What is the treatment for conjunctivitis (pink eye)?

Treatment for Pink Eye (Conjunctivitis)

The treatment for pink eye depends on its cause, with mild bacterial conjunctivitis often resolving without antibiotics, viral conjunctivitis requiring supportive care, and allergic conjunctivitis responding to antihistamines. 1, 2

Diagnosis by Type

Bacterial Conjunctivitis

• Presentation: Mucopurulent discharge, eyelids matted shut (especially in the morning)
• More common in children 3
• Treatment:
  • Mild cases: May resolve spontaneously without antibiotics within 7-10 days 1
  • Moderate to severe cases: Topical antibiotics such as:
    • Ofloxacin ophthalmic solution for infections caused by susceptible bacteria 4
    • Broad-spectrum topical antibiotics applied 2-3 times daily for 5-7 days 2

Viral Conjunctivitis

• Presentation: Watery discharge, gritty sensation, often preceded by respiratory infection
• Most common cause overall (80% of acute cases) 5
• Treatment:
  • Primarily supportive care with artificial tears and cold compresses 3
  • Strict hygiene measures to prevent transmission
  • For adenoviral cases with severe symptoms (blurring, photophobia):
    • Topical corticosteroids at minimum effective dose may be considered 1
    • Caution: Corticosteroids must be tapered and may prolong viral shedding

Herpes Simplex Virus Conjunctivitis

• Treatment:
  • Topical antivirals: ganciclovir 0.15% gel (3-5 times daily) or trifluridine 1% solution (5-8 times daily) 1
  • Oral antivirals: acyclovir, valacyclovir, or famciclovir 1
  • Avoid topical corticosteroids as they potentiate HSV infection 1

Allergic Conjunctivitis

• Presentation: Severe itching, watery discharge, often bilateral
• Treatment:
  • Topical antihistamines with mast cell-stabilizing activity 3
  • Artificial tears and cold compresses

Treatment Algorithm

1. Determine the likely cause:

   • Bacterial: Mucopurulent discharge, matted eyelids
   • Viral: Watery discharge, often with upper respiratory symptoms
   • Allergic: Itching, history of allergies, bilateral presentation

2. For suspected bacterial conjunctivitis:

   • If mild: Consider observation for 2-3 days
   • If moderate/severe or no improvement: Start topical antibiotics
   • For contact lens wearers: Always treat with antibiotics and consider systemic treatment 2

3. For viral conjunctivitis:

   • Supportive care (artificial tears, cold compresses)
   • Strict hygiene to prevent spread
   • Monitor for corneal subepithelial infiltrates (may require topical corticosteroids if vision affected) 1

4. For allergic conjunctivitis:

   • Topical antihistamines/mast cell stabilizers
   • Avoid allergen exposure

Special Considerations

• Neonatal conjunctivitis: Requires immediate attention and systemic antibiotics if gonococcal or chlamydial infection is suspected 2, 6
• Contact lens wearers: Higher risk for bacterial keratitis; should discontinue lens wear during infection 2
• Immediate ophthalmology referral for:
  • Severe pain
  • Decreased vision
  • Recent eye surgery
  • Immunocompromised patients
  • No improvement after 1 week of treatment 3

Prevention and Hygiene

• Frequent handwashing
• Avoid sharing towels, pillows, or washcloths
• Avoid touching or rubbing eyes
• Change pillowcases frequently during infection
• Children can typically return to school after 24 hours of antibiotic treatment for bacterial conjunctivitis 2

Remember that most cases of conjunctivitis are self-limiting, but proper diagnosis and treatment can reduce symptom duration and prevent complications.