What are the treatment options for conjunctivitis?

Treatment Options for Conjunctivitis

Treatment for conjunctivitis should be directed at the underlying cause, with most cases requiring only supportive care rather than antibiotics. 1

Classification and Cause-Specific Treatment

Viral Conjunctivitis

• Most common overall cause of infectious conjunctivitis
• Treatment is primarily supportive:
  • Cold compresses
  • Refrigerated artificial tears
  • Topical antihistamine eye drops for symptomatic relief
  • Strict hand hygiene to prevent transmission
  • Avoid sharing towels and pillows
  • Minimize contact with others for 10-14 days 1
• For severe cases with corneal subepithelial infiltrates:
  • Topical corticosteroids at minimum effective dose may be used
  • Prefer corticosteroids with poor ocular penetration (fluorometholone, rimexolone, or loteprednol) to minimize IOP elevation risk 1

Bacterial Conjunctivitis

• Second most common cause of infectious conjunctivitis
• Most uncomplicated cases resolve in 1-2 weeks
• Topical antibiotics can hasten clinical and microbiological resolution:
  • Broad-spectrum fluoroquinolones (e.g., moxifloxacin) 1, 2
  • Alternatives: erythromycin or bacitracin
• Clinical trials with moxifloxacin showed:
  • 66-69% clinical cure rate by day 5-6
  • 84-94% microbiological eradication rate
  • 80% clinical cure rate in neonates by day 9 2
• Special cases requiring aggressive treatment:
  • Gonococcal conjunctivitis: systemic ceftriaxone plus topical antibiotics
  • Chlamydial conjunctivitis: systemic erythromycin plus topical antibiotics 1

Allergic Conjunctivitis

• Treatment options include:
  • Wearing sunglasses as allergen barrier
  • Cold compresses
  • Refrigerated artificial tears
  • Avoiding eye rubbing and allergen exposure
  • Using hypoallergenic bedding and eyelid cleansers 1
• Pharmacological treatment:
  • Over-the-counter topical antihistamine/vasoconstrictor agents for mild cases
  • Second-generation topical histamine H1-receptor antagonists for more effective relief
  • Mast-cell stabilizers or combination antihistamine/mast-cell stabilizer medications for persistent cases 1

Special Considerations

Contact Lens Wearers

• Discontinue lens wear until conjunctivitis resolves
• Higher risk for Pseudomonas infection 1

Ligneous Conjunctivitis

• Caused by plasminogen deficiency
• Treatment options:
  • Intravenous lysplasminogen
  • Topical plasminogen drops
  • Surgical excision with immediate anticoagulation and immunosuppression 3

When to Refer to an Ophthalmologist

Immediate referral is necessary for cases involving:

• Visual loss
• Moderate or severe pain
• Severe purulent discharge
• Corneal involvement
• Conjunctivital scarring
• Lack of response to therapy
• Recurrent episodes
• History of HSV eye disease
• Immunocompromised patients 3, 1

Follow-up Recommendations

• Uncomplicated cases: Return if symptoms persist beyond 2-3 weeks
• Cases treated with corticosteroids: Regular monitoring of intraocular pressure and pupillary dilation
• Severe cases: Re-evaluation within 1 week 1

Common 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 1

Infection Control

• Hand washing is crucial to reduce transmission risk
• Avoid sharing personal items like towels and pillows
• For contagious forms, counsel patients about transmission modes:
  • Eye-hand contact
  • Sexual contact (for certain types)
  • Exposure to contaminated droplets
  • Exposure to airborne pathogens 3, 1

Remember that most cases of conjunctivitis are self-limiting, and treatment should be targeted to the specific cause rather than empiric antibiotic use in all cases.