From the Guidelines
Management for conjunctivitis and concomitant otitis media typically involves treating both conditions simultaneously with appropriate antimicrobial therapy. For bacterial conjunctivitis, topical antibiotic eye drops such as polymyxin B-trimethoprim, erythromycin ointment, or fluoroquinolones like moxifloxacin should be applied 4 times daily for 5-7 days, as recommended by the most recent guidelines 1. For otitis media, oral antibiotics are recommended, with amoxicillin as first-line therapy at 80-90 mg/kg/day divided twice daily for 10 days in children. If there's concern for resistant organisms, amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component) is preferred. For patients with penicillin allergy, alternatives include cefdinir, cefuroxime, or azithromycin. Symptomatic relief can be achieved with acetaminophen or ibuprofen for pain and fever.
Key Considerations
- Viral conjunctivitis is typically self-limiting and requires only supportive care with artificial tears and cold compresses.
- The connection between these conditions often involves shared pathogens affecting the conjunctiva and middle ear through the nasopharynx and Eustachian tubes, which is why treating both conditions concurrently is important for complete resolution and prevention of complications, as highlighted in recent studies 1.
- It is essential to differentiate between primary conjunctival disease and conditions in which conjunctival inflammation is secondary to systemic or ocular diseases, and to address the underlying cause of the condition, as emphasized in the conjunctivitis preferred practice pattern 1.
- Counseling is imperative for all contagious varieties of conjunctivitis to minimize or prevent spread of the disease in the community, and patients should be referred to an appropriate medical specialist for evaluation and treatment, as recommended in the guidelines 1.
- The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic adenoviral conjunctivitis, primarily by educating the patient and family about proper hygiene, as highlighted in recent findings 1.
From the Research
Management of Conjunctivitis
- The management of conjunctivitis depends on the cause, with viral conjunctivitis typically requiring supportive care, including artificial tears, cold compresses, and antihistamine eye drops 2.
- Bacterial conjunctivitis may be treated with topical antibiotics, which can decrease the duration of the infection and allow for an earlier return to school or work 3, 4.
- Allergic conjunctivitis can be treated with topical antihistamines and mast cell stabilizers, which can alleviate symptoms 3, 2.
Management of Conjunctivitis-Otitis Media
- The conjunctivitis-otitis syndrome is a common condition, with Haemophilus influenzae being a frequent cause 5, 6.
- Oral antimicrobial therapy, such as amoxicillin, may be effective in reducing the frequency of acute otitis media secondary to conjunctivitis 6.
- Risk factors for the conjunctivitis-otitis syndrome include younger age and a history of frequent episodes of acute otitis media 6.
Treatment Options
- Topical antibiotics, such as gentamycin, tobramycin, and azithromycin, are preferred for the treatment of bacterial conjunctivitis 4.
- Fluoroquinolones may be used for severe infections, but should be reserved due to their broad spectrum of activity 4.
- Artificial tears and eye bathings may be used as an alternative to topical antibiotics in cases of mild bacterial conjunctivitis 4.