What is the treatment for conjunctivitis?

Treatment of Conjunctivitis

The treatment of conjunctivitis must be specifically tailored to the underlying cause, with antibiotics indicated for bacterial conjunctivitis, antihistamines for allergic conjunctivitis, and supportive care for viral conjunctivitis. 1

Types of Conjunctivitis and Their Management

Viral Conjunctivitis

• Most cases of acute infectious conjunctivitis in adults are viral and self-limited, not requiring antimicrobial treatment 2
• Adenoviral conjunctivitis (epidemic keratoconjunctivitis) is highly contagious and patients should minimize contact with others for 10-14 days from symptom onset 2
• Treatment is supportive and may include:
  • Artificial tears
  • Topical antihistamines
  • Cold compresses
  • Oral analgesics 2, 3
• Antibiotics should be avoided in viral conjunctivitis due to potential adverse effects 2
• Topical corticosteroids may be helpful in severe cases with marked chemosis, eyelid swelling, epithelial sloughing, or membranous conjunctivitis, but require close follow-up 2

Herpes Simplex Virus Conjunctivitis

• Treatment options include:
  • Topical ganciclovir 0.15% gel three to five times daily
  • Trifluridine 1% solution five to eight times daily
  • Oral antivirals: acyclovir (200-400 mg five times daily), valacyclovir (500 mg two or three times daily), or famciclovir (250 mg twice daily) 2
• Topical corticosteroids should be avoided as they potentiate HSV infection 2
• Follow-up within one week of treatment is recommended 2

Varicella Zoster Virus Conjunctivitis

• For persistent or recalcitrant cases, oral antivirals are beneficial:
  • Acyclovir 800 mg five times daily for 7 days
  • Valacyclovir 1000 mg every 8 hours for 7 days
  • Famciclovir 500 mg three times daily for 7 days 2
• Immunocompromised patients may need more aggressive treatment 2
• Caution with systemic antiviral therapy in patients with impaired renal clearance 2

Bacterial Conjunctivitis

• Mild bacterial conjunctivitis:

  • Often self-limited and resolves spontaneously in immunocompetent adults 2
  • A 5-7 day course of broad-spectrum topical antibiotics can shorten duration and reduce transmissibility 2, 4
  • No specific antibiotic has proven superiority; choose the most convenient or least expensive option 2

• Moderate to severe bacterial conjunctivitis:

  • Characterized by copious purulent discharge, pain, and marked inflammation 2
  • Obtain conjunctival cultures and Gram staining if gonococcal infection is suspected 2
  • Antibiotic choice should be guided by laboratory results 2
  • MRSA infections may require specialized treatment as they are resistant to many commercially available antibiotics 2

• Gonococcal conjunctivitis:

  • Requires systemic antibiotic therapy 2
  • Saline lavage may promote comfort and faster resolution 2
  • Daily follow-up until resolution is necessary 2

• Chlamydial conjunctivitis:

  • Requires systemic therapy, especially in infants who may have infection at other sites 2
  • Sexual contacts should be treated concurrently 2
  • Re-evaluation after treatment is important due to potential treatment failure (up to 19%) 2

Allergic Conjunctivitis

• Topical antihistamines with mast cell-stabilizing activity are the treatment of choice 3
• Identifying and avoiding triggering allergens is important 1
• In severe cases, brief courses of topical corticosteroids may be required 1

Special Considerations

Contact Lens Wearers

• Patients should be advised not to wear contact lenses if they have signs or symptoms of bacterial conjunctivitis 5
• Contact lens use should be suspended until complete resolution of conjunctivitis 1

Prevention of Transmission

• Strict personal hygiene including frequent handwashing is essential 3
• Avoid sharing towels, pillows, or cosmetics 1
• For adenoviral conjunctivitis, minimize contact with others for 10-14 days 2

When to Refer to an Ophthalmologist

Patients should be evaluated by an ophthalmologist in the following circumstances:

• Visual loss
• Moderate or severe pain
• Severe purulent discharge
• Corneal involvement
• Conjunctival scarring
• Lack of response to therapy
• Recurrent episodes
• History of HSV eye disease
• History of immunocompromise 2
• Conjunctivitis in neonates 3

Antibiotic Selection for Bacterial Conjunctivitis

For bacterial conjunctivitis requiring antibiotic treatment, options include:

• Fluoroquinolones like moxifloxacin 0.5% ophthalmic solution (one drop in affected eye 3 times daily for 7 days) are effective against many common pathogens including Staphylococcus species, Streptococcus species, Haemophilus influenzae, and Chlamydia trachomatis 5
• In areas with limited antibiotic access, povidone-iodine 1.25% ophthalmic solution may be an effective alternative 2

Remember that most cases of conjunctivitis are self-limiting, but proper identification of the cause and appropriate treatment can reduce symptoms, prevent complications, and limit transmission.