What are the best ophthalmic drops for conjunctivitis (pink eye)?

Best Ophthalmic Drops for Pink Eye (Conjunctivitis)

For mild bacterial conjunctivitis, a 5-7 day course of any broad-spectrum topical antibiotic is effective, as there is no clinical evidence suggesting superiority of any particular antibiotic. 1

Treatment Based on Type of Conjunctivitis

Bacterial Conjunctivitis

Mild Bacterial Conjunctivitis

• Mild bacterial conjunctivitis is often self-limited and typically resolves spontaneously in immune-competent adults 1
• Topical antibacterial therapy provides earlier clinical and microbiological remission compared to placebo in days 2-5 of treatment 1
• Treatment recommendations:
  • 5-7 day course of a broad-spectrum topical antibiotic 1
  • Moxifloxacin 0.5% ophthalmic solution: One drop in affected eye 3 times daily for 7 days 2
  • Clinical cure rates with moxifloxacin range from 66-69% by day 5-6 2
  • Povidone-iodine 1.25% ophthalmic solution may be considered when access to antibiotics is limited 1

Moderate to Severe Bacterial Conjunctivitis

• Characterized by copious purulent discharge, pain, and marked inflammation 1
• Obtain conjunctival cultures and Gram staining if gonococcal infection is suspected 1
• Treatment should be guided by laboratory results 1
• Consider methicillin-resistant S. aureus (MRSA) in patients from nursing homes or with community-acquired infections 1
• Compounded topical antibiotics like vancomycin may be needed for resistant cases 1

Viral Conjunctivitis

Adenoviral Conjunctivitis

• No proven effective treatment for eradication of adenovirus infection 1
• Symptomatic treatment includes:
  • Artificial tears 1
  • Topical antihistamines 1
  • Cold compresses 1
• Avoid antibiotics due to potential adverse effects 1
• Topical corticosteroids may help in severe cases with marked chemosis, lid swelling, epithelial sloughing, or membranous conjunctivitis, but require close monitoring 1

Herpes Simplex Virus (HSV) Conjunctivitis

• Treatment options:
  • Topical ganciclovir 0.15% gel: 3-5 times daily 1
  • Topical trifluridine 1% solution: 5-8 times daily (not for >2 weeks due to epithelial toxicity) 1
  • Oral antivirals: acyclovir, valacyclovir, or famciclovir 1
• Avoid topical corticosteroids as they potentiate HSV infection 1

Allergic Conjunctivitis

• Topical antihistamines with mast cell-stabilizing activity are the treatment of choice 3

Comparative Efficacy of Antibiotics

• Moxifloxacin 0.5% administered three times daily has been shown to be more effective than polymyxin B/trimethoprim, with 81% of patients showing complete resolution at 48 hours versus 44% with polymyxin B/trimethoprim 4
• Moxifloxacin has good activity against various Gram-positive and Gram-negative ocular isolates 5
• Besifloxacin ophthalmic suspension 0.6% has shown similar efficacy to moxifloxacin for bacterial conjunctivitis 6

Special Considerations

When to Refer to an Ophthalmologist

• Visual loss 1
• Moderate or severe pain 1
• Severe purulent discharge 1
• Corneal involvement 1
• Conjunctival scarring 1
• Lack of response to therapy 1
• Recurrent episodes 1
• History of HSV eye disease 1
• Immunocompromised patients 1

Infection Control

• Counsel patients about contagious varieties to prevent spread 1
• Advise on modes of transmission: eye-hand contact, contaminated droplets, airborne pathogens 1
• Emphasize importance of handwashing 1
• Patients should not wear contact lenses if they have signs or symptoms of bacterial conjunctivitis 2

Pitfalls to Avoid

• Prolonged use of antibiotics may result in overgrowth of non-susceptible organisms, including fungi 2
• Topical trifluridine causes epithelial toxicity if used for more than 2 weeks 1
• Using topical corticosteroids in HSV conjunctivitis without antiviral coverage can potentiate infection 1
• Delayed referral for gonococcal conjunctivitis, which requires systemic antibiotics and daily monitoring 1
• Failure to consider sexual abuse in children with gonococcal or chlamydial conjunctivitis 1