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. 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 1

• Allergic Conjunctivitis:

  • Bilateral itching (most consistent sign)
  • Watery discharge
  • Eyelid edema
  • Chemosis and papillary reaction 1

Treatment Approaches

1. Supportive Care (All Types)

• Cold compresses
• Refrigerated artificial tears
• Topical antihistamine eye drops for symptomatic relief
• Strict hand hygiene to prevent spread 1

2. Viral Conjunctivitis

• Primarily supportive care as described above
• Avoid corticosteroids unless specifically indicated
• Instruct patients to avoid touching eyes and wash hands frequently
• Minimize contact with others for 10-14 days 1, 2

3. Bacterial Conjunctivitis

• Topical antibiotics:

  • Broad-spectrum options including fluoroquinolones like moxifloxacin 0.5%
  • Dosing: One drop in affected eye 3 times daily for 7 days 3
  • Clinical cure rates of 66-69% by day 5-6 with moxifloxacin 3
  • Alternatives include erythromycin or bacitracin 1

• Special cases requiring aggressive treatment:

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

4. Allergic Conjunctivitis

• Topical antihistamines and mast cell stabilizers for mild to moderate cases
• Topical corticosteroids for acute exacerbations (short-term use only)
• Cyclosporine 0.05% for severe vernal/atopic conjunctivitis
• Tacrolimus 0.1% for patients who don't respond to topical corticosteroids
• Environmental modifications to minimize allergen exposure 1

Important Considerations and Precautions

• Contact lens wear: Suspend use until conjunctivitis resolves completely 1, 3
• Corticosteroid monitoring: Regular monitoring of intraocular pressure and pupillary dilation when using corticosteroids 1
• Antibiotic resistance: Consider delayed antibiotic prescribing for uncomplicated bacterial conjunctivitis 4
• Hypersensitivity reactions: Discontinue medication immediately if allergic reactions occur 3

When to Refer to a Specialist

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

• Overuse of antibiotics: Most viral and many bacterial cases are self-limiting 5
• Inappropriate corticosteroid use: Never use in undiagnosed or potentially herpetic cases 6
• Inadequate infection control: Strict hand hygiene and avoiding sharing of personal items are essential 1
• Prolonged corticosteroid use: Can cause glaucoma and cataracts 1
• Antihistamine overuse: Can induce or worsen dry eye syndrome 1

Following these treatment guidelines while considering the specific type of conjunctivitis will help ensure optimal outcomes and prevent complications.