What is the treatment for conjunctivitis?

Treatment of Conjunctivitis

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

Diagnosis and Classification

• Conjunctivitis is inflammation of the conjunctiva that can be classified as infectious (viral or bacterial) or non-infectious (allergic, mechanical/irritative/toxic, immune-mediated) 2
• No single sign or symptom accurately differentiates viral from bacterial conjunctivitis, requiring comprehensive evaluation 3
• Viral conjunctivitis is the most common cause (80% of infectious cases), followed by bacterial and allergic forms 4

Treatment by Type

Viral Conjunctivitis

• Primarily supportive care as most cases are self-limiting 1, 5
• Treatment options include:
  • Artificial tears for lubrication 3
  • Cold compresses to reduce inflammation 3
  • Antihistamine eye drops for symptomatic relief 3
• Strict hygiene measures including frequent handwashing to prevent transmission 3, 4
• For adenoviral conjunctivitis with subepithelial infiltrates causing blurred vision or photophobia, topical corticosteroids at minimum effective dose may be considered 2

Bacterial Conjunctivitis

• Mild cases may resolve spontaneously without antibiotics 1, 5
• For moderate to severe cases, topical antibiotics are indicated:
  • Moxifloxacin 0.5% ophthalmic solution: one drop in affected eye 3 times daily for 7 days 6
  • Other antibiotics should be guided by culture results when available 1
• Patients should be advised to return if no improvement in 3-4 days 1
• Special considerations for specific bacterial causes:
  • Gonococcal conjunctivitis requires systemic antibiotics plus saline lavage 2
  • Chlamydial conjunctivitis requires systemic antibiotics (topical therapy alone is insufficient) 2
  • MRSA conjunctivitis may require compounded antibiotics like vancomycin 2

Allergic Conjunctivitis

• First-line treatment: Topical antihistamines with mast cell-stabilizing activity 1, 5
• Identify and avoid triggering allergens 1
• For severe cases, short-term topical corticosteroids may be necessary 1
• Regular follow-up for patients on prolonged corticosteroid therapy to monitor for glaucoma and cataract formation 2

Herpes Simplex Virus (HSV) Conjunctivitis

• Topical antivirals:
  • Ganciclovir 0.15% gel three to five times daily, or
  • Trifluridine 1% solution five to eight times daily 2
• Oral antivirals may be added:
  • Acyclovir 200-400mg five times daily
  • Valacyclovir 500mg two to three times daily
  • Famciclovir 250mg twice daily 2
• Avoid topical corticosteroids as they can potentiate HSV infection 2
• Follow-up within one week of treatment 2

Varicella Zoster Virus (VZV) Conjunctivitis

• Topical antibiotics to prevent secondary infection 2
• For persistent cases, oral antivirals may be beneficial 2
• Herpes zoster vaccination is strongly recommended for patients 50 years or older and immunocompromised patients 19 years or older 2

Special Considerations

• Contact lens wearers should discontinue lens use until complete resolution 1
• Neonatal conjunctivitis requires prompt consultation with pediatrician due to risk of systemic infection 2
• Patients with severe pain, decreased vision, corneal involvement, or lack of response to therapy should be referred to an ophthalmologist 2
• For patients prescribed topical corticosteroids, regular monitoring of intraocular pressure is essential 2

Prevention Measures

• Avoid sharing towels, pillows, or cosmetics 1
• Practice strict hand hygiene to prevent transmission 3
• Sanitize surfaces in cases of viral conjunctivitis 4
• Consider delayed antibiotic prescribing for suspected bacterial cases to reduce unnecessary antibiotic use 3