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 viral conjunctivitis, topical antibiotics for bacterial cases, and antihistamines or mast cell stabilizers for allergic conjunctivitis. 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

Viral Conjunctivitis

• Supportive care is the mainstay of treatment:

  • Cold compresses
  • Refrigerated artificial tears
  • Topical antihistamine eye drops for symptomatic relief
  • Strict hand hygiene to prevent transmission
  • Avoid sharing towels and pillows
  • Minimize contact with others for 10-14 days 1

• No specific antiviral treatment is routinely recommended for most cases 3

Bacterial Conjunctivitis

• Topical antibiotics are indicated, especially for:

  • Severe cases
  • Contact lens wearers (higher risk for Pseudomonas infection)
  • Cases caused by gonorrhea or chlamydia 1

• Fluoroquinolones such as moxifloxacin 0.5% ophthalmic solution:

  • Dosage: One drop in affected eye 3 times a day for 7 days
  • Effective against a wide range of pathogens
  • Clinical cure rates of 66-69% after 5-6 days of treatment 4

• Special cases requiring systemic treatment:

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

Allergic Conjunctivitis

• First-line treatment:

  • Topical antihistamines
  • Mast cell stabilizers
  • Combination products (antihistamine + mast cell stabilizer) 1

• For moderate to severe cases:

  • Topical corticosteroids for acute exacerbations
  • Cyclosporine 0.05% for severe vernal/atopic conjunctivitis
  • Tacrolimus 0.1% for patients who don't respond to corticosteroids 1

• Environmental modifications:

  • Minimize exposure to allergens
  • Apply cold compresses
  • Use lubricating eye drops 1

Important Considerations and Precautions

• Contact lens wear: Patients should avoid wearing contact lenses until conjunctivitis resolves 1, 4

• Corticosteroid use precautions:

  • Monitor intraocular pressure (IOP)
  • Perform baseline and periodic measurements
  • Watch for development of glaucoma and cataracts 1

• Antibiotic resistance concerns:

  • Delayed antibiotic prescribing may be appropriate for mild bacterial cases 5
  • Avoid unnecessary antibiotic use for viral conjunctivitis 6

Indications for Specialist Referral

Refer to an ophthalmologist if any of the following are present:

• 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, 5

Treatment Pitfalls to Avoid

• Misdiagnosis: No single sign or symptom accurately differentiates viral from bacterial conjunctivitis 5

• Inappropriate corticosteroid use: Can worsen herpes simplex keratitis and increase risk of glaucoma and cataracts 1

• Overuse of antibiotics: Most viral and many bacterial cases are self-limiting 6

• Neglecting infection control: Strict hand hygiene and avoiding sharing personal items are essential to prevent spread 1, 2