Treatment of Conjunctivitis (Pink Eye)
The treatment for conjunctivitis depends on the cause, with bacterial conjunctivitis requiring topical antibiotics for 5-7 days, viral conjunctivitis needing supportive care, and allergic conjunctivitis responding to topical antihistamines and mast cell stabilizers. 1
Diagnosis and Classification
- Conjunctivitis can be classified as viral, bacterial, or allergic, with viral being the most common overall cause 2
- Bacterial conjunctivitis typically presents with mattering and adherence of eyelids upon waking, purulent discharge, and absence of itching 2, 3
- Viral conjunctivitis usually presents with watery discharge, burning sensation, and sometimes preauricular lymphadenopathy 3, 4
- Allergic conjunctivitis is characterized by severe itching, watery discharge, and history of allergen exposure 5
Treatment by Type
Bacterial Conjunctivitis
- Apply a broad-spectrum topical antibiotic 4 times daily for 5-7 days 1
- Options include bacitracin ointment applied 1-3 times daily directly into the conjunctival sac 6 or erythromycin ointment 7
- For mild cases in immunocompetent adults, consider that bacterial conjunctivitis may resolve spontaneously without treatment 1, 2
- Delayed antibiotic prescribing has similar symptom control as immediate prescribing 3
- For moderate to severe cases with copious purulent discharge, obtain cultures before starting treatment 1
Viral Conjunctivitis
- No proven effective treatment for eradication of adenovirus infection 8
- Supportive care includes artificial tears, cold compresses, topical antihistamines, and oral analgesics to mitigate symptoms 8, 3
- Avoid antibiotics in viral conjunctivitis due to potential adverse effects 8
- Educate patients to minimize contact with others for 10-14 days from symptom onset to reduce spread 8
- For severe cases with marked chemosis, lid swelling, epithelial sloughing, or membranous conjunctivitis, topical corticosteroids may help reduce symptoms and scarring 8
Herpes Simplex Virus Conjunctivitis
- Treatment options include ganciclovir 0.15% gel three to five times per day or trifluridine 1% solution five to eight times per day 8
- Oral treatments include acyclovir (200-400 mg five times daily), valacyclovir (500 mg two or three times daily), or famciclovir (250 mg twice daily) 8
- Avoid topical corticosteroids as they potentiate HSV infection 8
- Follow up within 1 week with interval history, visual acuity measurement, and slit-lamp biomicroscopy 8
Allergic Conjunctivitis
- Topical antihistamines with mast cell-stabilizing activity are the treatment of choice 3
- Lubricants and cold compresses can provide symptomatic relief 9
- For severe cases, consider systemic antihistamines 9
Special Considerations
Gonococcal and Chlamydial Conjunctivitis
- Require systemic antibiotic therapy in addition to topical treatment 1
- Daily follow-up until resolution of conjunctivitis 1
- If corneal involvement is present, treat as for bacterial keratitis 1
Contact Lens Wearers
- Always treat for bacterial conjunctivitis 9
- Consider discontinuation of contact lens use, switching to daily disposables, or changing lens polymer 8
- Refer to evaluate for corneal ulcers 9
Follow-up Recommendations
- For severe viral conjunctivitis with corneal epithelial ulceration or membranous conjunctivitis, re-evaluate within 1 week 8
- For patients on topical corticosteroids, monitor IOP and pupillary dilation periodically 8
- For patients not on corticosteroids, instruct to return if symptoms of red eye, pain, or decreased vision persist after 2-3 weeks 8
Prevention of Spread
- Strict personal hygiene including frequent handwashing 3, 4
- Avoid sharing towels, pillows, and cosmetics 4
- Sanitize surfaces regularly 4