What is the treatment for fungal conjunctivitis (infection of the conjunctiva)?

From the Guidelines

Fungal conjunctivitis is typically treated with antifungal eye drops or ointments, such as natamycin 5% suspension, amphotericin B 0.15-0.3%, or voriconazole 1% eye drops, applied every 1-2 hours initially, then gradually tapered as symptoms improve 1. The treatment usually continues for 2-4 weeks or until the infection resolves completely. For severe cases, oral antifungals such as fluconazole (200-400 mg daily) or itraconazole (200 mg twice daily) may be added. It's essential to identify and discontinue any predisposing factors like contact lens wear or topical steroid use. Patients should avoid eye makeup and maintain good eye hygiene during treatment. Fungal conjunctivitis often requires longer treatment courses than bacterial infections because fungi are more difficult to eradicate. A definitive diagnosis through corneal scraping or conjunctival swab for culture is recommended before starting treatment, as fungal conjunctivitis can mimic other forms of conjunctivitis but requires specific antifungal therapy rather than antibiotics or antivirals. Some key points to consider in the treatment of fungal conjunctivitis include:

• The importance of early detection and treatment to prevent serious ocular and extraocular complications 1
• The need to differentiate between primary conjunctival disease and conditions in which conjunctival inflammation is secondary to systemic or ocular diseases 1
• The role of antifungal therapy in the treatment of fungal conjunctivitis, including the use of natamycin, amphotericin B, and voriconazole 1
• The potential need for oral antifungals in severe cases, such as fluconazole or itraconazole 1
• The importance of good eye hygiene and avoidance of eye makeup during treatment 1

From the FDA Drug Label

The preferred initial dosage in fungal keratitis is one drop of NATACYN ® (natamycin ophthalmic suspension) 5% instilled in the conjunctival sac at hourly or two-hourly intervals. ... Less frequent initial dosage (4 to 6 daily applications) may be sufficient in fungal blepharitis and conjunctivitis. NATACYN ® (natamycin ophthalmic suspension) 5% is indicated for the treatment of fungal blepharitis, conjunctivitis, and keratitis caused by susceptible organisms The treatment for fungal infection of the eye causing conjunctivitis is natamycin ophthalmic suspension 5%. The initial dosage is typically 4 to 6 daily applications. 2 2

From the Research

Treatment for Fungal Infection of the Eye Causing Conjunctivitis

• The treatment for fungal infection of the eye causing conjunctivitis typically involves the use of antifungal medications 3.
• Polyenes and azoles are two major classes of antifungal drugs used to treat fungal infections of the eye, including conjunctivitis 3.
• Natamycin suspension is currently the only US FDA-approved formulation for treating ophthalmic fungal infections, while other antifungals such as amphotericin B, fluconazole, and voriconazole are used off-label 3.
• The choice of antifungal medication may depend on the specific type of fungus causing the infection, as well as the severity of the infection 4, 5, 6.
• In general, antifungal medications such as natamycin, amphotericin B, and voriconazole have been shown to be effective in treating fungal keratitis and other ocular fungal infections 4, 5, 6.
• It is essential to note that conjunctivitis can also be caused by viral or bacterial infections, and the treatment approach may differ depending on the underlying cause 7.

Antifungal Medications Used to Treat Fungal Conjunctivitis

• Natamycin: a polyene antifungal drug that is currently the only US FDA-approved formulation for treating ophthalmic fungal infections 3.
• Amphotericin B: a polyene antifungal drug that has been shown to be effective in treating fungal keratitis and other ocular fungal infections 4, 5, 6.
• Voriconazole: an azole antifungal drug that has been shown to be effective in treating fungal keratitis and other ocular fungal infections 4, 5, 6.
• Fluconazole: an azole antifungal drug that may be used to treat fungal conjunctivitis, although its effectiveness may vary depending on the specific type of fungus causing the infection 5, 6.