From the Guidelines
Viral conjunctivitis is typically self-limiting and requires supportive care only, while bacterial conjunctivitis often requires antibiotic treatment. The management of conjunctivitis depends on the underlying cause, with viral and bacterial conjunctivitis being two common types that require different approaches 1. Viral conjunctivitis usually resolves within 1-2 weeks without antibiotics and presents with watery discharge, often affecting one eye initially before spreading to the other, and frequently accompanies upper respiratory symptoms. In contrast, bacterial conjunctivitis presents with purulent (thick, yellow-green) discharge, crusting of the eyelids, and may affect both eyes simultaneously, requiring topical antibiotics like erythromycin ointment, polymyxin B-trimethoprim drops, or fluoroquinolone drops (such as ciprofloxacin or moxifloxacin) for 5-7 days 1.
Some key points to consider in the management of conjunctivitis include:
- The use of cold compresses and artificial tears for symptom relief in viral conjunctivitis
- The importance of proper hand hygiene, avoiding touching the eyes, and not sharing towels or pillows to prevent the spread of infection
- The need for contact lens wearers to temporarily discontinue lens use until symptoms resolve completely
- The potential for antibiotic resistance in bacterial conjunctivitis, highlighting the need for medical reevaluation if symptoms worsen or do not improve with treatment 1
It is also important to note that some types of conjunctivitis, such as gonococcal and chlamydial conjunctivitis, require specific treatment approaches and may have significant potential sequelae if left untreated 1. Additionally, preventive measures such as vaccination against herpes zoster and measles, as well as proper hygiene practices, can help reduce the incidence of infectious conjunctivitis 1.
From the Research
Viral vs Bacterial Conjunctivitis
- The differentiation between viral and bacterial conjunctivitis can be challenging, as there is no single sign or symptom that accurately differentiates between the two 2.
- Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment, with signs and symptoms at presentation being variable 3.
- Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis, with most uncomplicated cases resolving in 1 to 2 weeks 3.
- Mattering and adherence of the eyelids on waking, lack of itching, and absence of a history of conjunctivitis are the strongest factors associated with bacterial conjunctivitis 3.
Diagnosis and Management
- A comprehensive history and physical examination can guide the diagnosis of conjunctivitis 2.
- Supportive care options for viral conjunctivitis include artificial tears, cold compresses, and antihistamine eye drops 2.
- Topical antibiotics can decrease the duration of bacterial conjunctivitis and allow earlier return to school or work 3.
- Delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing 2.
Treatment
- Topical antihistamines with mast cell-stabilizing activity are the treatment of choice for allergic conjunctivitis 2.
- Antibiotics are generally prescribed for acute bacterial conjunctivitis, but many cases are self-limited and resolve without antibiotic therapy 4.
- The use of topical antibiotics is associated with a modestly improved chance of resolution in comparison to the use of placebo 4.
- Fluoroquinolones show good activity in the treatment of acute bacterial conjunctivitis, but should be saved for severe infections due to their broad spectrum of activity 5.