What are the recommended eye drops for treating bilateral conjunctivitis?

Eye Drops for Bilateral Conjunctivitis

For bacterial conjunctivitis, topical fluoroquinolones such as moxifloxacin 0.5% or gatifloxacin 0.5% are the recommended first-line eye drops, administered 3 times daily for 7 days. For viral conjunctivitis, which is more common in adults, supportive care with artificial tears and cold compresses is recommended, as antibiotics are ineffective against viral causes.

Diagnosis and Classification

Before selecting eye drops, it's essential to determine the type of conjunctivitis:

• Bacterial conjunctivitis: Characterized by mucopurulent discharge, matted eyelids upon waking, and typically bilateral presentation 1
• Viral conjunctivitis: Presents with watery discharge, gritty sensation, often preceded by respiratory infection, with preauricular lymphadenopathy 1
• Allergic conjunctivitis: Marked by severe itching, watery discharge, and bilateral presentation 1

Treatment Recommendations by Type

Bacterial Conjunctivitis

1. First-line treatment:

   • Fluoroquinolones: Moxifloxacin 0.5% (3 times daily for 7 days) 2 or Gatifloxacin 0.5% (2-4 times daily for 7 days after initial loading dose) 3
   • These fourth-generation fluoroquinolones have better coverage of gram-positive pathogens than earlier generations 1

2. Alternative options:

   • Besifloxacin 0.6% with potency similar to fourth-generation agents 1
   • Broad-spectrum antibiotics like gentamicin or tetracycline 1

3. Clinical evidence:

   • Moxifloxacin 0.5% administered three times daily has been shown to cure bacterial conjunctivitis more effectively and significantly faster than polymyxin B/trimethoprim, with 81% resolution of symptoms within 48 hours 4

Viral Conjunctivitis

1. Primary treatment:

   • Supportive care with artificial tears for comfort 1
   • Cold compresses to reduce inflammation 5
   • Strict hygiene measures to prevent transmission 5

2. For severe cases:

   • Topical corticosteroids at minimum effective dose may be considered for adenoviral cases with severe symptoms, but must be tapered and may prolong viral shedding 1
   • For herpes simplex virus: Topical antivirals such as ganciclovir 0.15% gel or trifluridine 1% solution 1

Allergic Conjunctivitis

1. Recommended treatment:
   • Topical antihistamines with mast cell-stabilizing activity 1
   • Artificial tears to dilute allergens 1

Special Considerations

Contact Lens Wearers

• Always treat with antibiotics and consider systemic treatment 1
• Discontinue contact lens wear until the cornea returns to normal 5
• Consider alternatives to contact lenses once keratoconjunctivitis has resolved 5

Severe or Specialized Cases

• Gonococcal conjunctivitis: Requires systemic antibiotics (ceftriaxone) plus topical antibiotics 1
• Chlamydial conjunctivitis: Treat with oral azithromycin or tetracycline plus topical antibiotics 1

When to Refer to an Ophthalmologist

Immediate referral is necessary for patients with:

• 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 status 5

Prevention and Hygiene

• Frequent handwashing
• Avoid sharing towels or pillows
• Avoid touching or rubbing eyes
• Change pillowcases frequently during infection 1

Return to Work/School

Patients with bacterial conjunctivitis can typically return to work or school after 24 hours of antibiotic treatment, while those with viral conjunctivitis should minimize contact with others for 10-14 days from onset of symptoms 1.

Common Pitfalls to Avoid

1. Overuse of antibiotics for viral conjunctivitis
2. Prolonged use of corticosteroids without ophthalmology supervision
3. Failure to recognize potentially serious causes of conjunctivitis
4. Inadequate hygiene education
5. Delayed referral for severe or non-responsive cases 1

By correctly identifying the type of conjunctivitis and selecting appropriate eye drops, most cases can be effectively managed with good outcomes for vision and quality of life.