What eye drops are used to treat conjunctivitis?

Eye Drops for Conjunctivitis Treatment

The appropriate eye drop treatment for conjunctivitis depends on the specific cause, with bacterial infections requiring antibiotic drops, viral infections needing primarily supportive care, and allergic conjunctivitis responding to antihistamine/mast cell stabilizer drops.

Bacterial Conjunctivitis

• For bacterial conjunctivitis, a 5-7 day course of broad-spectrum topical antibiotic applied 4 times daily is recommended 1
• Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work 2
• Moxifloxacin 0.5% ophthalmic solution (instill one drop in the affected eye 3 times a day for 7 days) is effective against many common bacterial pathogens 3
• Gatifloxacin 0.5% ophthalmic solution can be used with a loading dose on day 1 (one drop every two hours while awake), followed by one drop 2-4 times daily on days 2-7 4
• Delayed antibiotic prescribing has similar symptom control as immediate prescribing for mild cases 5

Viral Conjunctivitis

• Viral conjunctivitis is self-limited and requires supportive care rather than antimicrobial treatment 6
• Supportive measures include artificial tears, cold compresses, and topical antihistamines for symptomatic relief 6
• Antibiotics should be avoided as they provide no benefit for viral infections and may cause toxicity 6
• Topical corticosteroids may be helpful in severe cases with marked chemosis, epithelial sloughing, or membranous conjunctivitis, but should be used with caution 6
• For herpes simplex virus conjunctivitis, treatment options include ganciclovir 0.15% gel (3-5 times daily) or trifluridine 1% solution (5-8 times daily) 7

Allergic Conjunctivitis

• Topical antihistamines with mast cell-stabilizing activity are the treatment of choice for allergic conjunctivitis 5
• Second-generation topical histamine H1-receptor antagonists are more effective than over-the-counter antihistamine/vasoconstrictor agents 7
• Many newer medications combine antihistamine activity with mast-cell stabilizing properties and can be used for either acute or chronic disease 7
• Emedastine eye drops (H1 antihistamine) can rapidly decrease itching and redness in seasonal allergic conjunctivitis 8
• For severe cases not adequately controlled, a brief course (1-2 weeks) of topical corticosteroids with a low side-effect profile can be added 7

Special Considerations

• For gonococcal conjunctivitis, systemic antibiotic therapy is necessary in addition to topical treatment 7
• Chlamydial conjunctivitis requires systemic antibiotic therapy as patients may also be infected at other sites 7
• For medication-induced conjunctivitis, discontinuation of the agent responsible results in resolution over weeks to months 7
• Pediculosis palpebrarum (eyelash lice) can be treated with bland ophthalmic ointment (petrolatum, erythromycin, bacitracin) applied 2-3 times daily for 10 days 7

When to Refer to an Ophthalmologist

• Immediate referral is recommended for patients with visual loss, moderate or severe pain, severe purulent discharge, corneal involvement, or lack of response to therapy 9
• Patients with conjunctivitis who have a history of HSV eye disease or are immunocompromised should be promptly referred 7
• Neonatal conjunctivitis requires immediate consultation with a pediatrician, especially if caused by gonococcus, chlamydia, or HSV 7, 9

Infection Control Measures

• Patient education about the contagious nature of infectious conjunctivitis is critical 6
• Strict hand hygiene, avoiding sharing personal items, and minimizing contact with others during the contagious period are important 1
• In healthcare settings, proper disinfection of equipment and consideration of abbreviated examination in dedicated exam rooms can help prevent spread 6

Common Pitfalls to Avoid

• Indiscriminate use of topical antibiotics or corticosteroids should be avoided 9
• Topical corticosteroids can potentiate HSV epithelial infections and should be avoided in cases of suspected herpes infection 7
• Failure to consider gonococcal or chlamydial infection in infants, which requires systemic treatment 9
• Not considering the possibility of child abuse in cases of sexually transmitted ocular disease in children 9