What are the treatment options for conjunctivitis?

Treatment Options for Conjunctivitis

The primary treatment for conjunctivitis depends on its etiology, with supportive care being the mainstay for viral conjunctivitis, topical antibiotics for bacterial conjunctivitis, and antihistamines for allergic conjunctivitis. 1

Diagnosis and Classification

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

• Viral conjunctivitis:

  • Watery discharge
  • Often bilateral
  • May have associated upper respiratory symptoms
  • Preauricular lymphadenopathy may be present

• Bacterial conjunctivitis:

  • Purulent or mucopurulent discharge
  • Matting of eyelids, especially upon waking
  • Conjunctival injection
  • Mild discomfort or foreign body sensation

• Allergic conjunctivitis:

  • Intense itching
  • Watery discharge
  • Often bilateral and seasonal

Treatment Approaches

1. Viral Conjunctivitis (Most Common)

• Supportive care is the mainstay of treatment:
  • Artificial tears for comfort
  • Cold compresses to reduce inflammation
  • Strict hygiene measures to prevent spread 1

2. Bacterial Conjunctivitis

• Topical broad-spectrum antibiotics for 5-7 days are recommended as first-line treatment 1
• Options include:
  • Moxifloxacin 0.5% ophthalmic solution: Instill one drop in the affected eye 3 times a day for 7 days 2
  • Polymyxin B-trimethoprim ophthalmic solution
  • Gentamicin ophthalmic solution 1
• Delayed antibiotic prescribing may be considered for mild cases, as it has similar symptom control as immediate prescribing 1, 3

3. Allergic Conjunctivitis

• Topical antihistamines with mast cell-stabilizing activity are the treatment of choice 3
• Cold compresses can provide symptomatic relief 1

Special Considerations

Specific Bacterial Infections

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

Herpes Simplex Virus

• If herpes simplex virus is suspected (vesicular rash or dendritic lesions), immediate referral to an ophthalmologist is necessary 1

Neonatal Conjunctivitis

• Requires immediate referral as it may indicate serious infections 1
• Different pathogens based on onset time:
  • 1-7 days: Gonococcal infection
  • 5-19 days: Chlamydial infection
  • First week: Common bacterial infections (S. aureus, Enterococcus, etc.)

Prevention and Hygiene

• Frequent handwashing
• Separate towels and washcloths
• Avoid sharing pillowcases
• Proper disinfection of toys and surfaces
• For contact lens wearers: discontinue lens wear until infection resolves 1

When to Refer to an Ophthalmologist

Refer patients with:

• Visual loss
• Moderate or severe pain
• Severe purulent discharge
• Corneal involvement
• Conjunctival scarring
• Lack of response to therapy after 3-4 days
• History of herpes simplex virus eye disease
• Immunocompromised status 1

Efficacy of Moxifloxacin

Moxifloxacin 0.5% ophthalmic solution has demonstrated:

• Clinical cure rates of 66-69% by days 5-6 in adult bacterial conjunctivitis
• Clinical cure rate of 80% by day 9 in neonatal bacterial conjunctivitis
• Microbiological eradication rates of 84-94% 2

The medication is effective against common conjunctival pathogens including Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, and Haemophilus influenzae 2.