What is the initial approach to treating conjunctivitis?

From the Guidelines

The initial approach to treating conjunctivitis should be directed at the root cause, with a focus on supportive care and avoiding indiscriminate use of topical antibiotics or corticosteroids. According to the most recent study 1, treatment methods vary depending on the type of conjunctivitis. For allergic conjunctivitis, conservative strategies such as reducing allergen exposure, using lubrication, and applying antihistamines and mast cell stabilizers are recommended.

Key Considerations

• For viral conjunctivitis, cold compresses and artificial tears can help reduce swelling and discomfort, as noted in the example answer.
• For bacterial conjunctivitis, antibiotic eye drops such as polymyxin B-trimethoprim, ciprofloxacin, or erythromycin may be prescribed, typically used 4 times daily for 5-7 days until symptoms resolve.
• Allergic conjunctivitis responds to antihistamine eye drops like ketotifen (Zaditor) or olopatadine (Pataday), used twice daily, along with avoiding allergens.
• Good hygiene is essential for all types of conjunctivitis, including avoiding touching or rubbing eyes, washing hands frequently, using separate towels, and replacing eye makeup.

Treatment Approach

The study 1 highlights the importance of early detection and treatment to prevent complications. Topical corticosteroids and topical calcineurin inhibitors such as cyclosporine and tacrolimus may be used for moderate disease, but their use should be cautious due to potential side effects. The most recent study 1 also emphasizes the need for directed treatment at the root cause, avoiding unnecessary use of antibiotics or corticosteroids.

Additional Considerations

• Contact lens wearers should temporarily switch to glasses to prevent further irritation.
• If symptoms worsen, vision becomes affected, or there's severe pain, immediate medical attention is necessary as these could indicate more serious conditions.
• The study 1 notes that systemic therapies are rarely warranted but may include montelukast, aspirin, and oral T-cell inhibitors like cyclosporine and tacrolimus, although their efficacy is inconclusive due to the lack of randomized trials.

From the FDA Drug Label

The recommended dosage regimen for the treatment of bacterial conjunctivitis is: Instill 1 drop in the affected eye(s) twice daily, eight to twelve hours apart for the first two days and then instill 1 drop in the affected eye(s) once daily for the next five days. The initial approach to treating conjunctivitis with azithromycin ophthalmic solution is to:

• Instill 1 drop in the affected eye(s) twice daily for the first two days
• Instill 1 drop in the affected eye(s) once daily for the next five days 2 Key points:
• Wash hands prior to using the solution
• Invert the closed bottle and shake once before each use
• Avoid contaminating the applicator tip
• Patients should be advised not to wear contact lenses if they have signs or symptoms of bacterial conjunctivitis 2

From the Research

Initial Approach to Treating Conjunctivitis

The initial approach to treating conjunctivitis depends on the cause of the condition. According to 3, the most common overall cause of infectious conjunctivitis is viral, which usually does not require treatment. However, bacterial conjunctivitis, the second most common cause, can be treated with topical antibiotics to decrease the duration of the condition and allow for an earlier return to school or work.

Treatment Options

• For bacterial conjunctivitis, topical antibiotics such as azithromycin 1.5% ophthalmic solution can be effective, as shown in 4.
• For allergic conjunctivitis, treatment consists of topical antihistamines and mast cell stabilizers, such as olopatadine 0.2% ophthalmic solution, which has been shown to be effective in alleviating symptoms 5, 6.
• Topical dual-action agents, such as olopatadine, azelastine, and ketotifen, are commonly used to treat mild subtypes of allergic conjunctivitis and have been shown to be effective in reducing symptoms 7.

Considerations

• The majority of cases of bacterial conjunctivitis are self-limiting and do not require treatment in uncomplicated cases 3.
• Conjunctivitis caused by gonorrhea or chlamydia, as well as conjunctivitis in contact lens wearers, should be treated with antibiotics 3.
• Treatment for viral conjunctivitis is supportive, and antihistamines and mast cell stabilizers can alleviate the symptoms of allergic conjunctivitis 3.