Treatment of Conjunctivitis in Pregnancy
For pregnant women with conjunctivitis, erythromycin or amoxicillin are the recommended treatments for chlamydial conjunctivitis, while topical antibiotics are appropriate for bacterial conjunctivitis, with corticosteroid eye drops being safe when indicated. 1
Diagnosis Considerations in Pregnancy
- Conjunctivitis in pregnancy requires careful consideration of the underlying cause before initiating treatment 1, 2
- Key diagnostic features to differentiate types of conjunctivitis:
- Bacterial: mucopurulent discharge, mattering of eyelids upon waking, absence of itching 2, 3
- Viral: watery discharge, often associated with upper respiratory symptoms 2, 3
- Allergic: intense itching, watery discharge, seasonal patterns 1, 3
- Chlamydial: follicular conjunctivitis in adults, may have concurrent genital infection 1
Treatment Algorithm Based on Etiology
Bacterial Conjunctivitis (Non-Gonococcal)
- Most uncomplicated cases resolve within 1-2 weeks, even without treatment 2, 3
- For moderate symptoms, a 5-7 day course of broad-spectrum topical antibiotic applied 4 times daily is recommended 4
- Safe options during pregnancy include:
- Topical antibiotics decrease duration of symptoms and allow earlier return to normal activities 4, 2
Chlamydial Conjunctivitis
- Pregnant women with chlamydial conjunctivitis should receive systemic treatment with either erythromycin or amoxicillin 1
- Doxycycline, quinolones, and tetracyclines are contraindicated during pregnancy 1
- Recommended regimens:
- Partners should also be evaluated and treated to prevent reinfection 1
Gonococcal Conjunctivitis
- Requires urgent treatment with both systemic and topical antibiotics 1
- Ceftriaxone is the recommended systemic treatment 1
- Daily follow-up until resolution is necessary 4
- Concurrent treatment for chlamydia is recommended due to high rates of co-infection 1
Viral Conjunctivitis
Allergic Conjunctivitis
- Topical antihistamines with mast cell-stabilizing activity are first-line treatment 1, 3
- Consumption of probiotic milk during pregnancy may decrease the risk of allergic conjunctivitis in infants 1
- For severe allergic inflammation, topical corticosteroids can be safely used in pregnancy 6
- A large cohort study found no association between topical ophthalmic corticosteroids during pregnancy and adverse neonatal outcomes 6
Special Considerations in Pregnancy
- Medication safety is paramount - avoid tetracyclines, fluoroquinolones, and other potentially teratogenic agents 1
- For severe inflammation requiring corticosteroids, topical ophthalmic preparations appear safe based on recent evidence 6
- Consider that hormonal changes during pregnancy may affect tear film and ocular surface, potentially exacerbating symptoms 1
- Prenatal screening and treatment of sexually transmitted infections can prevent neonatal conjunctivitis 1, 7
When to Refer to Ophthalmology
- Severe pain or decreased vision 3
- Suspected gonococcal infection 1, 4
- Corneal involvement 1, 5
- Failure to respond to appropriate therapy within 3-5 days 4
- History of rheumatologic disease or immunocompromised state 3
Common Pitfalls and Caveats
- Avoid prescribing doxycycline, tetracyclines, or fluoroquinolones to pregnant women 1
- Don't assume all red eyes in pregnancy are benign - rule out serious conditions like acute angle-closure glaucoma 3
- Remember that chlamydial and gonococcal infections require systemic treatment in addition to topical therapy 1, 4
- Consider that some cases of bacterial conjunctivitis are self-limiting and may not require antibiotic treatment 4, 2
- Be aware that increasing bacterial resistance is a concern, particularly with methicillin-resistant S. aureus (MRSA) 4