How many days should a patient with conjunctivitis be absent from work or school?

Duration of Absence for Conjunctivitis

Return to school or work depends on the patient's age, occupation, and the type and severity of conjunctivitis, with no universal number of days applicable to all cases. 1

Viral Conjunctivitis (Most Common)

For adenoviral conjunctivitis, patients should minimize contact with others for 10 to 14 days from the onset of symptoms in the last eye affected. 1

• Adenoviral conjunctivitis is highly contagious and can survive for weeks on surfaces without proper disinfection 1
• This is the most common overall cause of infectious conjunctivitis and is self-limited, typically resolving within 5-14 days 2, 3
• The American Academy of Ophthalmology emphasizes that patients need to understand the highly contagious nature of this condition 1

Occupation-Specific Considerations for Viral Conjunctivitis

• Healthcare workers, food service workers, and sales personnel pose particular challenges and may require the full 10-14 day absence 1
• Some occupations allow work from home or from a private office setting, which may permit earlier return 1
• There is documented evidence that ophthalmologists have been implicated in spreading epidemics of viral conjunctivitis 4

Bacterial Conjunctivitis

Topical antibiotics allow earlier return to school or work by shortening the duration of bacterial conjunctivitis. 3

• Most uncomplicated bacterial cases resolve in 1-2 weeks without treatment 3
• With topical antibiotic therapy (polymyxin-bacitracin), 62% of patients are clinically cured by 3-5 days versus only 28% with placebo 5
• By 8-10 days, 91% treated with antibiotics are cured versus 72% with placebo 5
• Patients can typically return once purulent discharge resolves and symptoms improve with antibiotic treatment, usually within 3-5 days 5

Special Bacterial Cases Requiring Extended Absence

• Gonococcal conjunctivitis requires immediate systemic antibiotics and may necessitate hospitalization 1, 2
• Chlamydial conjunctivitis requires systemic antibiotics in addition to topical therapy 6, 2, 3
• Sexual partners must be treated, and these cases may require longer absence until systemic treatment is effective 1

Allergic Conjunctivitis

Allergic conjunctivitis is not contagious and does not require absence from work or school. 1

• This affects up to 40% of the population and is characterized by itching as the most consistent sign 3
• Treatment with topical antihistamines and mast cell stabilizers alleviates symptoms 3
• Patients can continue normal activities while managing symptoms 1

Critical Factors That Modify Return-to-Work Decisions

Patient Age

• Children with bacterial conjunctivitis should remain home until purulent discharge resolves with antibiotic treatment 1
• Neonates with any purulent conjunctivitis require emergency evaluation and should not attend daycare until gonococcal and chlamydial causes are ruled out 6, 2

Severity Indicators Requiring Extended Absence

• Severe purulent discharge 1
• Corneal involvement 1
• Membranous or pseudomembranous conjunctivitis 1, 2
• Lack of response to initial therapy 1

Common Pitfalls to Avoid

• Do not assume all conjunctivitis requires the same absence duration—viral cases need 10-14 days while treated bacterial cases may return in 3-5 days 1, 5
• Do not allow patients with adenoviral conjunctivitis to return early even if symptoms improve, as they remain contagious for the full 10-14 day period 1
• Do not forget to consider occupation—healthcare and food service workers require stricter absence policies 1
• Always counsel patients on hand hygiene to reduce transmission risk regardless of conjunctivitis type 1