What is the treatment for conjunctivitis (pink eye)?

From the Guidelines

The treatment for conjunctivitis depends on its cause, and early detection and treatment can be both sight-saving and, in select cases, lifesaving. For bacterial conjunctivitis, antibiotic eye drops or ointments like erythromycin, polymyxin B/trimethoprim, or ciprofloxacin are typically prescribed, used 3-4 times daily for 5-7 days 1. Viral conjunctivitis, the most common type, usually resolves on its own within 1-2 weeks without specific medication, though artificial tears can provide symptom relief. Allergic conjunctivitis responds well to antihistamine eye drops like ketotifen (Zaditor) or olopatadine (Pataday), used as directed, often twice daily.

Key Considerations

• Applying a clean, cool compress to closed eyes several times daily can reduce discomfort, and avoiding eye rubbing prevents spreading infection.
• Good hygiene is essential: wash hands frequently, use separate towels and pillowcases, and dispose of eye makeup that may be contaminated.
• Contact lens wearers should temporarily switch to glasses until symptoms resolve.
• If symptoms worsen or don't improve within a few days, medical attention is necessary as untreated severe cases can lead to corneal damage and vision problems 1.

Prevention and Counseling

Prevention of conjunctivitis is also crucial, especially in cases of infectious conjunctivitis, where early diagnosis and treatment can reduce the public health and economic impact of community spread 1. Counseling is imperative for all contagious varieties of conjunctivitis to minimize or prevent spread of the disease in the community. Hand washing is important to reduce the risk of transmission of infection. Return to school or work depends on the age of the patient, occupation, and type and severity of conjunctivitis.

From the FDA Drug Label

For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms. For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin. The treatment for conjunctivitis (pink eye) is application of ointment directly into the conjunctival sac 1 to 3 times daily, as stated in the dosage and administration section of the drug label 2 and 2.

• The ointment should be applied uniformly over the lid margins in cases of blepharitis.
• Patients should take measures to avoid gross contamination of the ointment when applying it to the infected eye 2.
• Erythromycin and bacitracin are two possible treatments for conjunctivitis, but the choice of treatment depends on the causative organism 2 and 3.

From the Research

Treatment for Conjunctivitis (Pink Eye)

The treatment for conjunctivitis, also known as pink eye, depends on the underlying cause of the condition.

• For bacterial conjunctivitis, treatment with a broad-spectrum antibiotic can resolve the problem in 1 to 3 days in almost all cases 4.
• Viral conjunctivitis usually does not require treatment, but supportive care options such as artificial tears, cold compresses, and antihistamine eye drops can help alleviate symptoms 5, 6.
• Allergic conjunctivitis can be treated with topical antihistamines and mast cell stabilizers 5, 6.

Antibiotic Treatment

• Topical antibiotics can decrease the duration of bacterial conjunctivitis and allow for an earlier return to school or work 5.
• However, delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing 6.
• Conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics 5.

Corticosteroid Treatment

• Topical corticosteroids can be useful in treating ocular inflammation, but their use is generally recommended in severe cases of conjunctivitis due to potential risks such as prolonging adenoviral infections and potentiating/worsening herpes simplex virus infections 7.
• Ophthalmic formulations that combine corticosteroids with broad-spectrum anti-infectives could be effective and well-tolerated when used for short-term treatment (≤2 weeks) 7.

Referral to an Ophthalmologist

• Referral to an ophthalmologist 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, 6, 8.
• If no improvement is seen after ten days of treatment, or if the red eye is chronic or recurrent, referral to an ophthalmologist is also indicated 8.