What is the best treatment for conjunctivitis?

From the Guidelines

The best treatment for conjunctivitis is directed at the root cause, and early detection and treatment can be both sight-saving and, in select cases, lifesaving, as stated in the conjunctivitis preferred practice pattern 1. For typical viral or allergic conjunctivitis:

• Use artificial tears 4-6 times daily to lubricate and soothe the eye.
• Apply over-the-counter antihistamine eye drops like ketotifen (Zaditor) twice daily if allergy is suspected.
• Use a cool compress on closed eyes for 5-10 minutes, 3-4 times daily to reduce inflammation.
• Avoid touching or rubbing eyes and practice good hand hygiene.
• Remove contact lenses until symptoms resolve. It is essential to differentiate between primary conjunctival disease and conditions in which conjunctival inflammation is secondary to systemic or ocular diseases, as stated in the conjunctivitis preferred practice pattern 1. If symptoms persist beyond 1-2 weeks or if there's severe pain, vision changes, or thick discharge, see an eye doctor, as they may prescribe antibiotic eye drops for bacterial infections or stronger treatments for more serious conditions, and topical antibiotics can reduce the duration of symptoms, as recommended by the Working Group 1. These treatments work by lubricating the eye surface, reducing inflammation, and addressing common causes like allergies or minor irritations, and it is crucial to address the underlying systemic disease, as stated in the conjunctivitis preferred practice pattern 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE

Gatifloxacin ophthalmic solution is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms: • Aerobic gram-positive bacteria: Staphylococcus aureus Staphylococcus epidermidis Streptococcus mitis group* Streptococcus oralis* Streptococcus pneumoniae • Aerobic gram-negative bacteria: Haemophilus influenzae *Efficacy for these organisms were studied in fewer than 10 infections.

14 CLINICAL STUDIES

In two randomized, double-masked, multicenter, controlled clinical trials in which patients were dosed 3 times a day for 4 days, moxifloxacin ophthalmic solution produced clinical cures on Day 5 to 6 in 66% to 69% of patients treated for bacterial conjunctivitis. Microbiological success rates for the eradication of baseline pathogens ranged from 84% to 94% In a randomized, double-masked, multicenter, parallel-group clinical trial of pediatric patients with bacterial conjunctivitis between birth and 31 days of age, patients were dosed with moxifloxacin ophthalmic solution or another anti-infective agent. Clinical outcomes for the trial demonstrated a clinical cure rate of 80% at Day 9 and a microbiological eradication success rate of 92% at Day 9 Please note that microbiologic eradication does not always correlate with clinical outcome in anti-infective trials.

The best treatment for conjunctivitis is moxifloxacin ophthalmic solution or gatifloxacin ophthalmic solution, as they have been shown to be effective in treating bacterial conjunctivitis caused by susceptible strains of certain organisms, with clinical cure rates ranging from 66% to 80% and microbiological eradication success rates ranging from 84% to 94% 2, 3, 2.

• Key benefits of these treatments include:
  • High clinical cure rates
  • High microbiological eradication success rates
  • Effective against a range of bacterial organisms
• Important considerations:
  • Efficacy for certain organisms was studied in fewer than 10 infections
  • Microbiologic eradication does not always correlate with clinical outcome in anti-infective trials

From the Research

Treatment Options for Conjunctivitis

The treatment for conjunctivitis depends on the underlying cause, which can be viral, bacterial, or allergic 4, 5.

• Viral conjunctivitis is typically self-limiting and can be managed with supportive care options such as artificial tears, cold compresses, and antihistamine eye drops 5.
• Allergic conjunctivitis can be treated with topical antihistamines with mast cell-stabilizing activity 5.
• Bacterial conjunctivitis is more common in children and typically presents as mucopurulent discharge with the eyelids matted shut, and can be treated with antibiotics, although delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing 5.

Referral to an Ophthalmologist

Referral to an ophthalmologist is indicated in certain cases, such as:

• Severe pain or decreased vision 4, 6, 7, 5, 8
• Recent ocular surgery or trauma 4, 7, 5
• Vesicular rash on the eyelids or nose, or history of rheumatologic disease 5
• Immunocompromised state 5
• Chemical burns, intraocular infections, globe ruptures or perforations, and acute glaucoma 7

Importance of Accurate Diagnosis

A comprehensive history and physical examination are essential to guide diagnosis and treatment of conjunctivitis 4, 5.

• The cause of red eye can be diagnosed through a detailed patient history and careful eye examination 4.
• Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye 4.