What is the treatment for conjunctivitis in adults?

Treatment of Conjunctivitis in Adults

The treatment of conjunctivitis in adults should be tailored to the specific etiology, with mild bacterial conjunctivitis often resolving spontaneously without specific treatment in immunocompetent adults, while moderate to severe cases require appropriate antibiotic therapy based on the causative organism. 1

Diagnosis and Classification

Before initiating treatment, it's essential to identify the type of conjunctivitis:

1. Viral conjunctivitis

   • Most common cause (80% of acute cases) 2
   • Typically presents with watery discharge 3
   • Often associated with preauricular lymphadenopathy
   • Follicular reaction in inferior fornix 4

2. Bacterial conjunctivitis

   • Characterized by mucopurulent discharge with eyelids matted shut 3
   • Key indicators: morning eyelid adherence, lack of itching 5

3. Allergic conjunctivitis

   • Itching is the most consistent sign 5
   • Watery discharge similar to viral conjunctivitis 3

Treatment Algorithm

1. Viral Conjunctivitis

• Primary treatment: Supportive care
  • Artificial tears
  • Cold compresses
  • Antihistamine eye drops for symptomatic relief 3
• Infection control: Strict hygiene with frequent handwashing
• Avoid: Corticosteroids unless under ophthalmologist supervision (especially if herpes suspected) 4
• Follow-up: Self-limited, but advise return if symptoms worsen or persist beyond 7-10 days

2. Bacterial Conjunctivitis

Mild Bacterial Conjunctivitis

• May resolve spontaneously without treatment in immunocompetent adults 1
• Topical antibiotics can provide:
  • Earlier clinical and microbiological remission (days 2-5)
  • Reduced transmissibility
  • Shortened morbidity 1
• Recommended regimen: 5-7 day course of broad-spectrum topical antibiotic
  • Example: Moxifloxacin ophthalmic solution - one drop in affected eye 3 times daily for 7 days 6
• Alternative in resource-limited settings: Povidone-iodine 1.25% ophthalmic solution 1

Moderate to Severe Bacterial Conjunctivitis

• Obtain cultures if purulent discharge is copious or gonococcal infection is suspected
• Empiric broad-spectrum antibiotic pending culture results
• For MRSA concerns: Consider specialized antibiotics based on laboratory testing (e.g., vancomycin) 1

Special Cases

Gonococcal Conjunctivitis:

• Requires systemic antibiotics (not just topical)
• Saline lavage for comfort and faster resolution
• Daily monitoring until resolution
• Sexual contact tracing and treatment 1

Chlamydial Conjunctivitis:

• Systemic antibiotic therapy is necessary
• Sexual contact treatment concurrently
• Re-evaluation after treatment due to 19% treatment failure rate 1

3. Allergic Conjunctivitis

• First-line: Topical antihistamines with mast cell-stabilizing activity 3, 5
• Environmental modifications to reduce allergen exposure

Important Considerations

• Avoid indiscriminate use of topical antibiotics or corticosteroids 1
• Never use corticosteroids unless conjunctivitis is proven non-herpetic 4
• Disinfection protocols:
  • Dilute bleach soak (1:10 concentration) for tonometers
  • EPA-registered hospital disinfectants for surfaces 1
• Immediate ophthalmology referral for:
  • Severe pain
  • Decreased vision
  • Recent ocular surgery
  • Vesicular rash on eyelids/nose
  • Immunocompromised patients
  • Neonatal conjunctivitis 3

Common Pitfalls

1. Misdiagnosis: No single sign reliably differentiates viral from bacterial conjunctivitis
2. Overtreatment: Unnecessary antibiotics for viral conjunctivitis
3. Undertreatment: Failing to recognize serious causes requiring systemic treatment
4. Corticosteroid misuse: Can worsen herpetic infections and lead to vision loss
5. Inadequate follow-up: Especially for gonococcal or chlamydial infections

By following this evidence-based approach to conjunctivitis treatment, clinicians can effectively manage this common condition while minimizing complications and preventing unnecessary antibiotic use.