What is the treatment for conjunctivitis?

Treatment of Conjunctivitis

The treatment of conjunctivitis should be tailored to its specific cause, with viral conjunctivitis managed primarily with supportive care, bacterial conjunctivitis treated with topical antibiotics, and allergic conjunctivitis managed with topical antihistamines and mast cell stabilizers. 1

Diagnosis and Classification

Conjunctivitis can be classified as:

• Infectious (viral or bacterial)
• Allergic
• Mechanical/irritative/toxic

Key Diagnostic Features

• Viral conjunctivitis: Watery discharge, often bilateral, may have associated upper respiratory symptoms
• Bacterial conjunctivitis: Mucopurulent discharge, mattering and adherence of eyelids on waking
• Allergic conjunctivitis: Itching is the most consistent sign, often bilateral, seasonal patterns

Treatment Approaches by Type

Viral Conjunctivitis

Viral conjunctivitis is self-limiting and primarily requires supportive care:

• Artificial tears for symptomatic relief
• Cold compresses to reduce inflammation and discomfort
• Antihistamine eye drops for itching 1
• Strict personal hygiene with frequent handwashing to prevent transmission

For specific viral types:

• Herpes simplex/zoster: Topical ganciclovir 0.15% gel or trifluridine 1% solution; oral antivirals (acyclovir, valacyclovir, famciclovir) may be needed 1

Bacterial Conjunctivitis

While 41% of bacterial conjunctivitis cases resolve without treatment by days 6-10 1, topical antibiotics are recommended to:

• Decrease duration of symptoms
• Allow earlier return to work or school
• Prevent complications

Treatment options:

• 5-7 day course of broad-spectrum topical antibiotics 1
• Moxifloxacin 0.5% ophthalmic solution is effective against a wide range of gram-positive and gram-negative bacteria 2
• Gatifloxacin is also effective against common conjunctivitis-causing organisms 3
• Delayed antibiotic prescribing may be considered for mild cases 1

Special considerations:

• Conjunctivitis secondary to sexually transmitted infections (chlamydia, gonorrhea) requires systemic antibiotics in addition to topical therapy 1
• Patients can typically return to work or school after 24 hours of antibiotic treatment 1

Allergic Conjunctivitis

Allergic conjunctivitis affects up to 40% of the population 4 and requires:

• Topical antihistamines with mast cell-stabilizing activity 1, 5
• For severe acute exacerbations, modified corticosteroids like loteprednol etabonate may be used (better safety profile than traditional corticosteroids) 6
• Artificial tears to dilute allergens

Special Types of Conjunctivitis

Giant Papillary Conjunctivitis (GPC)

• Replace contact lenses more frequently
• Decrease wearing time
• Use preservative-free lens care systems
• Consider switching to daily disposable lenses
• Treat associated conditions like aqueous tear deficiency and meibomian gland dysfunction 7

Floppy Eyelid Syndrome

• Temporary relief by taping eyelids shut or wearing protective shield while sleeping
• Lubricants for mild cases
• Surgical intervention for definitive treatment
• Evaluate for sleep apnea, which is commonly associated 7

Giant Fornix Syndrome

• Prolonged systemic anti-staphylococcal antibiotics
• Intensive topical antibiotics and corticosteroids
• Consider supratarsal injections of antibiotics and corticosteroids
• Obtain cultures before starting treatment due to risk of MRSA 7

When to Refer to an Ophthalmologist

Immediate referral is indicated for:

• Neonatal conjunctivitis
• Severe pain
• Decreased vision
• Corneal involvement
• Conjunctival scarring
• Lack of response to therapy after 3-4 days
• Recurrent episodes
• History of herpes simplex virus eye disease
• Immunocompromised patients 1

Common Pitfalls to Avoid

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

Prevention

• Frequent handwashing
• Avoid sharing towels and pillowcases
• Appropriate contact lens care
• Patients with viral conjunctivitis should minimize contact with others for 10-14 days from symptom onset 1

By following these treatment guidelines based on the specific type of conjunctivitis, most cases can be effectively managed with good outcomes and minimal complications.