What is the management for conjunctivitis (pink eye)?

From the Guidelines

Management of conjunctivitis depends on its cause, with most cases resolving without specific treatment, and the primary goal is to reduce morbidity, mortality, and improve quality of life. For viral conjunctivitis, which is most common, treatment focuses on symptom relief with artificial tears, cold compresses, and good hygiene practices like frequent handwashing and avoiding touching the eyes, as recommended by the most recent study 1. This form typically resolves within 1-2 weeks without antibiotics. Bacterial conjunctivitis may benefit from antibiotic eye drops such as erythromycin ointment, polymyxin B-trimethoprim drops, or fluoroquinolones like ciprofloxacin or moxifloxacin, which are typically used 4 times daily for 5-7 days until symptoms resolve, as suggested by 1. Allergic conjunctivitis responds to allergen avoidance and antihistamine eye drops like ketotifen (Zaditor) or olopatadine (Patanol), used twice daily, as indicated by 1. Artificial tears can dilute allergens and irritants in all types of conjunctivitis.

Some key points to consider in the management of conjunctivitis include:

• Contact lens wearers should stop wearing lenses until symptoms resolve completely
• Patients should be advised that conjunctivitis is highly contagious, particularly viral and bacterial types, so they should avoid sharing towels, pillowcases, and makeup, and should stay home from work or school until discharge resolves, typically 24 hours after starting antibiotics for bacterial cases, as recommended by 1
• If symptoms worsen, vision becomes affected, or there's severe pain or light sensitivity, immediate medical attention is necessary as these could indicate more serious eye conditions, as suggested by 1
• Counseling is imperative for all contagious varieties of conjunctivitis to minimize or prevent spread of the disease in the community, and hand washing is important to reduce the risk of transmission of infection, as indicated by 1

It's essential to prioritize the most recent and highest quality study, which in this case is 1, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life. By following these guidelines and considering the most recent evidence, healthcare providers can provide effective management of conjunctivitis and improve patient outcomes.

From the FDA Drug Label

For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms. The ointment should be applied directly into the conjunctival sac 1 to 3 times daily. For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin.

The management for conjunctivitis (pink eye) includes applying ointment directly into the conjunctival sac 1 to 3 times daily, as stated in the drug labels for bacitracin (OPHTH) 2 and bacitracin (OPHTH) 2. The drug of choice may be either bacitracin or erythromycin, depending on the susceptible organisms causing the infection, as indicated in the drug labels for bacitracin (OPHTH) 2 and erythromycin (OPHTH) 3. Key points to consider:

• Apply ointment 1 to 3 times daily
• Use either bacitracin or erythromycin depending on the causative organisms
• Ensure proper hygiene when applying the ointment to avoid contamination, as instructed in the drug label for bacitracin (OPHTH) 2

From the Research

Management of Conjunctivitis (Pink Eye)

The management of conjunctivitis, also known as pink eye, depends on the cause of the infection. Here are some key points to consider:

• Viral Conjunctivitis: Usually does not require treatment, and signs and symptoms at presentation are variable 4.
• Bacterial Conjunctivitis: Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work. However, most uncomplicated cases resolve in 1 to 2 weeks without treatment 4, 5.
• Allergic Conjunctivitis: Treatment consists of topical antihistamines and mast cell inhibitors. Itching is the most consistent sign in allergic conjunctivitis 4, 6, 7.
• Conjunctivitis Secondary to Sexually Transmitted Diseases: Requires systemic treatment in addition to topical antibiotic therapy 4.
• Conjunctivitis in Contact Lens Wearers: Should be treated with antibiotics 4.

Treatment Options

Some treatment options for conjunctivitis include:

• Topical antibiotics, such as bacitracin, erythromycin, or aminoglycosides 8, 5
• Topical antihistamines, such as ketotifen, epinastine, or olopatadine 6, 7
• Mast cell stabilizers, such as cromolyn or nedocromil 6, 7
• Immunomodulators, such as cyclosporine A or tacrolimus, for severe cases of allergic conjunctivitis 6

Important Considerations

• The diagnosis of conjunctivitis is often clinical, and laboratory evaluation may not be necessary 8.
• The use of topical antibiotics should be based on the sensitivities of the likely pathogens 8.
• There is no long-term data on the efficacy of topical antihistamines and mast cell stabilizers for allergic conjunctivitis 7.