Treatment Options for Conjunctivitis
The treatment of conjunctivitis should be directed at the underlying cause, with most cases requiring only supportive care rather than antibiotics. 1, 2
Diagnosis and Classification
Conjunctivitis can be classified into three main types, each with distinct presentations:
Viral Conjunctivitis
- Watery discharge, burning sensation, gritty feeling
- Preauricular lymphadenopathy
- Most common cause (80% of acute cases)
Bacterial Conjunctivitis
- Mucopurulent discharge
- Eyelids matted shut upon waking
- Lack of itching
- More common in children than adults
Allergic Conjunctivitis
- Bilateral itching (hallmark symptom)
- Watery discharge
- Eyelid edema, chemosis
- Papillary reaction
Treatment Algorithm
1. Viral Conjunctivitis
- Primary treatment: Supportive care
- Cold compresses
- Refrigerated artificial tears
- Topical antihistamine eye drops for symptomatic relief
- Infection control: Critical to prevent spread
- Strict hand hygiene
- Avoid sharing towels and pillows
- Minimize contact with others for 10-14 days
- Duration: Self-limited, typically resolves in 1-2 weeks
- Caution: Avoid topical corticosteroids unless specifically indicated for severe subepithelial infiltrates
2. Bacterial Conjunctivitis
- Uncomplicated cases:
- Special cases requiring aggressive treatment:
- Gonococcal conjunctivitis: Systemic ceftriaxone plus topical antibiotics
- Chlamydial conjunctivitis: Systemic erythromycin plus topical antibiotics
3. Allergic Conjunctivitis
- Simple measures:
- Wearing sunglasses as barrier to allergens
- Cold compresses
- Refrigerated artificial tears
- Avoiding eye rubbing and allergen exposure
- Hypoallergenic bedding and eyelid cleansers
- Pharmacological treatment:
- Mild cases: Over-the-counter topical antihistamine/vasoconstrictor agents
- More effective: Second-generation topical histamine H1-receptor antagonists
- Persistent cases: Mast-cell stabilizers or combination antihistamine/mast-cell stabilizer medications
- Severe cases: Brief course (1-2 weeks) of topical corticosteroids with low side effect profile
Special Considerations
When to Refer to an Ophthalmologist
Immediate referral is necessary for cases involving:
- Visual loss
- Moderate or severe pain
- Severe purulent discharge
- Corneal involvement
- Conjunctival scarring
- Lack of response to therapy
- Recurrent episodes
- History of HSV eye disease
- Immunocompromised patients 1, 2
Contact Lens Wearers
- Should discontinue lens wear until conjunctivitis resolves
- Higher risk for Pseudomonas infection
- May require more aggressive treatment
Pitfalls to Avoid
- Indiscriminate use of antibiotics for viral conjunctivitis
- Prolonged use of corticosteroids without monitoring IOP
- Delayed referral for severe or non-responsive cases
- Inadequate infection control leading to spread
- Continued contact lens wear during active infection 2
Follow-Up Recommendations
- Uncomplicated cases: Return if symptoms persist beyond 2-3 weeks
- Cases treated with corticosteroids: Regular monitoring of IOP
- Severe cases: Re-evaluation within 1 week 2
Efficacy of Treatments
- Moxifloxacin ophthalmic solution 0.5% demonstrated clinical cure rates of 66-69% by day 5-6 in bacterial conjunctivitis, with microbiological eradication rates of 84-94% 3
- In pediatric patients, including neonates, moxifloxacin showed clinical cure rates of 80% and microbiological eradication rates of 92% 3
Remember that most cases of conjunctivitis are self-limited, but proper diagnosis and targeted treatment can reduce symptoms, prevent complications, and minimize spread of infectious forms.