Best Eyedrops for Conjunctivitis
The best eyedrop for conjunctivitis depends entirely on the etiology: topical fluoroquinolones (moxifloxacin, gatifloxacin, or levofloxacin) for bacterial conjunctivitis, second-generation topical antihistamines with mast-cell stabilizing properties for allergic conjunctivitis, and supportive care with artificial tears for viral conjunctivitis. 1, 2
Bacterial Conjunctivitis
For bacterial conjunctivitis, topical fluoroquinolones are the preferred first-line agents. 2
Specific Fluoroquinolone Options:
Moxifloxacin 0.5%: Instill 1 drop three times daily for 7 days 3
Gatifloxacin 0.5%: Day 1: 1 drop every 2 hours while awake (up to 8 times); Days 2-7: 1 drop 2-4 times daily 5
- Shows faster symptom reduction compared to levofloxacin, with lower MIC and better resistance profile against Gram-positive bacteria 6
Levofloxacin, ciprofloxacin, and besifloxacin are also effective alternatives 2
Important Considerations:
- No specific topical antibiotic demonstrates superiority over others, so choice can be based on dosing convenience, cost, and local resistance patterns 2
- For mild bacterial conjunctivitis in immunocompetent adults, the condition is often self-limited, but topical antibacterial therapy provides earlier clinical and microbiological remission in days 2-5 2
- The American Academy of Ophthalmology recommends a 5-7 day course of broad-spectrum topical antibiotics 2
Special Bacterial Cases Requiring Systemic Therapy:
- Gonococcal conjunctivitis: Requires systemic antibiotics PLUS topical therapy with daily follow-up until resolution 1, 2
- Chlamydial conjunctivitis: Requires systemic antibiotics as topical therapy alone is insufficient 1
- Neonatal conjunctivitis: Often requires systemic treatment coordinated with pediatrician 1
Allergic Conjunctivitis
Second-generation topical antihistamines with mast-cell stabilizing properties are the treatment of choice for allergic conjunctivitis. 1, 2
First-Line Treatment:
- Topical antihistamine/mast-cell stabilizer combinations 1, 2
- Adjunctive measures: cold compresses, refrigerated preservative-free artificial tears, and sunglasses as allergen barrier 2
Escalation for Severe Cases:
- Brief 1-2 week course of low side-effect profile topical corticosteroids if symptoms persist 1, 2
- Monitor intraocular pressure and evaluate for cataract development with corticosteroid use 1
- For refractory cases: topical cyclosporine or tacrolimus 1
Viral Conjunctivitis
Viral conjunctivitis requires supportive care only, as there is no proven effective treatment for adenovirus eradication. 2
Supportive Treatment:
Herpes Simplex Virus (HSV) Conjunctivitis:
- Topical antivirals: Ganciclovir 0.15% gel OR trifluridine 1% solution 1, 2
- Oral antivirals: Acyclovir, valacyclovir, or famciclovir may be added 1, 2
- CRITICAL WARNING: Never use topical corticosteroids in HSV conjunctivitis without antiviral coverage, as they potentiate infection 1, 2
Adenoviral Conjunctivitis with Severe Complications:
- Topical corticosteroids at minimum effective dose may be considered only for severe cases with marked chemosis, lid swelling, epithelial sloughing, membranous conjunctivitis, or subepithelial infiltrates causing visual symptoms 1, 2
- Requires close monitoring due to potential to prolong adenoviral infections 2
Critical Pitfalls to Avoid
- Avoid indiscriminate use of topical antibiotics or corticosteroids: Antibiotics can induce toxicity, and corticosteroids can prolong adenoviral infections and worsen HSV infections 1, 2
- Never use corticosteroids in suspected HSV epithelial infections 1
- Avoid contact lens wear during any active conjunctivitis 3
- Prolonged trifluridine use (>2 weeks) causes epithelial toxicity 2
When to Refer to Ophthalmology
Immediate referral is indicated for: 1, 2
- Visual loss
- Moderate or severe pain
- Severe purulent discharge
- Corneal involvement
- Conjunctival scarring
- Lack of response to therapy after 3-4 days
- Recurrent episodes
- History of HSV eye disease
- Immunocompromised state
- Neonatal conjunctivitis