What is the treatment for conjunctivitis?

Treatment of Conjunctivitis

The treatment of conjunctivitis must be specifically tailored to its underlying cause, with antibiotics indicated for bacterial conjunctivitis, antihistamines for allergic conjunctivitis, and supportive care for viral conjunctivitis. 1, 2

Viral Conjunctivitis

• Viral conjunctivitis is self-limited and requires only supportive care rather than antimicrobial treatment 3
• Supportive measures include artificial tears, cold compresses, and topical antihistamines for symptomatic relief 3
• Topical corticosteroids may be considered in severe cases with marked chemosis, epithelial sloughing, or membranous conjunctivitis, but should be used with caution due to risk of prolonging adenoviral infections or worsening HSV infections 3, 1
• Patient education about the highly contagious nature of viral conjunctivitis is essential, with emphasis on strict hand hygiene and avoiding sharing personal items 3

Bacterial Conjunctivitis

• For moderate to severe bacterial conjunctivitis, a 5-7 day course of broad-spectrum topical antibiotics such as moxifloxacin or gatifloxacin is recommended 4, 5
• Moxifloxacin and gatifloxacin are effective against common bacterial pathogens including Staphylococcus species, Streptococcus pneumoniae, and Haemophilus influenzae 4, 5
• Patients should be advised to return for evaluation if no improvement is seen after 3-4 days of treatment 2
• Most uncomplicated cases resolve in 1-2 weeks, with topical antibiotics decreasing duration and allowing earlier return to school or work 6

Special Considerations for Specific Infections

• Gonococcal conjunctivitis requires systemic antibiotics and daily follow-up until resolution 2
• Chlamydial conjunctivitis necessitates systemic antibiotic therapy, as more than 50% of patients may have infection at other sites 7, 2
• Sexual contacts of patients with sexually transmitted conjunctivitis should be treated concurrently 2
• In low-resource settings with limited antibiotic access, povidone-iodine 1.25% ophthalmic solution can be used for chlamydial conjunctivitis 7

Allergic Conjunctivitis

• Simple measures include wearing sunglasses as barriers to airborne allergens, cold compresses, and refrigerated artificial tears 1
• Topical antihistamines with mast cell-stabilizing properties are the treatment of choice 2
• For persistent or recurrent cases, mast cell stabilizers can be used 2
• In severe cases, a brief course (1-2 weeks) of topical corticosteroids with a low side-effect profile may be added 2

Infection Control Measures

• Proper hand hygiene is crucial to prevent transmission 3
• Avoid sharing towels, pillows, or cosmetics 2
• Contact lens wearers should discontinue use until complete resolution 2
• Healthcare settings should implement proper disinfection of equipment and consider abbreviated examinations in dedicated exam rooms 3

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 after 3-4 days 2
• Recurrent episodes 1
• History of HSV eye disease 1
• Immunocompromised patients 1

Special Considerations for Pediatric Patients

• Hospitalization may be necessary for severe gonococcal conjunctivitis and is mandatory for neonatal conjunctivitis 7
• Consider the possibility of child abuse in cases of sexually transmitted ocular disease in children 7
• Infants requiring systemic treatment should be managed in conjunction with a pediatrician 7

Common Pitfalls to Avoid

• Indiscriminate use of topical antibiotics or corticosteroids should be avoided 1
• Failure to consider gonococcal or chlamydial infection in infants, which requires systemic treatment 7
• Delayed referral to an ophthalmologist when there are signs of severe infection or lack of improvement 7