What is the treatment for conjunctivitis in a pregnant woman?

Treatment of Conjunctivitis in Pregnant Women

The treatment of conjunctivitis in pregnant women should be tailored to the specific cause, with careful consideration of medication safety during pregnancy, prioritizing topical treatments when possible and avoiding potentially teratogenic medications.

Diagnosis and Classification

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

• Viral conjunctivitis: Most common overall cause, typically self-limiting with watery discharge 1
• Bacterial conjunctivitis: Second most common cause, often presents with mucopurulent discharge and mattering of eyelids upon waking 1
• Allergic conjunctivitis: Distinguished by severe itching and allergen exposure 2
• Sexually transmitted infections: Requires systemic treatment and consideration of potential vertical transmission 3

Treatment Algorithm by Type

Viral Conjunctivitis

• Supportive care is the mainstay of treatment, as most cases resolve without specific intervention 4
• Recommended supportive measures include:
  • Cold compresses to reduce inflammation and discomfort 4
  • Artificial tears for symptomatic relief 4
  • Strict hand hygiene to prevent transmission 4

Bacterial Conjunctivitis

• Mild cases may resolve spontaneously without antibiotics 5
• For moderate to severe cases, topical antibiotics are recommended 5
• For pregnant women with bacterial conjunctivitis, erythromycin ophthalmic ointment is the preferred topical antibiotic due to its established safety profile in pregnancy 3
• For sexually transmitted bacterial conjunctivitis:
  • Chlamydial conjunctivitis: Erythromycin or amoxicillin is recommended during pregnancy (NOT doxycycline, quinolones, or tetracyclines) 3
  • Gonococcal conjunctivitis: Requires systemic antibiotics with careful selection for pregnancy safety 3

Allergic Conjunctivitis

• Simple measures include:
  • Wearing sunglasses as barriers to airborne allergens 5
  • Cold compresses for symptomatic relief 5
  • Refrigerated artificial tears 5
• Topical antihistamines with mast cell-stabilizing properties are the treatment of choice 5
• For persistent cases, mast cell stabilizers can be used 5
• Brief courses (1-2 weeks) of pregnancy-safe topical corticosteroids may be considered for severe cases after consultation with an ophthalmologist 5

Special Considerations for Pregnant Women

• Systemic antibiotics should be used only when absolutely necessary and selected based on pregnancy safety profiles 3
• Erythromycin and amoxicillin are the recommended systemic antibiotics for chlamydial conjunctivitis during pregnancy 3
• Avoid tetracyclines, doxycycline, and quinolones due to potential teratogenic effects 3
• For allergic conjunctivitis, identify and avoid triggering allergens when possible 5

When to Refer to an Ophthalmologist

Immediate referral is recommended for pregnant women with:

• Visual loss or decreased vision 5
• Moderate or severe pain 5
• Severe purulent discharge 5
• Corneal involvement 5
• Conjunctival scarring 5
• Lack of response to therapy within 3-4 days 5
• History of HSV eye disease 5

Prevention Strategies

• Maintain good hand hygiene and avoid touching or rubbing eyes 5
• Do not share towels, pillows, or cosmetics 5
• For contact lens wearers, suspend use until complete resolution 5
• Prenatal screening and treatment of sexually transmitted infections is the most effective prevention strategy for neonatal conjunctivitis 6

Common Pitfalls to Avoid

• Indiscriminate use of topical antibiotics or corticosteroids should be avoided 5
• Tetracyclines, doxycycline, and quinolones are contraindicated during pregnancy 3
• Failure to consider systemic treatment for sexually transmitted conjunctivitis can lead to complications 1
• Overlooking the importance of prenatal screening for prevention of neonatal conjunctivitis 6