concerns: Unnecessary antibiotic use for viral conjunctivitis contributes to resistance 2
• Cost implications: Requiring antibiotics or physician notes creates financial burden for families
• Diagnostic challenges: Distinguishing bacterial from viral conjunctivitis can be difficult without laboratory testing

When to Seek Medical Care Before Returning to School

Students should be evaluated by a healthcare provider before returning to school if they have:

• Moderate to severe eye pain
• Vision changes
• Severe purulent discharge
• No improvement after 3-4 days of treatment
• Corneal involvement
• History of herpes simplex virus eye disease 1

Following these guidelines helps balance preventing outbreaks while minimizing unnecessary school absences.