What is the treatment for conjunctivitis discharge?

Treatment of Conjunctivitis Discharge

The treatment for conjunctivitis discharge should be determined by the underlying cause, with supportive care including artificial tears and warm compresses being the primary treatment for most types, while antibiotics should be reserved only for confirmed bacterial cases. 1

Diagnosis and Classification

Before initiating treatment, it's essential to determine the type of conjunctivitis based on:

• Discharge characteristics:

  • Watery discharge: Typically viral or allergic
  • Mucopurulent/purulent discharge: Typically bacterial
  • Stringy mucous discharge: Typically allergic

• Associated symptoms:

  • Itching: Predominant in allergic conjunctivitis
  • Foreign body sensation: Common in viral and bacterial
  • Bilateral vs. unilateral presentation (viral often starts unilateral, becomes bilateral)

Treatment Algorithm by Type

1. Viral Conjunctivitis (most common, ~80% of cases)

• Primary treatment: Supportive care 2, 1

  • Artificial tears for comfort
  • Cold compresses to reduce inflammation
  • Strict hygiene measures to prevent spread

• Duration: Self-limited, typically improves within 5-14 days 2

• Warning: Antibiotics are ineffective against viral causes and should be avoided 1

2. Bacterial Conjunctivitis

• Primary treatment: Topical broad-spectrum antibiotics for 5-7 days 1

  • Options include:
    • Polymyxin B-trimethoprim ophthalmic solution
    • Gentamicin ophthalmic solution
    • Moxifloxacin 0.5% ophthalmic solution
    • Bacitracin ophthalmic ointment for susceptible organisms 3
    • Erythromycin ophthalmic ointment for susceptible organisms 4

• Adjunctive measures:

  • Warm compresses (preferred over cold) to soften discharge and loosen crusts 1
  • Gentle cleansing of eyelid margins with clean, warm washcloth

• Special cases:

  • Gonococcal conjunctivitis: Requires both systemic (ceftriaxone) and topical therapy 1
  • Chlamydial conjunctivitis: Requires systemic therapy (azithromycin, doxycycline, or levofloxacin) 1

3. Allergic Conjunctivitis

• Primary treatment: Topical antihistamines with mast cell-stabilizing activity 1, 5
• Adjunctive measures:
  • Cold compresses for symptomatic relief
  • Artificial tears to dilute allergens
  • Allergen avoidance when possible

Management of Discharge

1. For all types:

   • Clean eyelids and lashes with warm water and clean cloth
   • Wipe from inner to outer corner of eye
   • Use separate cloth for each eye to prevent cross-contamination

2. For bacterial discharge:

   • Warm compresses help soften crusted discharge
   • Apply 3-4 times daily for 5-10 minutes
   • Gently clean away discharge after softening

3. For viral discharge:

   • Cold compresses may provide symptomatic relief
   • Artificial tears can help flush irritants and thin discharge

Prevention of Spread

• Frequent handwashing with soap and water
• Avoid touching or rubbing eyes
• Use separate towels and washcloths
• Avoid sharing pillowcases
• Disinfect surfaces with 1:10 dilute bleach solution 1
• For contact lens wearers: discontinue lens wear until infection resolves 1

When to Refer to Ophthalmology

Immediate referral is indicated for:

• Neonatal conjunctivitis (potential emergency) 1
• Moderate to severe pain
• Visual loss
• Corneal involvement
• No response to therapy after 3-4 days
• Suspected herpes simplex virus (vesicular rash or dendritic lesions) 1
• Immunocompromised patients

Common Pitfalls to Avoid

1. Overuse of antibiotics: Most conjunctivitis cases are viral and self-limiting; indiscriminate antibiotic use contributes to resistance 1, 6

2. Corticosteroid use without specialist guidance: Never use topical steroids without confirming non-herpetic etiology, as they can worsen herpetic infections 7

3. Inadequate hygiene measures: Failure to implement proper hygiene can lead to spread, especially in viral cases 8

4. Delayed referral for severe cases: Certain types of conjunctivitis require specialist care to prevent complications 1

5. Misdiagnosis of underlying causes: Conjunctival inflammation may be secondary to other conditions like dry eye or blepharitis that require specific treatment 2