What are the treatment options for conjunctivitis?

Treatment Options for Conjunctivitis

The primary treatment for conjunctivitis should be supportive care, with specific medications tailored to the underlying cause (viral, bacterial, or allergic), while avoiding unnecessary antibiotics or corticosteroids that can prolong viral infections or cause complications. 1

Classification and Targeted Treatment Approaches

1. Viral Conjunctivitis (Most Common - 80% of cases)

• Clinical features: Watery discharge, burning sensation, gritty feeling, preauricular lymphadenopathy 1, 2
• Treatment:
  • Supportive care is the mainstay of treatment:
    • Cold compresses
    • Refrigerated artificial tears
    • Topical antihistamine eye drops for symptomatic relief 1
  • Avoid antibiotics as they are ineffective against viral causes 1
  • Avoid corticosteroids unless specifically indicated, as they can prolong adenoviral infections and are contraindicated in herpetic infections 1, 3
  • For herpes simplex viral conjunctivitis: Trifluridine (Viroptic) if dendrites are present 3

2. Bacterial Conjunctivitis

• Clinical features: Mucopurulent discharge, eyelids matted shut upon waking, lack of itching 1, 4
• Treatment:
  • Topical antibiotics can hasten clinical and microbiological resolution 1
  • Options include:
    • Moxifloxacin ophthalmic solution 0.5%: One drop in affected eye 3 times daily for 7 days 5
    • Other broad-spectrum antibiotics: fluoroquinolones, erythromycin, or bacitracin 1
  • Special cases:
    • Gonococcal conjunctivitis: systemic ceftriaxone plus topical antibiotics 1
    • Chlamydial conjunctivitis: systemic erythromycin plus topical antibiotics 1

3. Allergic Conjunctivitis

• Clinical features: Bilateral itching, watery discharge, eyelid edema, chemosis 1
• Treatment:
  • Topical antihistamines with mast cell-stabilizing activity are the treatment of choice 4
  • Treatment progression:
    • Mild cases: Over-the-counter topical antihistamine/vasoconstrictor agents
    • Moderate cases: Second-generation topical histamine H1-receptor antagonists
    • Persistent cases: Mast-cell stabilizers or combination antihistamine/mast-cell stabilizer medications
    • Severe cases: Brief course of topical corticosteroids with low side effect profile 1
  • Allergen avoidance measures:
    • Wearing sunglasses as a barrier
    • Avoiding eye rubbing and allergen exposure
    • Using hypoallergenic bedding 1

Evidence-Based Treatment Considerations

• Moxifloxacin ophthalmic solution has demonstrated clinical cure rates of 66-69% in bacterial conjunctivitis with microbiological eradication rates of 84-94% 5
• In pediatric patients with bacterial conjunctivitis, moxifloxacin showed an 80% clinical cure rate and 92% microbiological eradication rate 5
• Delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing for bacterial conjunctivitis 4

Prevention and Infection Control

• Strict hand hygiene is crucial to prevent transmission 1, 6
• Avoid sharing towels and pillows 1
• Minimize contact with others for 10-14 days for viral conjunctivitis 1
• Patients should discontinue contact lens wear until conjunctivitis resolves 1, 5

When to Refer to an Ophthalmologist

Immediate referral is indicated for:

• 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 1, 4

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
• Using combination antibiotic-corticosteroid products for undiagnosed conjunctivitis (never use unless proven non-herpetic) 3

By following these evidence-based treatment guidelines, most cases of conjunctivitis can be effectively managed with appropriate supportive care and targeted therapy when indicated.