From the Guidelines
Conjunctivitis should be treated based on its cause, with bacterial conjunctivitis requiring antibiotic eye drops, viral conjunctivitis typically resolving on its own, and allergic conjunctivitis responding to antihistamine eye drops, as stated in the most recent conjunctivitis preferred practice pattern 1.
Causes and Treatment of Conjunctivitis
The treatment of conjunctivitis is ideally directed at the root cause, with early detection and treatment being crucial to prevent complications and promote recovery 1. The most common types of conjunctivitis include:
- Bacterial conjunctivitis: treated with antibiotic eye drops like polymyxin B-trimethoprim (Polytrim) or erythromycin ointment applied 4 times daily for 5-7 days
- Viral conjunctivitis: typically resolves on its own within 1-2 weeks, with artificial tears and cold compresses providing symptom relief
- Allergic conjunctivitis: responds well to antihistamine eye drops like ketotifen (Zaditor) or olopatadine (Pataday) used twice daily
Patient Outcome Criteria
The outcome criteria for treating conjunctivitis include eliminating or reducing signs and symptoms, restoring or maintaining normal visual function, detecting and treating underlying systemic disease, preventing damage to the ocular surface and eyelids, and preventing the spread of infectious conjunctivitis 1.
Prevention of Spread and Reinfection
To prevent the spread of conjunctivitis and reinfection, it is essential to avoid touching the eyes, wash hands frequently, not share towels or pillowcases, and discard eye makeup 1.
Key Considerations
When treating conjunctivitis, it is crucial to avoid the indiscriminate use of topical antibiotics or corticosteroids, as they can induce toxicity or worsen certain infections 1. Topical antibiotics should be considered for mild, moderate, or severe presentations of conjunctivitis, as they reduce the duration of symptoms 1.
From the FDA Drug Label
INDICATIONS AND USAGE: For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms. INDICATIONS AND USAGE For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin.
- Conjunctivitis treatment: Both bacitracin (OPHTH) 2 and erythromycin (OPHTH) 3 are indicated for the treatment of superficial ocular infections involving the conjunctiva.
- Key consideration: The effectiveness of these treatments depends on the susceptibility of the causative organisms to the respective antibiotics.
From the Research
Causes and Symptoms of Conjunctivitis
- Conjunctivitis can be caused by viruses, bacteria, or allergies, and is one of the most common eye conditions in primary care 4.
- Viral and allergic conjunctivitis are more common in adults and typically present with watery discharge, while bacterial conjunctivitis is more common in children and presents with mucopurulent discharge 4.
- Symptoms of conjunctivitis can include redness, itching, and discharge, and can be accompanied by other symptoms such as fever and headache.
Diagnosis and Treatment of Conjunctivitis
- A comprehensive history and physical examination can guide diagnosis, but there is no single sign or symptom that accurately differentiates viral from bacterial conjunctivitis 4.
- Supportive care options for viral conjunctivitis include artificial tears, cold compresses, and antihistamine eye drops, while topical antihistamines with mast cell-stabilizing activity are the treatment of choice for allergic conjunctivitis 4.
- Topical antibiotics may be prescribed for bacterial conjunctivitis, but delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing 4, 5.
- Topical corticosteroids can be useful in treating ocular inflammation, but are generally recommended for severe cases of conjunctivitis due to the risks associated with steroid use 6.
Treatment Options for Specific Types of Conjunctivitis
- For seasonal allergic conjunctivitis, treatment options include artificial tears, antihistamines, decongestants, mast cell stabilizers, nonsteroidal anti-inflammatory drugs, and corticosteroids 7.
- Loteprednol etabonate, a novel corticosteroid, has been shown to be effective and safe in treating seasonal allergic conjunctivitis, with a lower risk of elevating intraocular pressure and forming cataracts compared to traditional corticosteroids 7.
- Topical antibiotics, such as moxifloxacin, have been shown to reduce the duration of conjunctival symptoms in children with infectious conjunctivitis, and may be associated with a lower risk of ocular side effects compared to non-fluoroquinolone antibiotics 5, 8.
Prevention and Management of Conjunctivitis
- Strict personal hygiene, including frequent handwashing, is essential to decrease the risk of transmission of conjunctivitis 4.
- Artificial tears and topical antibiotics may be used to reduce the duration of conjunctival symptoms and prevent infection 8.
- Ophthalmology referral is indicated for conjunctivitis in a neonate or patients with severe pain, decreased vision, recent ocular surgery, vesicular rash on the eyelids or nose, history of rheumatologic disease, or immunocompromised state 4.