What are the treatment options for conjunctivitis?

Treatment Options for Conjunctivitis

The treatment of conjunctivitis should be tailored to the specific type (viral, bacterial, or allergic), with supportive care being the primary approach for most cases, while reserving antibiotics for confirmed bacterial infections and antihistamines for allergic cases. 1

Classification and Diagnosis

Conjunctivitis can be classified into three main types, each with distinct characteristics:

• Viral Conjunctivitis:

  • Watery discharge
  • Burning sensation
  • Gritty feeling
  • Preauricular lymphadenopathy
  • Most common type (80% of acute cases) 2

• Bacterial Conjunctivitis:

  • Mucopurulent discharge
  • Eyelids matted shut upon waking
  • Lack of itching
  • More common in children than adults

• Allergic Conjunctivitis:

  • Bilateral itching (most consistent sign)
  • Watery discharge
  • Eyelid edema
  • Chemosis
  • Papillary reaction

Treatment Approaches

1. Viral Conjunctivitis

• Primary treatment: Supportive care 1, 3
  • Cold compresses
  • Refrigerated artificial tears
  • Topical antihistamine eye drops for symptomatic relief
• Infection control:
  • Strict hand hygiene
  • Avoid sharing towels and pillows
  • Minimize contact with others for 10-14 days 1
• Special consideration: If herpes simplex virus is suspected (presence of dendrites), trifluridine (Viroptic) is preferred and referral to an ophthalmologist is advisable 4

2. Bacterial Conjunctivitis

• Treatment options:
  • Topical antibiotics (decrease duration and allow earlier return to work/school) 1, 5
  • Broad-spectrum options include fluoroquinolones like moxifloxacin 0.5% 6
  • Dosing: One drop in affected eye 3 times daily for 7 days 6
  • Alternatives: erythromycin or bacitracin 1
• Special cases:
  • Gonococcal conjunctivitis: systemic ceftriaxone plus topical antibiotics 1
  • Chlamydial conjunctivitis: systemic erythromycin plus topical antibiotics 1
  • Contact lens wearers: higher risk for Pseudomonas infection 1, 5

3. Allergic Conjunctivitis

• First-line treatment:
  • Topical antihistamines with mast cell-stabilizing activity 1, 3
  • Environmental modification to minimize allergen exposure 1
  • Cold compresses
  • Lubricating eye drops
• For severe cases:
  • Topical corticosteroids for acute exacerbations 1
  • Cyclosporine 0.05% for severe vernal/atopic conjunctivitis 1
  • Tacrolimus 0.1% for patients not responding to corticosteroids 1

Important Precautions

• Contact lens wear: Advise patients to avoid wearing contact lenses until conjunctivitis resolves 1, 6
• Corticosteroid use:
  • Never use corticosteroids unless proven to be non-herpetic 4
  • Monitor intraocular pressure when using corticosteroids 1
  • Prolonged use can cause glaucoma and cataracts 1
• Antibiotic considerations:
  • Prolonged use may result in overgrowth of non-susceptible organisms 6
  • Moxifloxacin is contraindicated in patients with hypersensitivity to quinolones 6

When to Refer to an Ophthalmologist

Immediate referral is indicated for cases involving:

• 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, 3

Treatment Efficacy

Clinical trials have shown that moxifloxacin ophthalmic solution produced clinical cures in 66-69% of patients with bacterial conjunctivitis after 3 times daily dosing for 4 days, with microbiological success rates of 84-94% 6. In pediatric patients, including neonates, clinical cure rates of 80% and microbiological eradication rates of 92% have been reported 6.

Most uncomplicated cases of bacterial conjunctivitis are self-limiting, but treatment with antibiotics can shorten the course of disease and prevent complications in high-risk cases 5, 7.