What are the recommended eye drops for treating conjunctivitis?

Recommended Eye Drops for Conjunctivitis

The recommended eye drops for conjunctivitis depend on the specific etiology, with bacterial conjunctivitis typically requiring topical antibiotics, viral conjunctivitis needing supportive care, and allergic conjunctivitis responding best to antihistamine/mast cell stabilizer combinations. 1

Bacterial Conjunctivitis

• Fluoroquinolones such as moxifloxacin 0.5% (instill one drop in the affected eye 3 times a day for 7 days) or gatifloxacin 0.5% (instill one drop every two hours on day 1, then 2-4 times daily for days 2-7) are effective against common bacterial pathogens 2, 3
• For gonococcal conjunctivitis, systemic antibiotic therapy is required in addition to topical treatment, with daily follow-up until resolution 1, 4
• For chlamydial conjunctivitis, systemic antibiotics are indicated as topical therapy alone is insufficient 1, 4
• In resource-limited settings, povidone-iodine 1.25% ophthalmic solution can be used to treat chlamydial conjunctivitis 1
• Delayed antibiotic prescribing has similar symptom control as immediate prescribing for mild cases 5

Viral Conjunctivitis

• Supportive care is the mainstay of treatment with artificial tears, cold compresses, and antihistamine eye drops 5, 6
• For herpes simplex virus conjunctivitis, topical options include ganciclovir 0.15% gel (3-5 times daily) or trifluridine 1% solution (5-8 times daily) 1
• Oral antivirals may be added for HSV conjunctivitis: acyclovir (200-400 mg five times daily), valacyclovir (500 mg 2-3 times daily), or famciclovir (250 mg twice daily) 1
• Topical corticosteroids should be avoided in suspected HSV epithelial infections 1
• For severe cases with subepithelial infiltrates causing visual symptoms, topical corticosteroids at minimum effective dose may be considered 1

Allergic Conjunctivitis

• Topical antihistamines with mast-cell stabilizing properties are the treatment of choice 1, 5
• Cold compresses and refrigerated artificial tears provide symptomatic relief 1
• For severe cases unresponsive to antihistamines/mast cell stabilizers, a brief course (1-2 weeks) of topical corticosteroids with a low side effect profile can be added 1
• Concomitant use of cooled preservative-free artificial tears may alleviate coexisting tear deficiency and dilute allergens 1
• In severe cases, topical cyclosporine or tacrolimus can be considered 1

Special Considerations

• Avoid indiscriminate use of topical antibiotics or corticosteroids as antibiotics can induce toxicity and corticosteroids can potentially prolong adenoviral infections and worsen HSV infections 1, 7, 4
• Patients with conjunctivitis should be referred to an ophthalmologist if they experience visual loss, moderate or severe pain, severe purulent discharge, corneal involvement, conjunctival scarring, lack of response to therapy, recurrent episodes, history of HSV eye disease, or are immunocompromised 1, 7, 4
• For neonatal conjunctivitis, systemic treatment is often required, and management should be coordinated with a pediatrician 1, 4
• Strict hand hygiene is essential to prevent transmission to others or to the unaffected eye 4

Monitoring and Follow-up

• Patients using topical corticosteroids should have baseline and periodic measurement of intraocular pressure and pupillary dilation to evaluate for glaucoma and cataract 1
• Return for evaluation if no improvement after 3-4 days of treatment 4
• For gonococcal conjunctivitis, daily follow-up until resolution is necessary 4
• Most cases of bacterial conjunctivitis can be treated effectively in an outpatient setting 1, 4