What is the treatment for conjunctivitis (pink eye)?

Treatment of Conjunctivitis (Pink Eye)

The treatment of conjunctivitis should be tailored to the specific type: viral conjunctivitis requires supportive care only, bacterial conjunctivitis may benefit from topical antibiotics, and allergic conjunctivitis responds to antihistamines and mast cell stabilizers. 1

Diagnosis and Classification

Before initiating treatment, it's crucial to identify the type of conjunctivitis:

• Viral Conjunctivitis (80% of cases)

  • Characterized by: Watery discharge, burning sensation, gritty feeling, preauricular lymphadenopathy
  • Most common cause overall 1, 2

• Bacterial Conjunctivitis

  • Characterized by: Mucopurulent discharge, eyelids matted shut upon waking, lack of itching
  • More common in children than adults 1, 3

• Allergic Conjunctivitis

  • Characterized by: Bilateral itching (key symptom), watery discharge, eyelid edema, chemosis, papillary reaction 1, 4

Treatment Algorithm

1. Viral Conjunctivitis

• Primary treatment: Supportive care only
  • Cold compresses
  • Refrigerated artificial tears for lubrication
  • 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, 2

2. Bacterial Conjunctivitis

• Treatment options:

  • Topical antibiotics to decrease duration and allow earlier return to school/work
  • Options include:
    • Bacitracin ophthalmic ointment applied 1-3 times daily 5
    • Erythromycin ophthalmic ointment 6
    • Fluoroquinolones for broader coverage 1

• Special cases requiring aggressive treatment:

  • Gonococcal conjunctivitis: Systemic ceftriaxone plus topical antibiotics
  • Chlamydial conjunctivitis: Systemic erythromycin plus topical antibiotics 1
  • Contact lens wearers: Require antibiotic treatment due to higher risk for Pseudomonas infection 1, 3

3. Allergic Conjunctivitis

• First-line treatment:

  • Topical antihistamines with mast cell-stabilizing activity 1, 3
  • Environmental modification to minimize allergen exposure
  • Cold compresses
  • Lubricating eye drops 1

• For moderate to severe cases:

  • Topical corticosteroids for acute exacerbations (short-term use)
  • Cyclosporine 0.05% for severe vernal/atopic conjunctivitis
  • Tacrolimus 0.1% for patients not responding to topical corticosteroids 1, 7

Important Precautions and Monitoring

• When using corticosteroids:

  • Monitor intraocular pressure (IOP)
  • Perform baseline and periodic measurements
  • Watch for glaucoma and cataract development
  • Use modified corticosteroids like loteprednol etabonate for improved safety profile 1, 7

• Contact lens considerations:

  • Suspend use until conjunctivitis resolves completely 1

• Infection control:

  • Strict hand hygiene
  • Avoid touching eyes
  • Sanitize surfaces 1, 2

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, 3

Common Pitfalls to Avoid

• Overuse of antibiotics for viral conjunctivitis (ineffective and contributes to resistance) 8, 3
• Prolonged use of corticosteroids without monitoring (can cause glaucoma and cataracts) 1
• Using antihistamines excessively (can worsen dry eye syndrome) 1
• Failing to recognize potentially serious causes requiring specialist care 1, 3
• Using punctal plugs (can prevent elimination of allergens and inflammatory mediators) 1