What is the treatment for conjunctivitis (pink eye) in an 11-year-old?

Treatment of Conjunctivitis in an 11-Year-Old

For bacterial conjunctivitis in an 11-year-old, topical antibiotics such as erythromycin ointment or ofloxacin drops should be applied 2-3 times daily for 5-7 days, as they are associated with earlier clinical remission compared to placebo. 1

Diagnosis and Differentiation

Before initiating treatment, it's crucial to determine the type of conjunctivitis:

• Bacterial conjunctivitis: Characterized by mucopurulent discharge and matted eyelids upon waking
• Viral conjunctivitis: Presents with watery discharge and often upper respiratory symptoms
• Allergic conjunctivitis: Distinguished by severe itching and history of allergies

No single sign or symptom accurately differentiates viral from bacterial conjunctivitis, but the type of discharge and associated symptoms can guide diagnosis 2.

Treatment Algorithm Based on Type

1. Bacterial Conjunctivitis

• First-line treatment: Topical antibiotics
  • Erythromycin ophthalmic ointment: Apply approximately 1 cm to affected eye(s) up to six times daily 3
  • Ofloxacin ophthalmic solution: Apply to affected eye(s) 2-3 times daily 4
  • Gentamicin, tetracycline, or fluoroquinolones are also effective options 1
• Duration: 5-7 days of treatment
• Return to school: After 24 hours of antibiotic treatment 1

2. Viral Conjunctivitis

• Treatment: Supportive care
  • Artificial tears for comfort
  • Cold compresses
  • Strict hygiene measures to prevent transmission
• Duration: Self-limiting, typically resolves within 7-10 days
• Return to school: Should minimize contact with others for 10-14 days from onset 1

3. Allergic Conjunctivitis

• Treatment: Topical antihistamines with mast cell-stabilizing activity
• For severe cases: Consider allergen-specific immunotherapy 1

Prevention of Spread

For all types of conjunctivitis, especially infectious forms:

• Frequent handwashing with soap and water
• Avoid sharing towels, washcloths, and pillows
• Avoid touching or rubbing eyes
• Change pillowcases frequently during infection 1

When to Refer to an Ophthalmologist

Immediate referral is necessary if the child presents with:

• Visual loss
• Moderate or severe pain
• Severe purulent discharge
• Corneal involvement
• Conjunctival scarring
• Lack of response to therapy after 2-3 days
• Recurrent episodes
• History of HSV eye disease
• Immunocompromised status 5, 1

Important Considerations

• Bacterial conjunctivitis may resolve spontaneously without treatment in 7-10 days, but antibiotics can reduce transmissibility and allow earlier return to school 1
• Avoid overuse of antibiotics for viral conjunctivitis
• Avoid prolonged use of corticosteroids without ophthalmology supervision
• Multiple-dose eyedrop containers should be discarded after treatment to prevent reinfection 5
• Reevaluation should be performed in 24-48 hours for simple cases that don't improve 1

For this 11-year-old patient, treatment should begin with appropriate antibiotics if bacterial conjunctivitis is suspected, or supportive care if viral or allergic causes are more likely. The benefits of antibiotics are most pronounced in days 2-5 of treatment, with diminishing advantage over placebo in days 6-10 1.