What is the treatment for red eye?

Treatment of Red Eye

Treatment of red eye should be directed at the underlying cause, with indiscriminate use of topical antibiotics or corticosteroids avoided as they can induce toxicity and potentially worsen certain infections. 1, 2

Diagnosis and Classification

Before initiating treatment, it's essential to identify the specific type of conjunctivitis:

• Viral conjunctivitis: Most common, highly contagious, typically self-limiting 1
• Bacterial conjunctivitis: May be self-limiting in mild cases, but often requires antibiotic treatment 2
• Allergic conjunctivitis: Triggered by allergens, requires different management approach 1
• Other causes: Dry eye, blepharitis, contact lens-related issues 1

Treatment by Type

Viral Conjunctivitis

• Primarily supportive care as antibiotics are ineffective against viral infections 1
• Patient education on proper hygiene to prevent transmission (frequent handwashing, separate towels, avoiding close contact) 1
• Cold compresses and refrigerated artificial tears for symptomatic relief 1
• Topical corticosteroids may be considered in severe cases with marked chemosis, lid swelling, or membranous conjunctivitis, but require close monitoring 1
• Povidone-iodine preparations have shown potential benefit in reducing viral titers and shortening clinical course 1

Bacterial Conjunctivitis

• Mild cases may resolve without antibiotics 2
• For moderate to severe cases, topical antibiotics such as moxifloxacin ophthalmic solution 0.5% (one drop in affected eye 3 times daily for 7 days) 3
• Gonococcal conjunctivitis requires systemic antibiotics and daily follow-up 2
• Chlamydial conjunctivitis necessitates systemic antibiotic therapy 2
• Return for evaluation if no improvement after 3-4 days of treatment 2

Allergic Conjunctivitis

• Simple measures: wearing sunglasses as barriers to allergens, cold compresses, refrigerated artificial tears 1, 2
• Avoid eye rubbing and allergen exposure 1
• Mild cases: over-the-counter topical antihistamine/vasoconstrictor agents 1
• More effective: second-generation topical histamine H1-receptor antagonists 1
• For persistent cases: mast-cell stabilizers or medications combining antihistamine with mast-cell stabilizing properties 1, 2
• Brief course (1-2 weeks) of topical corticosteroids with low side-effect profile for severe cases 1, 2

Dry Eye Related Conjunctivitis

• Preservative-free artificial tears 1
• Treatment of underlying blepharitis if present 1
• Environmental modifications to reduce dryness 4

Infection Control Measures

• Proper disinfection of equipment is crucial to prevent transmission 1
• Dilute bleach soak (sodium hypochlorite) at 1:10 concentration for tonometer disinfection 1
• 70% isopropyl alcohol, 3% hydrogen peroxide, and ethyl alcohol are no longer recommended for tonometer disinfection 1
• Surfaces should be disinfected with EPA-registered hospital disinfectants 1
• Consider deferring IOP measurement for patients with acute conjunctivitis 1
• During epidemics, consider triaging patients to a dedicated "red-eye room" 1

Warning Signs Requiring Ophthalmology Referral

• Severe pain not relieved with topical anesthetics 4
• Vision loss 5
• Copious purulent discharge 4
• Corneal involvement 4
• Traumatic eye injury 4
• Recent ocular surgery 4
• Distorted pupil 4
• Herpes infection 4
• Recurrent infections 4
• Chemical burns 6
• Intraocular infections 6
• Acute glaucoma 6

Common Pitfalls

• Indiscriminate use of antibiotics for viral conjunctivitis (ineffective and may cause toxicity) 1, 2
• Inappropriate use of corticosteroids which can worsen HSV infections and prolong adenoviral infections 1
• Failure to recognize red flags requiring urgent ophthalmology referral 5
• Not addressing underlying conditions such as dry eye syndrome 7
• Inadequate infection control measures leading to spread of contagious forms 1
• Continued contact lens wear during active infection 2