Eye Discharge

Conjunctivitis accounts for over 25% of all eye complaints in general practice and is the most common cause of eye discharge.

Discharge type as a diagnostic clue

• Purulent discharge → bacterial conjunctivitis
• Clear or mucous discharge → viral or allergic conjunctivitis
• Watering without discharge, in an infant → think blocked nasolacrimal duct
• Painful unilateral red eye with watering (not discharge) → think outside conjunctivitis — see the red-eye differential in red-eye.md

Congenital nasolacrimal duct obstruction

• Delayed nasolacrimal duct development occurs in ~6% of infants; the lacrimal sac becomes infected, causing a persistent discharge from one or both eyes
• Spontaneous resolution occurs by 6 months of age in the majority of infants

Management

• Topical antibiotics for infective episodes if required
• Frequent lacrimal sac massage with normal saline
• Refer for lacrimal passage probing before 6 months if discharge is profuse and irritating, or between 6–12 months if it hasn’t self-corrected

Watery eye (epiphora) in adults

A persistently watering eye without true discharge is a distinct presentation from conjunctivitis — see dacrocystitis-dacrocystocoele-dacrostenosis.md for the adult epiphora assessment algorithm (punctal, canalicular and nasolacrimal duct causes) and its full lacrimal-drainage-system approach.