Infectious Eye Diseases in Optical Practice

Recognising likely infectious conditions helps set proportionate controls. Most eye infections are managed safely in primary care with hygiene, brief exclusion, and patient advice. A few require urgent referral when red flags appear.^[1][7]

Adenoviral conjunctivitis

Adenovirus spreads easily via hands, instruments, and surfaces. Patients may present with watery red eyes, follicles, and high contagion. Cleaning high-touch kit with a compatible disinfectant - and allowing full contact time - supports safe care. Short exclusion of symptomatic staff can be considered.^[2][1]

Herpes simplex keratitis

Active epithelial lesions carry a risk of viral shedding. Examination is safest with care, avoiding contact with lesions, and ensuring instrument disinfection. Staff with cold sores should follow hand hygiene scrupulously and avoid touching lesions before patient contact.^[3][1]

Herpes zoster ophthalmicus

Older and immunocompromised patients face higher risk. Early recognition and urgent referral reduce complications. Staff immune to varicella are unlikely to be affected, yet good hygiene and covering lesions remain standard.^[4][6]

Common bacterial conditions

Conjunctivitis, blepharitis, and styes can shed organisms to shared kit. Excluding symptomatic staff from direct patient contact until managed, alongside frequent hand hygiene and cleaning, helps reduce transmission.^[1][7]

Respiratory viruses with ocular features

Influenza and COVID-19 can present with ocular irritation or conjunctivitis. Source control during peaks, optional masks, and robust hand hygiene can reduce spread without disrupting clinics.^[5][6]

Red flags and escalation

Features such as severe pain, photophobia, reduced vision, corneal involvement, or herpetic dendrites warrant urgent escalation.^[3][4]

Urgent escalation is required for severe pain, photophobia, reduced vision, or corneal involvement.^[3][4]

Safety comes first; IPC should never delay referral when vision is at risk.^[7]

Communication with patients

Brief, blame-free explanations help patients understand hygiene steps. Advice for patients often includes:

• not sharing towels
• using single-use tissues
• cleaning spectacles

Written instructions in large print can support those who need them.^[1][2]

Staff health considerations

Staff with acute infectious symptoms should avoid patient contact. Line managers can record exclusion periods briefly and arrange cover. Return-to-work protocols work best when they focus on safety and service continuity.^[6][7]

Records that hold up

Document suspected diagnosis, hygiene measures used, escalation choices, and patient advice. Note who authorised any staff exclusion and the review date. Keep entries factual and free of speculation.^[7][1]

References (numbered in text) Why we include references

1. Infection control - College of Optometrists (College of Optometrists) Find (opens in a new tab)
2. Adenoviral Keratoconjunctivitis — Alexander Bialasiewicz; Sultan Qaboos University Medical Journal (2007) Find (opens in a new tab)
3. Evidence-based treatment of herpes simplex virus keratitis — Scott Guess; Donald U. Stone; James Chodosh; Ocul Surf (2007) Find (opens in a new tab)
4. Herpes Zoster Ophthalmicus: Presentation, Complications, Treatment, and Prevention — John Litt; Anthony L. Cunningham; Francisco Arnalich-Montiel et al.; Infectious Diseases and Therapy (2024) Find (opens in a new tab)
5. Ocular Manifestations of COVID-19: A Systematic Review and Meta-analysis — Naser Nasiri et al.; Journal of Ophthalmic & Vision Research (2021) Find (opens in a new tab)
6. COVID-19: managing healthcare staff with symptoms of a respiratory infection — UK Health Security Agency (UKHSA) (guidance) Find (opens in a new tab)
7. Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance — Department of Health & Social Care (Updated 2022) Find (opens in a new tab)