What eye drops are used to treat conjunctivitis (pink eye)?

Eye Drops for Conjunctivitis (Pink Eye)

The treatment of conjunctivitis depends on the specific cause, with topical antibiotics recommended for bacterial conjunctivitis, antihistamines for allergic conjunctivitis, and primarily supportive care for viral conjunctivitis. 1, 2

Bacterial Conjunctivitis

First-line Treatment

• Fluoroquinolone eye drops are recommended as first-line therapy:
  • Moxifloxacin 0.5% ophthalmic solution: 1 drop in affected eye 3 times daily for 7 days 2, 3
  • Alternative fluoroquinolones: besifloxacin, levofloxacin, gatifloxacin, ciprofloxacin, or ofloxacin 2

Dosing for Bacterial Conjunctivitis

• Moxifloxacin 0.5%: 1 drop 3 times daily for 7 days 3
• Ofloxacin: 1-2 drops every 2-4 hours for days 1-2, then 1-2 drops 4 times daily for days 3-7 4

Special Considerations

• Obtain conjunctival cultures if discharge is copious 2
• For gonococcal conjunctivitis: systemic antibiotics (ceftriaxone + azithromycin) plus topical treatment 2
• For chlamydial conjunctivitis: systemic therapy is required (azithromycin or doxycycline) 1
• Daily follow-up for gonococcal conjunctivitis until resolution 2
• Return for follow-up if symptoms persist after 3-4 days of treatment 2

Viral Conjunctivitis

Treatment

• Primarily supportive care:
  • Cold compresses
  • Artificial tears
  • Strict hand hygiene to prevent transmission 5

For HSV Conjunctivitis

• Ganciclovir 0.15% gel: 3-5 times daily (preferred due to less toxicity) 1
• Alternative: Trifluridine 1% solution 5-8 times daily 1
• Oral antivirals: Acyclovir (200-400mg five times daily), valacyclovir (500mg 2-3 times daily), or famciclovir (250mg twice daily) 1
• Avoid topical corticosteroids as they potentiate HSV infection 1
• Follow-up within 1 week of treatment 2

Allergic Conjunctivitis

First-line Treatment

• Topical antihistamines with mast cell-stabilizing properties 1, 5
  • Over-the-counter options: ketotifen, olopatadine
  • Prescription options: alcaftadine, bepotastine, epinastine, azelastine

Additional Measures

• Cold compresses
• Refrigerated artificial tears
• Avoiding allergens and eye rubbing 1
• Hypoallergenic bedding, eyelid cleansers, frequent clothes washing 1

For Persistent/Severe Allergic Conjunctivitis

• Brief course (1-2 weeks) of topical corticosteroids with low side effect profile (e.g., loteprednol, fluorometholone) 1
• Topical cyclosporine or tacrolimus for severe cases 1
• Caution: Monitor IOP and examine for cataract formation if corticosteroids are used 1

Common Pitfalls to Avoid

1. Inappropriate steroid use: Avoid in viral conjunctivitis, especially HSV, as they can worsen infection 1, 6

2. Prolonged antibiotic use: Can lead to resistance and overgrowth of non-susceptible organisms 3

3. Contact lens wear: Advise patients to avoid wearing contact lenses until conjunctivitis resolves 3

4. Misdiagnosis: Be alert for alarming signs that suggest more serious conditions (severe pain, decreased vision) 7

5. Inadequate follow-up: Ensure appropriate follow-up, especially for gonococcal, chlamydial, and HSV conjunctivitis 2

6. Missing underlying causes: Consider systemic conditions that may present with conjunctivitis 7

7. Overlooking neonatal conjunctivitis: Requires immediate referral to pediatrician, especially for gonococcal or chlamydial infection 2