What is the treatment for conjunctivitis (pink eye)?

Treatment of Conjunctivitis (Pink Eye)

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

Diagnosis and Classification

Conjunctivitis can be classified into three main types, each requiring different treatment approaches:

1. Viral Conjunctivitis

   • Characterized by: Watery discharge, burning sensation, gritty feeling, preauricular lymphadenopathy
   • Most common overall cause of infectious conjunctivitis 2

2. Bacterial Conjunctivitis

   • Characterized by: Mucopurulent discharge, eyelids matted shut upon waking, lack of itching
   • More common in children than adults 1

3. Allergic Conjunctivitis

   • Characterized by: Bilateral itching, watery discharge, eyelid edema, chemosis, papillary reaction
   • Encountered in up to 40% of the population 2

Treatment Algorithm

1. Viral Conjunctivitis

• Primary treatment: Supportive care only 1
  • Cold compresses
  • Refrigerated artificial tears
  • Topical antihistamine eye drops for symptomatic relief
• Avoid: Indiscriminate use of antibiotics or corticosteroids (can prolong adenoviral infections) 3
• Duration: Usually self-limiting, resolves within 1-2 weeks 2

2. Bacterial Conjunctivitis

• Uncomplicated cases:

  • Topical antibiotics can hasten clinical resolution 1
  • Options include:
    • Fluoroquinolones
    • Erythromycin ointment (apply directly to conjunctival sac 1-3 times daily) 4
    • Bacitracin ointment (apply directly to conjunctival sac 1-3 times daily) 5

• Special cases requiring aggressive treatment:

  • Gonococcal conjunctivitis: Systemic ceftriaxone plus topical antibiotics 1
  • Chlamydial conjunctivitis: Systemic erythromycin plus topical antibiotics 1

3. Allergic Conjunctivitis

• Simple measures: 3, 1

  • Wearing sunglasses as barrier to airborne allergens
  • Cold compresses
  • Refrigerated artificial tears
  • Avoiding eye rubbing and allergen exposure
  • Hypoallergenic bedding, eyelid cleansers

• Pharmacological treatment: 3

  • 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

Infection Control Measures

• Strict hand hygiene
• Avoid sharing towels and pillows
• Minimize contact with others for 10-14 days for viral conjunctivitis 1
• Patients should be instructed to avoid touching their eyes and wash hands frequently 6

Special Considerations

Contact Lens Wearers

• Discontinue lens wear until conjunctivitis resolves (higher risk for Pseudomonas infection) 1
• Should always be treated for bacterial conjunctivitis 7

When to Refer to Ophthalmology 1, 8

• Visual loss
• Moderate or severe pain
• Severe purulent discharge
• Corneal involvement
• Lack of response to therapy after 2-3 weeks
• Recurrent episodes
• History of HSV eye disease
• Immunocompromised patients
• Neonatal conjunctivitis
• Recent ocular surgery

Common Pitfalls to Avoid

• Using antibiotics unnecessarily for viral conjunctivitis
• Prolonged use of corticosteroids without monitoring intraocular pressure
• Delayed referral for severe or non-responsive cases
• Inadequate infection control leading to spread
• Continued contact lens wear during active infection 1

Remember that most cases of conjunctivitis are self-limiting, and treatment should focus on symptom relief while avoiding unnecessary medications that may cause complications.